Echinacea

Selected References:

  • Barcz E, et al. 2007. Influence of Echinacea purpurea intake during pregnancy on fetal growth and tissue angiogenic activity. Folia Histochemica et Cytobiologica 45:Supp. 1; 35-39.
  • Chow G, et al. 2006. Dietary echinacea purpurea during murine pregnancy: Effect on maternal hemopoiesis and fetal growth. Biol Neonate; 89: 133-138.
  • Gallo M, et al. 2000. Pregnancy outcome following gestational exposure to echinacea. Arch Intern Med. 160:3141-3143.
  • Heitmann K, et al. 2016. Pregnancy outcome after prenatal exposure to echinacea: The Norwegian Mother and Child Cohort Study. Eur J Clin Pharmacol. 72(5): 623-630.
  • Huntley AL, et al. 2005. The safety of herbal medicinal products derived from Echinacea species. Drug Saf 28(5):387-400.
  • Lewicka A, et al. 2019. Supplementation of plants with immunomodulatory properties during pregnancy and lactation—maternal and offspring health effects. Nutrients 11(8):1958.
  • Linde K, et al. 2009. Echinacea for preventing and treating the common cold. Cochrane Database of Systematic Reviews 2(2):CD000530
  • Matthias A, et al. 2008. Bioavailability of Echinacea alkamides in human breast milk. Planta Med; 74-SL59.
  • Natural Standard (Ed). Herbs & Supplements – Echinacea (E. angustifolia DC, E. pallida, E. purpurea). Nature Medicine Quality Standard. [Retrieved on November 2014]. naturalstandard.com
  • Ondrizek RR, et al. 1999. Inhibition of human sperm motility by specific herbs used in alternative medicine. J Assist Reprod Genet. 16(2):87-91.
  • Perri D, et al. 2006. Safety and efficacy of echinacea (Echinacea angustifolia, E. purpurea and E. pallida) during pregnancy and lactation. Can J Clin Pharmacol 13(3):e261-7.
  • Peprah P, et al 2019. ‘We are nothing without herbs’: a story of herbal remedies use during pregnancy in rural Ghana. BMC 19(1):65.
  • Sarecka-Hujar B, Szulc-Musioł B. 2022 Herbal Medicines—Are They Effective and Safe during Pregnancy? Pharmaceutics; 14(1):171.

Echinacea

Selected References:

 

Echinacea

Selected References:

  • American College of Obstetricians and Gynecologists (ACOG). 2017. Update on immunization and pregnancy: tetanus, diphtheria, and pertussis vaccination. Committee Opinion no. 718.
  • American College of Obstetricians and Gynecologists (ACOG). 2018. Maternal Immunization. Committee Opinion no. 741.
  • American College of Obstetricians and Gynecologists (ACOG). 2019. Influenza vaccination during pregnancy. Committee Opinion no. 732.
  • Centers for Disease Control and Prevention (CDC). 2022. Guidelines for vaccinating pregnant women. Available at: https://www.cdc.gov/vaccines/pregnancy/hcp-toolkit/guidelines.html
  • Centers for Disease Control and Prevention (CDC). 2023. Vaccines During Pregnancy FAQs. Available at: https://www.cdc.gov/vaccinesafety/concerns/vaccines-during-pregnancy.html
  • Centers for Disease Control and Prevention (CDC). 2020. Vaccinations: breastfeeding guidelines & recommendations. Available at: https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/vaccinations-medications-drugs/vaccinations.html
  • Etti M, et al. 2022. Maternal vaccination: a review of current evidence and recommendations. Am J Obstet Gynecol. Apr;226(4):459-474.
  • Giles ML, et al. 2019. The safety of inactivated influenza vaccines in pregnancy for birth outcomes: a systematic review. Hum Vaccin Immunother 15(3):687-699.
  • Keller-Stanislawski B, et al. 2014. Safety of immunization during pregnancy: a review of the evidence of selected inactivated and live attenuated vaccines. Vaccine. 32(52):7057-64.
  • Ohfuji S, et al. 2020. Safety of influenza vaccination on adverse birth outcomes among pregnant women: A prospective cohort study in Japan. Int J Infect Dis 93:68-76.
  • Shafiee A, et al. 2023. COVID-19 vaccination during pregnancy: a systematic review and meta-analysis. BMC Pregnancy Childbirth. Jan 20;23(1):45
  • Vygen-Bonnet S, et al. 2020. Safety and effectiveness of acellular pertussis vaccination during pregnancy: a systematic review. BMC Infect Dis 20(1):136.
  • Zhang C, et al. 2018. A systematic review and meta-analysis of fetal outcomes following the administration of influenza A/H1N1 vaccination during pregnancy. Int J Gynaecol Obstet 141(2):141-150.

