What is pregnancy support?

Introduction

Pregnancy is a time of dramatic transitions. Body systems that once sustained a
single human now support two. Organs, blood vessels, body chemistry, and even the
solid supporting structures of a woman’s body all go through changes; in the
meantime, the fetus’s body grows from a tiny bundle of cells to a full-sized
baby.

Since ancient times, women have tried herbs and other natural treatments to ease
discomfort or assist with pregnancy, childbirth, and breast-feeding. However,
pregnancy is also a circumstance when the potential risk of any treatment rises
dramatically. Seemingly benign medications, even natural ones, have been found to
cause birth defects or disorders or to increase the risk of complications. Some
traditional remedies, such as blue cohosh for labor stimulation, must
be discontinued for safety reasons.

Thorough study is needed before any treatment can be considered absolutely safe in
pregnancy, and in many cases this research may never be done because of
insurmountable ethical considerations regarding the safety of the fetus. It is
important to talk with a doctor before deciding to use any treatment, whether it
is natural or conventional.

Principal Proposed Natural Treatments

Many natural treatments have shown promise for conditions related to pregnancy.
This section will discuss those treatments (except those for nausea and vomiting
and preeclampsia) with the most scientific support. The safety
of the following treatments has not been confirmed, except for nutrients such as
vitamins and minerals, for which appropriate dosages for pregnancy have been
established.

Venous insufficiency. Increased pressure from the expanding
abdomen and other factors can lead to the pooling of fluid in the legs, a
condition called venous insufficiency (closely related to varicose
veins).

Venous insufficiency occurs outside pregnancy too, and a variety of natural
treatments, including buckwheat, butcher’s broom, citrus bioflavonoids, gotu kola,
horse chestnut, oligomeric proanthocyanidins, and red vine leaf, have shown
promise in their treatment. Only one natural treatment, oxerutins,
has been studied in a double-blind trial enrolling pregnant women with venous
insufficiency. In this study of sixty-nine women, researchers found oxerutins more
effective than placebo.

Hemorrhoids. Hemorrhoids are actually varicose veins
in or around the anus. Oxerutins and citrus bioflavonoids have been studied
for hemorrhoids during pregnancy. A double-blind study enrolling ninety-seven
pregnant women found oxerutins (1,000 milligrams [mg] daily) significantly better
than placebo at reducing the pain, bleeding, and inflammation of hemorrhoids.
Evidence for citrus bioflavonoids is limited to one open trial. Other natural
treatments for varicose veins are often recommended for hemorrhoids too, although
research on their use for this condition in pregnancy is lacking.

Anemia. Anemia is common during pregnancy and
is usually caused by a deficiency in iron. However, iron supplements can be hard
on the stomach, thereby aggravating morning sickness. One study found evidence
that a fairly low supplemental dose of iron (20 mg daily) is nearly as effective
for treating anemia of pregnancy as 40 mg or even 80 mg daily and is less likely
to cause gastrointestinal side effects. (A daily dosage of 20 mg is lower than the
amount contained in standard prenatal vitamins.)

Pregnant women who are not anemic should not take more than the recommended daily allowance of iron in pregnancy, as excess iron intake may be harmful for both pregnant women and their fetuses. One study suggests that iron plus folate is more effective for the treatment of iron-deficiency anemia in pregnancy than iron alone, even in women who do not appear to be folate-deficient.

Prevention of neural tube defects and other birth defects.
Folate supplements can help prevent a serious and common
type of birth defect known as neural tube defects (NTDs). Folate, or
folate plus multivitamin-multimineral supplements, may help prevent other birth
defects too, including cleft palate and anomalies of the heart and urinary tract.
One preliminary study of 859 babies suggests that zinc may help prevent NTDs, but
evidence of this is weak.

Other Proposed Natural Treatments

Other natural remedies have been recommended for treating discomforts and complications of pregnancy or decreasing risks to the fetus and baby.

Assisting childbirth. Castor oil.
Castor bean
oil was noted by the ancient Egyptians to stimulate labor,
and it is still used by some conventional physicians and midwives to induce
contractions (for example, it is used when labor does not occur spontaneously
after the woman’s water has broken). A recent controlled trial of one hundred
pregnant women compared oral castor oil to no treatment and found that 57.7
percent of those given castor oil began labor within twenty-four hours, compared
to only 4.2 percent of those without treatment. Other preliminary studies also
suggest that castor oil may help. Castor oil is a strong laxative, and diarrhea is
a nearly universal effect.

In addition, considering how common this treatment is, research on its safety and effectiveness is surprisingly scant. One case of a potentially fatal complication linked to the use of castor oil has been reported, though some have questioned whether the castor oil was responsible. In addition, an observational study of South African women found that those self-treating with castor oil or other traditional herbs (or both) had a higher incidence of meconium (fetal feces) in the amniotic fluid, a sign of fetal distress.

