Ashwagandha Should Not Be Used During Pregnancy
Ashwagandha (Withania somnifera) should be avoided during pregnancy due to insufficient human safety data and the general principle that herbal medicines pose unknown risks to the developing fetus. 1
Evidence-Based Rationale
Lack of Human Safety Data
- There are no rigorous scientific studies establishing the safety of dietary supplements, including ashwagandha, during pregnancy 1
- The Teratology Society explicitly states that it should not be assumed that herbal supplements are safe for the embryo or fetus 1
- Despite ashwagandha's widespread use in Ayurvedic medicine, safety data specific to pregnancy in humans is essentially non-existent 2
The "Natural" Fallacy
- The public perception that herbal medicines are "gentle and safe" has no scientific basis 1
- Active ingredients in plant extracts are chemicals with the same potential to cause serious adverse effects as purified medications 1
- Many pregnant women use herbal medicines under the false assumption they are safer than conventional medicine, but this belief is not evidence-based 2
Animal Studies Are Insufficient
- While one recent animal study (2025) showed no adverse effects on reproduction and development in Wistar rats at doses up to 2,000 mg/kg/day 3, animal data cannot be extrapolated to guarantee human safety
- Another safety study in healthy adults (not pregnant) showed no adverse effects over 8 weeks 4, but this does not address pregnancy-specific concerns including teratogenicity, effects on labor, or fetal development
Known Risks of Herbal Medicine in Pregnancy
- Herbal medicines can cause embryotoxicity, teratogenic effects, and abortifacient effects 5
- Some phytochemicals cross the placenta and reach the fetus 5
- Plant constituents can stimulate uterine contractions, cause hormonal imbalances, and potentially result in abortion or congenital malformations 5
Clinical Approach
Patient Counseling
- Obstetricians should advise women not to expose their fetuses to the risks of herbal medicines 1
- Healthcare professionals must actively question pregnant women about herbal medicine use, as patients frequently do not report it 2
- Educate patients that "natural" does not equal "safe" during pregnancy 2
Common Pitfalls to Avoid
- Do not assume that traditional use or availability over-the-counter indicates safety 1, 2
- Do not rely on animal studies alone to justify use in pregnant women 3
- Be aware that 7-55% of pregnant women use herbal medicines depending on cultural background, so screening is essential 2
When Patients Are Already Taking Ashwagandha
- Recommend immediate discontinuation upon pregnancy confirmation
- Document the exposure timing and duration
- Monitor pregnancy carefully, though specific monitoring parameters for ashwagandha exposure are not established