Dugoua Jean-Jacques, Perri Daniel, Seely Dugald, Mills Edward, Koren Gideon
Graduate Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University ofToronto, Toronto, Canada.
Can J Clin Pharmacol. 2008 Winter;15(1):e66-73. Epub 2008 Jan 18.
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. Key words: Blue cohosh, caulophyllum thalictroides, pregnancy, lactation, breastfeeding, systematic review.
临床医生和患者对草药在妊娠和哺乳期的使用指征及安全性均缺乏基础知识。本文是一系列系统综述孕期和哺乳期常用草药证据的文章之一。
系统综述关于蓝升麻使用、安全性及药理学的文献，重点关注与妊娠和哺乳期相关的问题。
我们检索了7个电子数据库，并根据所获证据的等级整理数据。
根据美国助产士的一项调查，约64%的助产士报告使用蓝升麻作为引产辅助药物。科学文献中有3例病例报告显示，分娩时服用蓝升麻可能导致：1）围产期中风；2）急性心肌梗死、严重充血性心力衰竭和休克；3）严重多器官缺氧损伤。有1例病例报告显示蓝升麻具有堕胎特性。体外证据表明蓝升麻可能有致畸、胚胎毒性和产氧毒性作用。在哺乳期，蓝升麻的安全性未知。
基于现有科学信息，蓝升麻应：1）在孕期极其谨慎使用；2）仅在医学专业监督下使用；3）不作为非处方产品向公众提供。迫切需要对使用蓝升麻的助产士进行回顾性或前瞻性队列研究，以确定其安全性。关键词：蓝升麻、类叶升麻、妊娠、哺乳、母乳喂养、系统综述。
