Main Article Content
Blue cohosh, caulophyllum thalictroides, pregnancy, lactation, breastfeeding, systematic review
There is a lack of basic knowledge on the part of both clinicians and patients as to the indications for use and safety of herbal medicines in pregnancy and lactation. This is one article in a series that systematically reviews the evidence for commonly used herbs during pregnancy and lactation.
To systematically review the literature for evidence on the use, safety and pharmacology of blue cohosh, focusing on issues pertaining to pregnancy and lactation.
We searched 7 electronic databases and compiled data according to the grade of evidence found.
According to a survey of midwives in the United States, approximately 64% of midwives reported using blue cohosh as a labour-inducing aid. There are three case reports in the scientific literature that blue cohosh taken at the time of delivery may cause; 1) perinatal stroke, 2) acute myocardial infarction, profound congestive heart failure and shock and 3) severe multi-organ hypoxic injury. There is one case report that blue cohosh possesses abortifacient properties. There is in vitro evidence that blue cohosh may have teratogenic, embryotoxic and oxytoxic effects. In lactation, the safety of blue cohosh is unknown.
Based on the available scientific information, blue cohosh should; 1) be used with extreme caution during pregnancy, 2) be used only under medical professional supervision and 3) not be available to the public as an over-the-counter product. There is an urgent need to conduct a retrospective or prospective cohort study of midwifes using blue cohosh in order to determine its safety
2. Perri S. Getting to the root of it - A profile of blue cohosh. Midwifery Today Int Midwife 2002;62:27-8.
3. Gunn TR, Wright IM. The use of black and blue cohosh in labour. N Z Med J 1996; 109:410-1.
4. Jellin JM, Batz F, Hitchens K. Natural medicines comprehensive database. Stockton, CA: Therapeutic Research Faculty, 2002:1530.
5. Newall CA, Anderson LA, Phillipson JD. Herbal medicines: a guide for health-care professionals. London, UK: Pharmaceutical Press, 1996:296.
6. Jhoo JW, Sang S, He K, et al. Characterization of the triterpene saponins of the roots and rhizomes of blue cohosh (Caulophyllum thalictroides). J Agric Food Chem 2001;49:5969-74.
7. Rao RB, Hoffman RS. Nicotinic toxicity from tincture of blue cohosh (Caulophyllum thalictroides) used as an abortifacient. Vet Hum Toxicol 2002;44:221-2.
8. Jones TK, Lawson BM. Profound neonatal congestive heart failure caused by maternal consumption of blue cohosh herbal medication. J Pediatr 1998;132:550-2.
9. McGuffin M, Hobbs C, Upton R, Goldberg A. American Herbal Products Association's BotanicalSafety Handbook. Boca Raton, FL: CRC Press, 1997:231.
10. Farnsworth NR, Bingel AS, Cordell GA, Crane FA, Fong HH. Potential value of plants as sources of new antifertility agents I. J Pharm Sci 1975;64:535-98.
11. Ganzera M, Dharmaratne HR, Nanayakkara NP, Khan IA. Determination of saponins and alkaloids in Caulophyllum thalictroides (blue cohosh) by high-performance liquid chromatography and evaporative light scattering detection. Phytochem Anal 2003;14:1-7.
12. Kennelly EJ, Flynn TJ, Mazzola EP, et al. Detecting potential teratogenic alkaloids from blue cohosh rhizomes using an in vitro rat embryo culture. J Nat Prod 1999;62:1385 -9.
13. Keeler RF. Teratogens in plants. J Animal Sci 1984;58:1029-39.
14. Finkel RS, Zarlengo KM. Blue Cohosh and Perinatal Stroke. The New England Journal of Medicine 2004;351:302.
15. Potterton D, Chan GM, Nelson LS, Finkel RS, Zarlengo RM. More on blue cohosh and perinatal stroke. N Engl J Med 2004;351:2239-41.
16. Ortega JA, Lazerson J. Anagyrine -induced red cell aplasia, vascular anomaly, and skeletal dysplasia. J Pediatr 1987;111:93-9.
17. Smith CA. Homoeopathy for induction of labour. Cochrane Database Syst Rev 2001:CD003399.
18. Beer AM, Heiliger F. Randomized, double -blind trial of caulophyllum d4 for induction of labor after premature rupture of the membranes at term. Geburtshilfe und Frauenheilkunde 1999;59:431-5.
19. Edmunds J. Blue cohosh and newborn myocardial infarction? Midwifery Today Int Midwife 1999;Winter:34-5.
20. Pilcher J, Burman G, Delzell W. The action of the so- called female remedies on the excised uterus of the guinea pig. Arch Int Med 1916;18:557-83.
21. Pilcher J, Mauer R. The action of “female remedies” on intact uteri of animals. Surg Gynecol Obstet 1918;27:97-9.
22. Duke JA. Handbook of medicinal herbs. Boca Raton: CRC, 1985.
23. Kessler DA. Introducing MEDWatch: a new approach to reporting medication and device adverse effects and product problems. JAMA 1993;269:2765-8.
24. Ferguson HC, Edwards LD. A pharmacological study of crystalline glycoside of caulophyllum thalictoides. J Am Pharm Assoc 1954;43:16-21.