Butterbur Supplements Should Be Avoided During Pregnancy
Butterbur supplements should not be taken during pregnancy due to lack of safety data, potential hepatotoxicity, and the general principle that herbal products without rigorous safety testing pose unacceptable risks to the developing fetus.
Evidence Against Herbal Supplement Use in Pregnancy
The fundamental issue with butterbur and other herbal supplements during pregnancy is the absence of rigorous scientific studies demonstrating safety for the embryo or fetus 1. The Teratology Society has explicitly stated that it should not be assumed herbal supplements are safe during pregnancy 1.
Key Safety Concerns
Herbal medicines contain active chemical ingredients similar to purified medications and have the same potential to cause serious adverse effects, despite public perception that they are "gentle and safe" 1
Butterbur products specifically have demonstrated hepatotoxic effects in animal studies at doses equivalent to human suggested daily intake, including marked enhancement of liver enzyme CYP2B expression (>10-fold) and liver enlargement 2
Plant-based remedies can cause embryotoxicity, teratogenic effects, and abortifacient effects, with some phytochemicals capable of crossing the placenta to reach the fetus 3
Regulatory and Quality Control Issues
Herbal remedies are not evaluated according to the same standards as pharmaceuticals and lack the regulatory oversight required for medications used in pregnancy 4
Current EU and US legislation on dietary supplements only requires safety for the direct consumer (the mother), not considering long-term health effects for the fetus due to fetal programming and epigenetic alterations 5
There is poor quality control and significant variation in chemical composition between different butterbur products, leading to unpredictable safety profiles 2
Clinical Recommendation Algorithm
When a pregnant patient asks about butterbur supplements:
Advise against use - Explain that there are no adequate safety studies in pregnancy 1, 4
Identify the underlying condition - Determine why the patient is considering butterbur (typically migraine prevention or allergic rhinitis)
Offer evidence-based alternatives - Provide pregnancy-compatible treatments for the specific condition with established safety profiles
Educate about risks - Explain that "natural" does not equal "safe," and that herbal products contain pharmacologically active chemicals with potential for harm 1
Common Pitfalls to Avoid
Do not assume traditional use equals safety - If traditional use is the only available information, patients must be made aware of this limitation to make informed decisions 4
Do not underestimate patient use - Many pregnant women consume herbal supplements without informing their healthcare providers, requiring proactive questioning 4
Do not ignore potential drug interactions - Herbal products can interact with prescribed medications, particularly concerning during pregnancy 4