Blue and Black Cohosh

Another herbal preparation that has been shown clinically to be associated with detrimental effects in pregnant women is blue cohosh, which has long been recommended by midwives to induce labor [134]. Use of blue cohosh, however, may be associated with neonatal congestive heart failure and ischemic infarct. Jones and Lawson in 1998 reported a case study describing a woman who had taken blue cohosh to promote uterine contractions [135]. This 36-year-old woman was otherwise healthy aside from being euthyroid, and was advised to take 1 tablet of blue cohosh beginning 1 month before delivery by her midwife; however, she elected to take 3 tablets per day. No other naturopathic remedies were used. After a precipitous labor (1 h), a normal weight (3.66 kg) baby was delivered. However, within 20 min, the infant required intubation and mechanical ventilatory support and was later diagnosed as having acute anterolateral myocardial infarction. Of course, it is impossible to draw a true cause-and-effect conclusion from such a case study.

Another more recent report described a normal weight, term infant born to a healthy 20-year-old woman whose obstetrician advised her to drink a tea made from blue cohosh to facilitate labor [136]. At approximately 26 h of age, the newborn infant began to have seizures and was found to have an evolving infarct in the distribution of the left middle cerebral artery. Urine and meconium were positive for the cocaine metabolite benzoylecgonine, and testing of the contents of the blue cohosh ingested by the mother produced similar results. The authors concluded that either benzoylecgonine is a metabolite of both cocaine and blue cohosh, or the blue cohosh itself was contaminated with cocaine. Regardless, use of this herb during pregnancy is contraindicated. Researchers also caution against the use of black cohosh, which is similarly used to induce labor, although clinical evidence of detrimental effects is lacking [137].

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