Acupuncture. Acupuncture has shown some promise for
reducing pain in labor, but the quality of most of the supporting evidence is
relatively poor. In one study, sterile water injections were found to be more
effective than acupuncture for lower back pain and relaxation during labor. It is
unclear whether or not the persons in the study knew what treatment they were
receiving at the time.

In one placebo-controlled trial, real acupuncture was no better than sham acupuncture in relieving pelvic pain before labor. A carefully conducted review of ten randomized, controlled trials involving 2,038 women could not uncover consistent evidence of acupuncture’s effectiveness for labor pain either alone or with other treatments. In one study involving sixty women, postoperative acupuncture or electro-acupuncture reduced pain within the first two hours (but no longer) and demand for pain medication within the first twenty-four hours after cesarean section.

A study of forty-five pregnant women found that women who received acupuncture on the mathematically calculated birth “due date” gave birth sooner than those who did not received acupuncture. However, this trial used a no-treatment control group instead of sham acupuncture, making its results unreliable. Another study suggested that the use of acupuncture may help stimulate normal term labor. A third study of 106 women with premature rupture of membranes (water breaking too early) found that acupuncture did not effectively speed up delivery. It should be noted that none of these three studies used sham acupuncture as a control, making their results unreliable. However, in a subsequent trial that attempted to address this problem, real acupuncture administered for two days before a planned induction of labor (artificial stimulation of labor) was no better than sham acupuncture at preventing the need for induction or shortening the time of labor.

Two studies suggest that acupuncture and associated therapies can help “turn” a breech presentation of the fetus. In 2008, researchers published a review of six randomized, controlled trials that investigated acupuncture-like therapies (moxibustion, acupuncture, or electro-acupuncture) applied to a specific acupuncture point (BL 67). They concluded that these therapies were effective at decreasing the incidence of breech presentations at the time of delivery. Again, however, not all of these studies employed a sham-acupuncture group for comparison.

Other natural treatments. One double-blind, placebo-controlled trial evaluated the effects of red raspberry in 192 pregnant women. Treatment (placebo or 2.4 grams [g] of raspberry leaf daily) began at thirty-two weeks of pregnancy and was continued until the onset of labor. The results failed to show any statistically meaningful differences between the groups. Red raspberry did not significantly shorten labor, reduce pain, or prevent complications.

Blue cohosh is a toxic herb and should not be used. One published case report documents profound heart failure in a baby born to a mother who used blue cohosh to induce labor. Severe medical consequences were also seen in a child whose mother took both black and blue cohosh.

Proteolytic
enzymes may reduce inflammation and discomfort following
episiotomy. Hypnotherapy and massage therapy have shown some
promise for assisting labor. In a large controlled trial (more than six hundred
participants), lavender oil aromatherapy failed to improve pain after
childbirth.

Constipation. Constipation frequently occurs during pregnancy,
for reasons that are not entirely clear. Fiber supplements, such as psyllium seed,
are commonly recommended for the treatment of constipation in pregnancy because of
their apparent safety. Flaxseed is another high-fiber seed,
and alternative practitioners often recommend it. However, flaxseed contains
estrogen-like substances that might pose hazards to the fetus; one study found an
effect on reproductive organs and function in baby rats whose mothers ate large
amounts of flaxseed during pregnancy.

Other natural remedies for constipation during pregnancy include dandelion root and a combination of glucomannan and lactulose. However, there is no meaningful evidence to indicate that they are effective.

One should avoid the use of powerful laxatives, including natural remedies such as buckthorn, cascara, rhubarb, castor bean oil, and Senna, because they can induce uterine contractions. The traditional remedy yellow dock, though milder, might warrant similar caution.

Leg cramps. Pregnant women sometimes experience painful leg cramps. A double-blind study of seventy-three women with this symptom found that magnesium was significantly more effective than placebo in decreasing their distress. Calcium has also been studied for this problem, but research gives little indication that it helps. A combination of vitamins B1 and B6 has also been suggested for leg cramps, but evidence that it helps remains minimal.

Prevention of prematurity. Not entirely consistent evidence
suggests that the use of fish oil or its constituents by
pregnant women might help prevent premature births. Double-blind studies have
evaluated the minerals calcium, zinc, and magnesium for this purpose too, but the
results have been mixed. A number of trials suggest that anemia is linked to
prematurity; however, evidence as to whether iron supplements can help remains
inconclusive. Several studies have evaluated folate but did not find it effective
for preventing premature birth.

