Is Astragalus (a herbal supplement) safe for breastfeeding mothers?

Astragalus Safety in Breastfeeding

Astragalus should be avoided during breastfeeding due to insufficient safety data, and breastfeeding women should be counseled to defer its use until after lactation is complete.

Evidence-Based Rationale

Lack of Safety Data for Astragalus

• No clinical trials have evaluated astragalus safety in lactating women or their infants, and herbal supplements generally lack high-quality evidence supporting their safety during breastfeeding 1.
• The most comprehensive medication safety resource for breastfeeding, LactMed (Drugs and Lactation Database), should be consulted for any emerging data, though herbal supplements are notably under-researched 2, 3.
• Herbal medicines have not been systematically studied for safety during lactation, with limited evidence available to guide clinical recommendations 1, 4.

General Principles for Herbal Use During Lactation

• Most medications compatible with breastfeeding have established safety profiles, but herbal supplements fall outside this category due to lack of rigorous testing 2, 5.
• When breastfeeding women consider any herbal supplement, clinicians should assess: (1) why it is being used, (2) what benefits are sought, and (3) whether use can be deferred until after breastfeeding 6.
• If the herbal medication is not critical to maternal health, deferral during breastfeeding is the safest approach to avoid potential complications to the infant 6.

Clinical Decision Algorithm

Step 1: Assess Medical Necessity

• Determine if astragalus is being used for a specific medical condition that requires treatment 6.
• Identify if there are conventional medications with known safety profiles that could be used instead 6.

Step 2: Consider Timing

• If astragalus use is not medically essential, recommend postponing until after breastfeeding is complete 6.
• This eliminates any potential risk to the infant from unknown transfer into breast milk 1.

Step 3: Monitor if Use Continues

• If a mother chooses to use astragalus despite counseling, monitor the infant for unusual sedation, irritability, feeding changes, or any adverse symptoms 7.
• Advise the mother to report any concerning infant symptoms immediately 7.

Important Counseling Points

Prevalence and Perception Issues

• 59.9% of breastfeeding women use at least one herbal medicine, indicating widespread use despite limited safety data 4.
• 43.4% of women perceive herbal medicines as safer than conventional medicines, a misconception that requires correction 4.
• Only 28.6% of herbal medicine users inform their physicians, highlighting the need for direct questioning about supplement use 4.

Information Gap

• 70.1% of breastfeeding women report lack of information resources about herbal medicine safety during lactation 4.
• Clinicians must proactively ask about herbal and non-traditional medication use, as patients may not volunteer this information 6.

Common Pitfalls to Avoid

• Do not assume herbal products are safe simply because they are "natural" - this is a dangerous misconception that many patients hold 4.
• Do not fail to ask specifically about herbal supplement use - most women will not mention it unless directly questioned 6.
• Do not recommend astragalus as a galactagogue or for immune support without evidence of safety in this population 1, 8.

Alternative Approaches

For Immune Support

• Focus on evidence-based nutrition during lactation, including adequate protein (19 g/day additional in first 6 months), vitamins, and minerals 2.
• Ensure proper hydration (approximately 700 mL/day above baseline) 2.

For General Maternal Health

• Recommend conventional medications with established safety profiles when treatment is needed 2, 6.
• Emphasize that the benefits of continued breastfeeding are substantial for both mother and infant, including protection against infectious diseases and reduced cancer risk 2, 5.