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Pregnancy outcomes after prenatal exposure to echinacea: the Norwegian Mother and Child Cohort Study

  • Pharmacoepidemiology and Prescription
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European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Introduction

Previous studies have shown that echinacea is among the most widely used herbal medicines during pregnancy in Western countries. Despite its frequent use, we know little about the safety of this herbal medicine during pregnancy. The primary aim of this study was to study the consequences of the use of echinacea on malformations and common adverse pregnancy outcomes. Secondly, we aimed to characterize women using this herb in pregnancy.

Method

This study is based on the Norwegian Mother and Child Cohort Study (MoBa) and included 68,522 women and their children. Information was retrieved from three self-administered questionnaires completed by the women in pregnancy weeks 17 and 30 and 6 months after birth. Information on pregnancy outcomes was retrieved from the Medical Birth Registry of Norway. Generalized estimating equations analyses were performed to assess the association between exposure to echinacea and pregnancy outcomes. Pearson’s chi-square test was used to assess factors related to use of echinacea in pregnancy.

Results

Among 68,522 women, 363 (0.5 %) reported the use of echinacea during pregnancy. These women were characterized by high age and delivery before 2002 and were to a less extent smoking in pregnancy. The use of echinacea was not associated with an increased risk of malformations or adverse pregnancy outcomes.

Conclusion

This study revealed no increased risk of malformations or adverse pregnancy outcomes after the use of echinacea in pregnancy. Studies on the safety of commonly used herbal medications are important to identify herbals that should be avoided in pregnancy.

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Acknowledgments

The Norwegian Mother and Child Cohort Study is supported by the Norwegian Ministry of Health and the Ministry of Education and Research, NIH/NIEHS (contract no. N01-ES-75558), and NIH/NINDS (grant no. 1 UO1 NS 047537-01 and grant no. 2 UO1 NS 047537-06A1).

We are grateful to all the participating families in Norway who take part in this ongoing cohort study. We thank master’s degree student Ingebjørg Sandøy Rødahl and postdoc Janne Smedberg, School of Pharmacy, University of Oslo, Norway, for help with editing of the manuscript.

Authors’ contributions

HN, LH, and KH drafted the study protocol. All authors participated in the design and analytical plan of the study. KH performed the statistical analyses and drafted the manuscript. All authors (KH, GCH, LH, HN) contributed to the interpretation of the results and to the final manuscript. All authors (KH, GCH, LH, HN) read and approved the final manuscript.

Author information

Authors and Affiliations

  1. Department of Global Public Health and Primary Care and Centre for Pharmacy, Faculty of Medicine and Dentistry, University of Bergen, P.O. Box 7804, 5020, Bergen, Norway

    K. Heitmann & L. Holst

  2. Regional Medicines Information and Pharmacovigilance Centre (RELIS), Oslo University Hospital, Oslo, Norway

    G. C. Havnen

  3. PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, School of Pharmacy, University of Oslo, Oslo, Norway

    H. Nordeng

  4. Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway

    H. Nordeng

Authors
  1. K. Heitmann
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  2. G. C. Havnen
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  3. L. Holst
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  4. H. Nordeng
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Corresponding author

Correspondence to K. Heitmann.

Ethics declarations

Informed written consent was obtained from each participant. MoBa has been approved by the Regional Committee for Ethics in Medical Research, Region South, and the Norwegian Data Inspectorate.

Conflicts of interest

The authors declare that they have no conflicts of interest.

Appendices

Appendix 1

ᅟ Characteristics of study participants according to echinacea use (n = 68,522)
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Appendix 2

ᅟ Description of the three pregnancies resulting in major malformations after exposure of echinacea during early pregnancy
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Heitmann, K., Havnen, G.C., Holst, L. et al. Pregnancy outcomes after prenatal exposure to echinacea: the Norwegian Mother and Child Cohort Study. Eur J Clin Pharmacol 72, 623–630 (2016). https://doi.org/10.1007/s00228-016-2021-5

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  • DOI: https://doi.org/10.1007/s00228-016-2021-5

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