One study failed to find vitamin C helpful for preventing premature birth. However, another study found that vitamin C (100 mg per day after twenty weeks of pregnancy) helped prevent early rupture of the chorioamniotic membrane (water breaking). Another study found that the use of vitamin E (400 international units daily) and vitamin C (500 mg per day) after premature water breaking helped hold off delivery by several days.

Prevention of low birth weight. Babies born below a specific weight (5.5 pounds), called low birth weight, are at greater risk for complications. A meta-analysis of seven controlled studies looked at the effects of calcium supplementation on birth weight. These studies predominantly focused on preventing hypertension or preeclampsia (or both) in the pregnant woman, both of which can result in low-birth-weight babies. Overall, calcium appeared to decrease the percentage of babies weighing less than 5 pounds 8 ounces. However, other analysts looking at a somewhat different group of studies came to the opposite conclusion.

Quite a few double-blind studies have examined zinc and magnesium for preventing low birth weight, with mixed results. Results have been similarly mixed in other controlled trials of folate and fish oil or one of its fatty acids. Vitamin D and B vitamins have also been proposed, but evidence of their usefulness is weak.

It was earlier believed that iron was helpful in preventing low birth weight. However, a large-scale unblinded study of well-nourished women found that routine iron supplements in pregnancy had no effect on birth weight. Iron supplementation in pregnant women who are not anemic may not be good for either the woman or the fetus. In another study, a double-blind, placebo-controlled study of 1,877 women, the use of combined vitamin E and vitamin C failed to prove helpful in preventing low birth weight.

Other uses of natural treatments. A common problem in pregnancy is an increased tendency toward swollen or bleeding gums, a condition known as gingivitis. Two small double-blind studies suggest that folate mouthwash may help. However, folate supplements do not appear to be especially effective against gingivitis.

A condition called intrahepatic cholestasis may occur during pregnancy, causing
jaundice and other complications. Preliminary evidence suggests that the
supplement S-adenosylmethionine might be helpful for preventing
this.

A single-blind trial found suggestive evidence that vitamin C, taken at a dose of 100 mg daily, might help prevent bladder infections in pregnancy. A placebo-controlled study of thirty women suggested that the mineral chromium may be useful for gestational diabetes, the term for diabetes that occurs during pregnancy. Vitamin B6 has also been proposed for this condition, but evidence in support of its effectiveness is minimal.

The use of fish oil or its constituents docosahexaenoic acid (DHA) and eicosapentaenoic acid by pregnant women might help support healthy cognitive and visual function in their children. Also, low levels of vitamin B12 may increase the risk of miscarriage, and B12 supplements may help.

A small preliminary study found that fish oil was significantly more effective
than placebo at alleviating postpartum depression. However, two
other studies failed to find either fish oil or one of its chief components, DHA,
helpful for preventing perinatal (including postpartum) depression.

Herbs and Supplements to Avoid During Pregnancy and Breast-feeding

Virtually no medicinal herb has been established as safe in pregnancy or
breast-feeding, and even herbs that might seem safe because of their wide use in
cooking could cause problems when they are taken in the form of highly
concentrated extracts. For example, based on food use, it is unlikely that cooked
garlic presents much risk; however, garlic supplements contain certain
rather potent and potentially toxic ingredients present only in raw garlic. Few
people eat large quantities of raw garlic on a regular basis, so there is no
history of its long-term use to show its effects.

Other herbs that are traditionally regarded with caution during pregnancy include andrographis, boldo, catnip, chasteberry, essential oils, feverfew, juniper, licorice, nettle, red clover, rosemary, shepherd’s purse, and yarrow. For example, chasteberry has shown a theoretical potential for inhibiting milk supply. In addition, herbs with estrogen-like properties could possibly affect the fetus; these herbs include soy, isoflavones, red clover, flaxseed, lignans, and hops.

These products have been found on occasion to contain toxic heavy metals, poisonous herbs, or unlabeled prescription drugs. In one case report, a brain-damaged child born to a woman using an Ayurvedic formula was found to have the highest bloods levels of lead ever recorded in a living newborn. Analysis of the formula revealed a very high lead content and toxic levels of mercury. In general, it is probably accurate to say that no herb can be regarded as definitely benign.

However, other supplements that are not essential nutrients are in much the same
position as herbs, and they could conceivably cause harm. For example, the
supplement conjugated linoleic acid appears to reduce the fat content
of breast milk, with potentially harmful effects on the nursing infant. Chitosan
may cause impaired nutrient absorption and at times may contain arsenic.
(Contamination with toxic substances is also a real possibility with certain
calcium supplements, which have been found to contain high levels of lead.)
Nonetheless, many herbs and supplements have a high enough safety factor that
researchers have felt comfortable recommending their use by pregnant women.

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