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Some supplements may actually cause harm during a pregnancy.

By Page Leggett
Novant Health

It’s easy to see why many people believe anything “all natural” must be good for us. But remember: There are plenty of things in the natural world we still need to be wary of. Pregnant women and women trying to get pregnant need to be especially wary of herbs and supplements.

It’s not that they’re inherently bad. They may be quite beneficial. It’s just that you should discuss all supplements — even those that seem benign — with your doctor. Dr. Joseph Stringfellow of Novant Health City Lake OB/GYN, explains.

Why should a woman who’s pregnant or trying to become pregnant discuss every medication — including vitamins and supplements — with her doctor? Why does it matter?

There’s an assumption that anything herbal or anything that’s “natural” or “all natural” must be safe, and that’s not always the case. Some supplements may actually cause harm during a pregnancy. It’s important to have a conversation with your doctor about what you’re taking or thinking about taking.

Supplements aren’t as closely regulated as prescription medicine. And the data on their safety can be sparse. You want to make sure that what you’re taking — even if it’s over the counter — won’t have any potentially dangerous interactions with anything else you might be on.

What’s an example of a supplement that’s commonly taken and presumed to be safe that could, in fact, be harmful?

Fenugreek is an over-the-counter lactation supplement that a lot of women want to take late in pregnancy to stimulate milk production. But it may actually cause contractions. Preterm labor is a very real risk if Fenugreek (derived from an herb similar to clover) is taken too early.

What common questions do you get from patients about herbs, vitamins and supplements?

Women who become pregnant often ask me about a supplement they’ve already been taking. Suddenly, they wonder if it’s safe for the baby. A lot of times, I’m being introduced to a supplement for the first time; I have a lot to learn myself about some of these medicines. The patient and I review the ingredients together and determine if it’s safe.

Do you have an example of one, like the Fenugreek example, that women may already be on that you suggest they discontinue during pregnancy?

St. John’s Wort is commonly used to treat mood disorders such as depression. It’s generally considered safe but may not be recommended for pregnant women.

What could happen if a pregnant woman doesn’t discuss with you every supplement she’s on?

We want to make sure an expectant mom is getting all the nutrients she and her baby need. A lot of vitamins and supplements come in combinations. Pregnant women may require extra iron. A vitamin that has iron plus other ingredients may not be supplying enough.

Vitamin E is another. You can get too much of it; it can be toxic at certain levels.

It’s important for pregnant women to have an honest conversation with their doctors about what they’re taking. It’s not my goal to get you to give up a supplement that’s working for you. I don’t have a bias against supplements. Physicians may seem skeptical, but it’s only because there’s limited knowledge on the efficacy and side effects of natural remedies not regulated by the Food and Drug Administration.

My goal is for patients to have a healthy pregnancy and delivery. I can’t do my job of caring for patients unless I know everything they’re taking and if those supplements could have possible interactions with other medications.

Can a pregnant woman stop taking a supplement abruptly? Or does she need to wean herself off?

With most supplements, you can just stop without having to taper off. There may be mild, short-term symptoms of coming off, but in general, discontinuing a supplement is pretty easy.

Are there supplements you generally recommend for your pregnant patients?

Yes. The two most common are vitamin B6 and ginger. Both are used to treat nausea. With ginger, you can use the root in cooking or grind it up and have it in a smoothie. It also comes in candied form.

Anything else you want to add on the topic?

I want to encourage an open, honest dialogue with patients. I always have their best interest at heart. If a patient prefers supplements over prescription drugs, that’s a discussion we need to have. I believe in patient autonomy. We can work as a team to find the right approach for her and her baby.