European Journal of Clinical Pharmacology

, Volume 72, Issue 5, pp 623–630 | Cite as

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

  • K. HeitmannEmail author
  • G. C. Havnen
  • L. Holst
  • H. Nordeng
Pharmacoepidemiology and Prescription



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.


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.


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.


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.


Echinacea Pregnancy Herbal medicine MoBa 



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.

Compliance with ethical standards

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.


  1. 1.
    Natural medicines comprehensive database (2013) Echinacea monograph. Natural medicines comprehensive database. Accessed 07 March 2014
  2. 2.
    Blumenthal M, Goldberg A, Brinkmann J (eds) (2000) Herbal medicine: expanded commission E monographs, 1st edn. Integrative Medicine, NewtonGoogle Scholar
  3. 3.
    Karsch-Volk M, Barrett B, Kiefer D, Bauer R, Ardjomand-Woelkart K, Linde K (2014) Echinacea for preventing and treating the common cold. Cochrane Database Syst Rev 2, CD000530. doi: 10.1002/14651858.CD000530.pub3 PubMedPubMedCentralGoogle Scholar
  4. 4.
    Hepner DL, Harnett M, Segal S, Camann W, Bader AM, Tsen LC (2002) Herbal medicine use in parturients. Anesth Analg 94(3):690–693CrossRefPubMedGoogle Scholar
  5. 5.
    Holst L, Wright D, Haavik S, Nordeng H (2009) The use and the user of herbal remedies during pregnancy. J Altern Complement Med 15(7):787–792. doi: 10.1089/acm.2008.0467 CrossRefPubMedGoogle Scholar
  6. 6.
    Nordeng H, Havnen GC (2004) Use of herbal drugs in pregnancy: a survey among 400 Norwegian women. Pharmacoepidemiol Drug Saf 13(6):371–380. doi: 10.1002/pds.945 CrossRefPubMedGoogle Scholar
  7. 7.
    Holst L, Havnen GC, Nordeng H (2014) Echinacea and elderberry—should they be used against upper respiratory tract infections during pregnancy? Front Pharmacol 5:31. doi: 10.3389/fphar.2014.00031 CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Gallo M, Sarkar M, Au W, Pietrzak K, Comas B, Smith M, Jaeger TV, Einarson A, Koren G (2000) Pregnancy outcome following gestational exposure to echinacea: a prospective controlled study. Arch Intern Med 160(20):3141–3143CrossRefPubMedGoogle Scholar
  9. 9.
    Romm A (2010) Botanical medicine for women’s health. Churchill Livingstone/Elsevier, St. LouisGoogle Scholar
  10. 10.
    Mills E, Duguoa JJ, Perri D, Koren G (2006) Herbal medicines in pregnancy and lactation: an evidence-based approach. Taylor & Francis, London; New YorkCrossRefGoogle Scholar
  11. 11.
    Mills SY, Bone K (2005) The essential guide to herbal safety. Elsevier Churchill Livingstone, St. LouisGoogle Scholar
  12. 12.
    Gardner ZE, McGuffin M, Association AHP (2013) American herbal products association’s botanical safety handbook, 2nd edn. CRC Press, Boca Raton, American HerbalGoogle Scholar
  13. 13.
    Committee on Herbal Medicinal Products (2012) Final community herbal monograph on Echinacea angustifolia DC., radix. European Medicines Agency, LondonGoogle Scholar
  14. 14.
    Magnus P, Irgens LM, Haug K, Nystad W, Skjaerven R, Stoltenberg C (2006) Cohort profile: the Norwegian Mother and Child Cohort Study (MoBa). Int J Epidemiol 35(5):1146–1150. doi: 10.1093/ije/dyl170 CrossRefPubMedGoogle Scholar
  15. 15.
    Irgens LM (2000) The Medical Birth Registry of Norway: epidemiological research and surveillance throughout 30 years. Acta Obstet Gynecol Scand 79(6):435–439CrossRefPubMedGoogle Scholar
  16. 16.
