Q&A: Is it safe to continue taking St. John's Wort while pregnant?

Questions about herbals in pregnancy are difficult to answer. In general, a lot of people believe herbal remedies are overall safer than pharmaceuticals because they are natural. But any substance that can lead to biological effects can lead to negative effects—after all, snake poisons are "natural" but you wouldn't take them in pregnancy!

So here is the problem: the best way to judge the safety of any medication in pregnancy is to look at scientific studies. Animal studies are not totally predictive of risk for human pregnancy, but can give a hint about dangers. Human studies are the best determinants, but you can imagine that most pregnant women don't want to take experimental medications. What we are left with then are registries, logs of outcomes for moms and babies who took a medication or herbal during pregnancy either because they felt it was necessary or before they knew they were pregnant. Unfortunately, very little is known about the safety of St. John's Wort during pregnancy. Scientists actually know more about some of the pharmacological treatments for depression than they do about herbal treatments, because they have been studied more rigorously.

Talk to your doctor or midwife about your depression, and make a decision together. Some moms-to-be find that non-medical treatments like cognitive-behavioral therapy or supportive counseling are enough, while others choose to take medications. Medication choice should be guided by research, which probably means choosing a pharmaceutical rather than an herbal product.

For more information about medications in pregnancy check out www.otispregnancy.org.