Echinacea

Selected References:  

  • Ahmadi R, et al. 2015. International conference of social science, medicine and nursing, Istanbul, Turkey.  
  • Altshuler LL, et al. 1996. Pharmacologic management of psychiatric illness during pregnancy: Dilemmas and guidelines. Am J Psychiatry. 153:592-606. 
  • Ang MS, et al. 1990. Maternal lithium therapy and polyhydramnios. Obstet Gynecol. 76(3 Pt 2):517-519. 
  • Cohen LS, et al. 1994. A reevaluation of risk of in utero exposure to lithium. JAMA. 271(2):146-150.  
  • Diav-Citrin O, et al. 2014. Pregnancy outcome following in utero exposure to lithium: a prospective, comparative, observational study. Am Journal of Psychiatry. 171:785-794.  
  • Di Florio A, et al. 2017. Lithium use in pregnancy and the risk of cardiac malformations. N Engl J Med. 377(9):893.  
  • Forsberg L, et al. 2017. Maternal mood disorders and lithium exposure in utero were not associated with poor cognitive development during childhood. Acta Paediatr. Doi:10.1111/apa.14152. 
  • Goodnick PJ, et al. 1982 Differences in lithium kinetics between bipolar and unipolar patients. J Clin Psychopharmacol. 2:48-50. 
  • Hastie R, et al. 2021. Maternal lithium use and the risk of adverse pregnancy and neonatal outcomes: a Swedish population-based cohort study. BMC Med. 19(1):291. 
  • Jacobsen SJ. et al. 1992. Prospective multicentre study of pregnancy outcome after lithium exposure during first trimester. Lancet. 339:530-533.  
  • Khan SJ, et al. 2016. Bipolar disorder in pregnancy and postpartum: principles of management. Curr Psychiatry Rep. 18(2):13.  
  • Kozma C. 2005. Neonatal toxicity and transient neurodevelopmental deficits following prenatal exposure to lithium: Another clinical report and review of the literature. Am J Med Genet. 132A:441-444. 
  • Krause S, et al. 1990. Polyhydramnios with maternal lithium treatment. Obstet Gynecol. 75(3 Pt 2):504-6. 
  • Kummerlowe MN, et al. 2024. Retrospective review of postpartum lithium use including during lactation. Breastfeed Med. 19(10):796-800. 
  • Lithium FDA Full Prescribing Information. 2018. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/017812s033,018421s032,018558s027lbl.pdf.   
  • Molenaar NM, et al. 2021, Management of lithium dosing around delivery: an observational study. Bipolar Disord. 23(1):49-54. 
  • Morrell P. et al. 1983. Lithium toxicity in the neonate. Arch Dis Child. 58:539-541.  
  • Newport DJ, et al. 2005. Lithium placental passage and obstetrical outcome: implications for clinical management during date pregnancy. Am J Psychiatry. 162(11):2162-2170.  
  • Patorno E, et al. 2017.  Lithium use in pregnancy and the risk of cardiac malformations. N Engl J Med. 376(23):2245-54.  
  • Poels EMP, et al. 2020. Lithium use during pregnancy and the risk of miscarriage. J Clin Med. 9(6). 
  • Poels EMP, et al. 2022. The effect of prenatal lithium exposure on the neuropsychological development of the child. Bipolar Disord. 24(3):310-319. 
  • Raoof NT, et al. 1989. Lithium inhibits human sperm motility in vitro. Br J Clin Pharmac. 28, 715-717. 
  • Robert E. et al. 1990. Comments on teratogen update on lithium by J. Warkany. Teratology. 42:205. 
  • Schmidt CT, et al. 2023. Transfer of anticonvulsants and lithium into amniotic fluid, umbilical cord blood & breast milk: A systematic review & combined analysis. Prog Neuropsychopharmacol Biol Psychiatry. 8;124:110733. 
  • Schou M. 1990. Lithium treatment during pregnancy, delivery, and lactation: an update. Journal of Clinical Psychiatry. 51(10):410-413.  
  • Smith CJ, Payne VM. 2024. Epidemiology studies on effects of lithium salts in pregnancy are confounded by the inability to control for other potentially teratogenic factors. Hum Exp Toxicol. 43:9603271241236346. 
  • Stoppa A, et al. 2024. A case of pregnancy with severe polyhydramnios related to long-term use of lithium. Bipolar Disord. 26(4):405-408. 
  • Van der Lugt NM, et al. 2012. Fetal, neonatal and developmental outcomes of lithium-exposed pregnancies. Early Hum Dev. 88(6):375-378. 
  • Viguera AC, et al. 2000. Risk of recurrence of bipolar disorder in pregnant and nonpregnant women after discontinuing lithium maintenance. Am J Psychiatry. 157(2):179-184.  
  • Viguera AC, et al.2007. Risk of recurrence in women with bipolar disorder during pregnancy: prospective study of mood stabilizer discontinuation. Am J Psychiatry. 164(12):1817-1824. 
  • Viguera AC, et al. 2007. Lithium in breast milk and nursing infants: clinical implications. Am J Psychiatry 164(2):342-345. 
  • Zivanovic O. 2017. Lithium: A classic drug frequently discussed, but, sadly, seldom prescribed! Aust N Z J Psychiatry 4867417695889. 

