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Herbal Medicines in Pregnancy and Lactation: An Evidence-Based Approach
Herbal Medicines in Pregnancy and Lactation: An Evidence-Based Approach by Edward Mills, Jean-Jacques Dugoua, Dan Perri, and Gideon Koren Abingdon. Boca Raton, FL: Taylor and Francis; 2006. Hardcover, 354 pages. ISBN-13 978-0415-37392-0. $129.95.

Pregnancy and lactation are certainly two of the most important phases of human growth and development, as any deleterious effect or interruption of the normal gestational development can have serious, if not fatal, consequences to the developing embryo or fetus. Products that may interfere with lactation or that possess toxic properties may pass from the mother’s milk to her baby and can also have potentially devastating effects.

Herbal medicines have always been, and will continue to be, an important therapeutic option for humankind, but it is only recently that herbal products have come under scrutiny for their beneficial or potentially toxic components. Of the thousands of plants used for medicinal purposes worldwide, very little information exists regarding their effects on pregnancy and lactation. Such an important topic merits more controlled research, especially since herbal products are very popular in various countries around the world, including the United States.

Herbal Medicines in Pregnancy and Lactation fills an important gap in the information resources regarding herbal medicine. This topic is covered only in a limited number of books regarding natural medicines (the most notable being Sheila Humphrey’s The Nursing Mother’s Herbal, Fairview Press, 1st ed, 2003).

Herbal Medicines in Pregnancy and Lactation consists of 6 chapters that cover various topics regarding the use of herbal products, as well as vitamins and other nutritional dietary supplements, during this critical period of human development.

Chapter 1 briefly covers the most important aspects of traditional usage of herbs. Chapter 2 introduces the reader to the topic of pharmacognosy, the study of drugs obtained from plants, animals, and microorganisms. This chapter focuses on important therapeutic products derived from plants. Some of the most important chemical compounds contained in plants that have therapeutic value are summarized, along with their chemical structures. Such is the case for flavonoids, which are natural phenolic pigments found in many plants and which can act both as free radical scavengers as well as natural anti-inflammatory agents. Other important natural compounds contained in plants include lignans, which not only have antimicrobial and anticancer properties, but are also characterized by possessing estrogenic properties, similar in action to the natural female hormones.

Chapter 3 succinctly explains the methodology employed in compiling the information about the use of plants during pregnancy and lactation, leading the reader to reputable sources of pertinent information for further query, including books, scientific journals, and Web sites. Among the more professional and trustworthy sources of information consulted are The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines (Integrative Medicine Communications, 1998), an English translation by the American Botanical Council, and the Natural Standard database.

This brief but very important section provides the grades of evidence for the indications of beneficial use and the evidence of harm, which are applied to the herbal medicines, vitamins, and supplements covered in the book. Grading for level of evidence for indications is indicated with letters A–

F. A is equivalent to very strong scientific evidence, B1 is strong scientific evidence, B2 is good scientific evidence, C is fair scientific evidence, D is weak scientific evidence, E is theoretical and/or clinical evidence, and F is historical or traditional evidence of use by medical professionals, herbologists, scientists, or aboriginal groups.

The evidence of harm for a particular herb, vitamin, or supplement is classified into levels. Level 1a mentions strong scientific evidence that the plant can cause harm to the mother and/or infant. This information is based upon statistically significant evidence from one or more systematic reviews of the scientific literature. Level 1b pertains to strong scientific evidence drawn from one or more controlled studies. Level 1c indicates good scientific evidence, based on one or more case reports of harm on the mother and/or fetus. Level 2 indicates fair scientific evidence based upon case reports. Level 3 contains in vitro evidence based on laboratory studies undertaken with experimental animals or human cells. Level 4 pertains to theoretical evidence based on scientific theory or expert opinion. Level 5 is for unknown effects due to lack of available information.

Chapter 4 deals with an alphabetical listing of selected medicinal plants and their therapeutic applications both in traditional (also known as indigenous or folk) medicine as well as modern scientific herbal medicine (also known as phytotherapy). This chapter is the medullar core of the book, covering 60 species of curative herbs, from alfalfa (Medicago sativa, Fabaceae) to yarrow (Achillea millefolium, Asteraceae), which are commonly used both in traditional folkloric medicine as well as phytotherapy.

For each of the herbal species covered, the authors mention the common and scientific (Latin) names, which greatly aid in establishing the identity of the herb in question, since various unrelated plants may share the same common name, thus causing confusion to both the consumer as well as the health practitioner. Also, the indications of usage are mentioned for both oral and topical applications of the herb in question. The effects of the plant on pregnancy are mentioned, according to evidence-based research, as well as the grades of levels of evidence put forth in Chapter 3. For each of these sections, an evidence grade has been given, based on available research in the efficacy and safety of the plant’s potential applications.

Chapter 5 covers both fat- and water-soluble vitamins and their potential harm on the developing human. The effects on pregnancy of selected nutritional supplements, including bromelain, an enzyme obtained from pineapples (Ananas comosus, Bromeliaceae), and fish oils, a source of omega-3 fatty acids, are covered in Chapter 6.

This book is a necessary and useful resource for phytotherapists, pharmacists, naturopaths, physicians, and nurses who need a reliable source of information regarding the use of herbs and supplements during pregnancy and lactation. Intended primarily for the scientific community, its content may not be readily accessible to laypersons, including pregnant or lactating women, who lack a biomedical background.

—Armando E. González-Stuart, PhD Herbal Research Coordinator University of Texas at El Paso-UT Austin Cooperative Pharmacy Program, Austin, TX