Is ashwagandha (Withania somnifera) safe to use during pregnancy?

Ashwagandha Should Be Avoided During Pregnancy

Ashwagandha (Withania somnifera) should not be used during pregnancy due to its traditional reputation as an abortifacient and the absence of adequate human safety data in pregnant women, despite reassuring animal studies.

Evidence Against Use in Pregnancy

Traditional Medicine Concerns

• Ashwagandha is specifically listed among medicinal plants that should be avoided during pregnancy due to potential abortifacient and/or teratogenic activity in a comprehensive review of herbal safety 1
• The folkloric reputation for inducing abortion or sterility, while not substantiated in preclinical experiments, raises sufficient concern to warrant avoidance during pregnancy 2
• Phytochemicals in medicinal plants can cross the placenta, induce uterine contractions, cause hormonal imbalances, and potentially result in abortion or congenital malformations 1

Lack of Human Pregnancy Data

• No controlled studies have evaluated ashwagandha's safety specifically in pregnant women 3
• The available safety studies were conducted only in healthy non-pregnant adults for 8 weeks, which cannot be extrapolated to pregnancy 3
• Unlike medications with established pregnancy categories and human data, ashwagandha lacks the rigorous safety evaluation required for use during pregnancy 1

Animal Studies Show No Harm But Are Insufficient

Preclinical Safety Profile

• Animal studies using the OECD Guideline 421 protocol found no adverse effects on reproduction, development, body weight, reproductive organ weight, or thyroid hormone levels in Wistar rats at doses up to 2,000 mg/kg/day 4
• The No Observed Adverse Effect Level (NOAEL) was 2,000 mg/kg in adult rats with no evidence of toxicity at various developmental stages 4
• Ashwagandha has not demonstrated genotoxicity or mutagenicity in standard tests and was actually protective against chromosome abnormalities 2

Why Animal Data Is Not Enough

• Animal reproductive studies, even when reassuring, cannot guarantee human safety—this is why medications require human pregnancy data before being considered safe 1
• The wide range of modes of action of phytochemicals means some medicinal plants may be safe during certain trimesters but harmful at others, requiring trimester-specific human data 1
• Many herbal products that appear safe in animals have later been associated with adverse pregnancy outcomes in humans 1

Clinical Practice Implications

Risk-Benefit Analysis

• The potential risks of using an unstudied herbal product during pregnancy outweigh any theoretical benefits, especially when safer alternatives exist for most conditions 1
• More than 75% of women who use herbal remedies during pregnancy do not inform their healthcare providers, creating a dangerous knowledge gap 5
• Healthcare providers should specifically ask pregnant women about herbal remedy use and counsel against ashwagandha 5

Common Pitfalls to Avoid

• Do not assume "natural" means safe—the notion that herbal products are free of toxic effects because they are natural is a dangerous misconception 1
• Do not rely solely on animal safety data—preclinical studies cannot predict all human pregnancy outcomes 1, 4
• Do not fail to document herbal use—actively inquire about and document all herbal supplement use in pregnant patients 5
• Do not dismiss traditional medicine warnings—folkloric reputations for abortifacient effects should be taken seriously in the absence of contradictory human data 2

Alternative Approach

• For conditions where ashwagandha might be considered (stress, anxiety, sleep), recommend evidence-based alternatives with established pregnancy safety profiles 1
• If a patient is already taking ashwagandha when pregnancy is discovered, discontinue immediately and monitor for any adverse effects 1
• Counsel patients planning pregnancy to discontinue ashwagandha before conception 1