Echinacea

Selected References:

  • Akhigbe RE, et al. 2022. Codeine alters female reproductive function by targeting ovarian steroidogenesis and folliculogenesis via the induction of oxidative stress, inflammation, and apoptosis, Reproductive Toxicology 109: 1-9.  
  • Azuine RE, et al. 2019. Prenatal risk factors and perinatal and postnatal outcomes associated with maternal opioid exposure in an urban, low-income, multiethnic US population. JAMA network 2(6): e196405-196405.  
  • Berlin CM, Jr, et al. 2009. Safety issues of maternal drug therapy during breastfeeding. Clinical pharmacology and therapeutics  85(1): 20-22. 
  • Bowie, AC, et al. 2022. Prescribed opioid analgesics in early pregnancy and the risk of congenital anomalies: a population-based cohort study. CMAJ. 194(5): E152-E162. 
  • Bracken MB. 1986. Drug use in pregnancy and congenital heart disease in offspring. N Engl J Med. 314(17):1120. 
  • Bracken MB, Holford TR. 1981. Exposure to prescribed drugs in pregnancy and association with congenital malformations. Obstet Gynecol. 58(3):336-344. 
  • Brogly SB, et al. 2021. Prenatal opioid analgesics and the risk of adverse birth outcomes. Epidemiology. 32(3), 448–456. 
  • Brogly SB, et al. 2023. Safety of prenatal opioid analgesics: Do results differ between public health insurance beneficiary and population-based cohorts? Birth Defects Res. 115(5):555-562. 
  • Broussard CS, et al. 2011. Maternal treatment with opioid analgesics and risk for birth defects. Am J Obstet Gynecol. 204(4):314.e1-11.
  • Corsi DJ, et al. 2020. Association of Maternal opioid use in pregnancy with adverse perinatal outcomes in Ontario, Canada, From 2012 to 2018. JAMA Netw Open. 3(7):e208256. 
  • Corsi DJ, et al. 2021. The effects of opioids on female fertility, pregnancy and the breastfeeding mother‐infant dyad: A Review. Basic Clin Pharmacol Toxicol. 128(5):635-641. 
  • Esposito, DB, et al. 2022. Characteristics of prescription opioid analgesics in pregnancy and risk of neonatal opioid withdrawal syndrome in newborns. JAMA Netw Open 5(8): e2228588. 
  • Fältmarch S, et al. 2019. Use of opioids during pregnancy and effects of pregnancy outcomes. Pharmacoepidemiol Drug Saf. 28: 1239– 1245.  
  • Fishman B, et al. 2019. Pregnancy outcome following opioid exposure: A cohort study. PLOS ONE 14(7): e0219061 
  • Flannagan KS, et al. 2020. Is opioid use safe in women trying to conceive? Epidemiology. 31(6): 844–851. 
  • Fronczak CM, et al. 2012. The insults of illicit drug use on male fertility. Journal of andrology. 33(4): 515-528. 
  • Interrante JD, et al. 2021. Prescription opioid use during pregnancy and risk for preterm birth or term low birthweight. Journal of opioid management 17(3):215-225. 
  • Ito S. 2018. Opioids in breast milk: Pharmacokinetic principles and clinical implications. The Journal of Clinical Pharmacology, 58: S151-S163. 
  • Juurlink DN, et al. 2012. Postpartum maternal codeine therapy and the risk of adverse neonatal outcomes: a retrospective cohort study. Clinical Toxicol. 50:5.  
  • Kallen B,  Reis M. 2015. Use of tramadol in early pregnancy and congenital malformation risk. Reprod Toxicol. 58:246-251. 
  • Kelly LE, et al. 2013. A clinical tool for reducing central nervous system depression among neonates exposed to codeine through breast milk. PLoS ONE. 8(7):370073. 
  • Khan K,  Chang J. 1997. Neonatal abstinence syndrome due to codeine. Arch Dis Child. 76:F59-F60.  
  • Konijnenberg C, el at. 2022. Verbal and nonverbal memory in school-aged children born to opioid-dependent mothers. Early human development, 171, 105614. 
