Introduction

The National Institutes of Health's (NIH) Office of Dietary Supplements (ODS) defines a botanical as "a plant or plant part valued for its medicinal or therapeutic properties, flavor, and/or scent" and an herb as a type of botanical [113]. As such, depending on their purpose, products made from botanicals may be called herbal products, botanical products, or phytomedicines. Although it is commonly believed that products such as botanicals labeled as "natural" are necessarily safe and in fact healthful, this contention is not necessarily true. In fact, the actions and efficacy of botanicals range from nonexistent, to mild, to potent.

The prevalence of botanical preparation use during pregnancy has been documented in several settings. Using a cross-sectional survey design, Forster and colleagues reported that 36% of women living in Australia used at least one herbal supplement during pregnancy [114]. The most common supplements taken were raspberry leaf, ginger, and chamomile. Women were more likely to take herbal supplements if they were older, well educated, English speaking, nonsmokers, and primiparous. Studies conducted in the United States and Norway suggest that 7-36% of pregnant women use these products with echinacea, iron-rich herbs, ginger, and chamomile being the most commonly used [115-117].

It is important to emphasize that there is a relative dearth of high-quality, rigorous research relating the use of most botanicals to health and well-being in any phase of the lifecycle. Thus, it is essential that clinicians keep up to date on current evidence that might support or refute benefits, or perhaps contraindications, of these products. Along with the ODS (http://ods.od.nih.gov/), another good source of reliable information concerning botanical supplements is the National Center for Complementary and Alternative Medicine (http://nccam.nih.gov/). Abstracts of research conducted with botanical supplements can be directly accessed at the website "CAM on PubMed" (http://nccam. nih.gov/camonpubmed/).

In this section, we highlight two botanicals (ginger and echinacea), which are commonly taken by pregnant women. In addition, we will review the available evidence concerning two botanicals (chamomile and blue cohosh) that are contraindicated during pregnancy.

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