The use of botanicals during pregnancy and lactation.

Women are the largest consumers of healthcare, and this extends to their utilization of complementary and alternative medicine (CAM). Researchers have attempted to uncover the reasons why women turn to CAM in general and to botanical medicine in particular. Desire to have personal control over their health has been cited as the strongest motive for women to use herbal medicine. Second was dissatisfaction with conventional treatment and its disregard for a holistic approach, as well as concerns about the side effects of medications.' These concerns may explain, in part, the fact that many women use herbal remedies during pregnancy. A survey of 578 pregnant women in the eastern United States reported that 45% of respondents had used herbal medicines, and a survey of 588 women in Australia revealed that 36% had used at least 1 herbal product during pregnancy. Women probably feel comfortable using herbal remedies because of their perceived safety, easy access, and the widespread availability of information about them (ie, Internet, magazines, books). While it is true that many botanicals are mild in both treatment effects and side effects, the data regarding safety during pregnancy are very limited. Given the small sample sizes in clinical trials studying botanicals in pregnant women, only large differences in measures of pregnancy outcomes would likely be detected. For example, if an herb were thought to increase the rate of spontaneous abortion from 6% to 7%, a sample size of more than 19000 women would be needed. It is highly unlikely that there will be any studies of a botanical (or drug) with this large a sample size. So when addressing the safety of an herb during pregnancy, we must look at the totality of the evidence, which includes traditional and contemporary use, animal studies, pharmacological studies, and clinical trial data, when available. Survey data tell us that women often do not share their use of herbal remedies with their healthcare providers due to fear of offending providers or to the belief that clinicians will be ignorant about their use. Practitioners should maintain an open and respectful demeanor when counseling pregnant and nursing women about the use of botanical medicines, and they should know how to access unbiased and authoritative information sources, so they may reliably answer questions on inadvertent exposures and provide guidance on herbal products that might be beneficial.