  • Lazaryan M,  et al. 2015. Codeine should not be prescribed for breastfeeding mothers or children under the age of 12. Acta paediatrica 104(,6): 550-556. 
  • Lind JN, et al. 2017. Maternal use of opioids during pregnancy and congenital malformations. A Systematic Review. Pediatrics. 139(6):e20164131.  
  • Mactier H, et al. 2020. Prenatal opioid exposure – Increasing evidence of harm. Early human development, 150, 105188. 
  • Mangurten HH. 1980. Neonatal codeine withdrawal in infants of non-addicted mothers. Pediatrics. 65:159-160. 
  • Meny RG, et al. 1993. Codeine and the breastfed neonate. Journal of human lactation  9(4): 237-240. 
  • Nair V, et al. 2012. Neonatal withdrawal syndrome due to maternal codeine use. Paediatr Child Health. 17(5):e40-e41. 
  • Nezvalová-Henriksen K, et al. 2011. Effects of codeine on pregnancy outcomes from a large population-based cohort study. Eur J Clin Pharmacol. 67:1253-1261. 
  • Rothman KJ, et al. 1979. Exogenous hormones and other drug exposures of children with congenital heart disease. Am J Epidemiol. 109(4):433-439. 
  • Rubenstein E, et al. 2019. Brief Report: Maternal opioid prescription from preconception through pregnancy and the odds of autism spectrum disorder and autism features in children. Journal of autism and developmental disorders, 49(1): 376–382. 
  • Saxén I. 1975. Associations between oral clefts and drugs taken during pregnancy. Int J Epidemiol. 4(1):37-44. 
  • Sachs, Hari Cheryl, and Committee On Drugs. 2013. The transfer of drugs and therapeutics into human breast milk: an update on selected topics. Pediatrics  132(3): e796-809. 
  • Shaw GM, et al. 1992. Congenital cardiac anomalies relative to selected maternal exposures and conditions during early pregnancy. Eur J Epidemiol. 8(5):757-760. 
  • Shaw GM, et al. 1998. Maternal illness, including fever and medication use as risk factors for neural tube defects. Teratology. 57(1):1-7. 
  • Semet M, et al. 2017. The impact of drugs on male fertility: a review. Andrology, 5(4), 640-663. 
  • Sujan AC, et al. 2019. Maternal prescribed opioid analgesic use during pregnancy and associations with adverse birth outcomes: A population-based study. PLoS Medicine. 16(12). 
  • U.S. Food and Drug Administration. 2017. Use of codeine and tramadol products in breastfeeding women – questions and answers. Available at https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/use-codeine-and-tramadol-products-breastfeeding-women-questions-and-answers. Accessed 2 June 2025.   
  • Van Leeuwen G, et al. 1965. Narcotic withdrawal reaction in a newborn infant due to codeine. Pediatrics. 36:635-636. 
  • Varney B, et al. 2024. Opioid analgesic exposure during the first trimester of pregnancy and the risk of major congenital malformations in infants: a systematic review and meta-analysis†. Anaesthesia. 79(9):967-977. 
  • Willmann, S, et al. 2009. Risk to the breast-fed neonate from codeine treatment to the mother: a quantitative mechanistic modeling study. Clin Pharmacol Ther. 86, 634–643. 
  • Yazdy MM, et al. 2013. Periconceptional use of opioids and the risk of neural tube defects. 2013. Obstet Gynecol. 122(4):838-844. 
  • Zierler S, Rothman KJ. 1985. Congenital heart disease in relation to maternal use of Bendectin and other drugs in early pregnancy. N Engl J Med. 313(6):347-352. 
  • Zipursky J, Juurlink DN. 2020. The implausibility of neonatal opioid toxicity from breastfeeding. Clin Pharmacol Ther. 108(5):964-970. 

 

Echinacea
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