    Norwegian Institute of Public Health (2011) Definisjonsrapporter for variabler i Medisinsk fødselsregister (in Norwegian). English: Definition reports for variables in the Medical Birth Registry of Norway. Accessed 05 Jan 2016
  17. 17.
    European Surveillance of Congenital Anomalies (2014) Guide 1.4, Chapter 3.3. EUROCAT subgroups of congenital anomalies (version 2014; implemented in EDMP December 2014, used for website prevalence tables from December 2014). Accessed 08 Jan 2016
  18. 18.
    Hardin JW, Hilbe J (2013) Generalized estimating equations. CRC Press, Boca RatonGoogle Scholar
  19. 19.
    Holst L, Nordeng H, Haavik S (2008) Use of herbal drugs during early pregnancy in relation to maternal characteristics and pregnancy outcome. Pharmacoepidemiol Drug Saf 17(2):151–159. doi: 10.1002/pds.1527 CrossRefPubMedGoogle Scholar
  20. 20.
    Bayne KE (2005) Master thesis: use of herbal medicine during pregnancy. Universitet i Oslo, OsloGoogle Scholar
  21. 21.
    Heitmann K, Holst L, Nordeng H, Haavik S (2010) Attitudes to use of herbal medicine during pregnancy (Holdninger til og bruk av urtemedisin i svangerskapet). Norsk Farmaceutisk Tidsskrift 118(10):16–19Google Scholar
  22. 22.
    Nordeng H, Havnen GC (2005) Impact of socio-demographic factors, knowledge and attitude on the use of herbal drugs in pregnancy. Acta Obstet Gynecol Scand 84(1):26–33. doi: 10.1111/j.0001-6349 CrossRefPubMedGoogle Scholar
  23. 23.
    Kennedy DA, Lupattelli A, Koren G, Nordeng H (2013) Herbal medicine use in pregnancy: results of a multinational study. BMC Complement Altern Med 13:355. doi: 10.1186/1472-6882-13-355 CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Glover DD, Rybeck BF, Tracy TS (2004) Medication use in a rural gynecologic population: prescription, over-the-counter, and herbal medicines. Am J Obstet Gynecol 190(2):351–357. doi: 10.1016/j.ajog.2003.08.033 CrossRefPubMedGoogle Scholar
  25. 25.
    Maats FH, Crowther CA (2002) Patterns of vitamin, mineral and herbal supplement use prior to and during pregnancy. Aust N Z J Obstet Gynaecol 42(5):494–496CrossRefPubMedGoogle Scholar
  26. 26.
    Pinn G, Pallett L (2002) Herbal medicine in pregnancy. Complement Ther Nurs Midwifery 8(2):77–80. doi: 10.1054/yctnm.2001.0620 CrossRefPubMedGoogle Scholar
  27. 27.
    Tsui B, Dennehy CE, Tsourounis C (2001) A survey of dietary supplement use during pregnancy at an academic medical center. Am J Obstet Gynecol 185(2):433–437. doi: 10.1067/mob.2001.116688 CrossRefPubMedGoogle Scholar
  28. 28.
    Gibson PS, Powrie R, Star J (2001) Herbal and alternative medicine use during pregnancy: a cross-sectional survey. Am J Obstet Gynecol 185:44–45CrossRefGoogle Scholar
  29. 29.
    Burton NC (2014) Use of herbal medicine in pregnancy—interviews among 173 women at Sørlandet Hospital. University of Bergen, NorwayGoogle Scholar
  30. 30.
    Nilsen RM, Vollset SE, Gjessing HK, Skjaerven R, Melve KK, Schreuder P, Alsaker ER, Haug K, Daltveit AK, Magnus P (2009) Self-selection and bias in a large prospective pregnancy cohort in Norway. Paediatr Perinat Epidemiol 23(6):597–608. doi: 10.1111/j.1365-3016.2009.01062.x CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • K. Heitmann
    • 1
    Email author
  • G. C. Havnen
    • 2
  • L. Holst
    • 1
  • H. Nordeng
    • 3
    • 4
  1. 1.Department of Global Public Health and Primary Care and Centre for Pharmacy, Faculty of Medicine and DentistryUniversity of BergenBergenNorway
  2. 2.Regional Medicines Information and Pharmacovigilance Centre (RELIS)Oslo University HospitalOsloNorway
  3. 3.PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, School of PharmacyUniversity of OsloOsloNorway
  4. 4.Division of Mental HealthNorwegian Institute of Public HealthOsloNorway

Personalised recommendations