Elderberry Safety During Breastfeeding
Elderberries can likely be consumed in moderate food amounts while breastfeeding, but elderberry supplements should be avoided due to insufficient safety data in lactating women and their newborns.
Current Evidence on Herbal Supplements and Lactation
The American Academy of Pediatrics emphasizes that the most comprehensive source of information regarding safety of maternal medications and supplements during breastfeeding is the Drugs and Lactation Database (LactMed) 1. However, there is no high-quality clinical trial evidence specifically evaluating elderberry safety in breastfeeding mothers or effects on nursing infants 2.
Key Safety Considerations
Lack of Lactation-Specific Data
- A systematic review of popular herbal supplements in lactating women found that dietary and herbal supplements, including those commonly used, have not been evaluated in high-quality clinical trials for safety during lactation 2.
- No studies have examined elderberry transfer into breast milk, infant exposure levels, or clinical outcomes in breastfed newborns 2.
- The absence of evidence is particularly concerning for newborns, whose immature systems may respond differently to bioactive compounds 2.
Immune System Effects
- Elderberry contains high concentrations of anthocyanins and polyphenols that demonstrate immunomodulatory effects 3, 4.
- While elderberry may reduce duration and severity of viral respiratory illnesses, studies show it affects inflammatory marker production, though this effect may decline with ongoing supplementation 5.
- There is no evidence that elderberry causes dangerous immune overstimulation or "cytokine storm," but these studies were not conducted in breastfeeding dyads 5.
Chemical Composition Variability
- Wild-collected elderberries show significant phytochemical variation, with flavonol and chlorogenic acid content ranging from 7.0 to 209.7 mg per 100g fresh weight 6.
- Geographic location significantly affects phytochemical content, with southeastern US elderberries containing higher concentrations than northern varieties 6.
- This variability in supplement composition creates unpredictable exposure for nursing infants 6, 4.
Clinical Recommendation Algorithm
For food consumption:
- Elderberries consumed as occasional food (cooked in jams, pies, or syrups) in typical dietary amounts are likely acceptable, as food proteins and compounds transfer to breast milk in varying amounts without established harm for most foods 1.
For supplement use:
- Avoid elderberry supplements (capsules, concentrated extracts, high-dose formulations) during lactation due to lack of safety data 2.
- If a breastfeeding mother insists on using elderberry for perceived immune benefits, counsel her that there is no evidence supporting safety in this population 2.
- Recommend evidence-based alternatives for viral illness prevention, such as hand hygiene and vaccination 5.
Important Caveats
- Most medications and supplements that breastfeeding women take are compatible with breastfeeding, but elderberry specifically lacks the necessary safety evaluation 1.
- Physicians must provide counseling highlighting the lack of reliable safety profiles for elderberry supplements during lactation 2.
- The dramatic increase in elderberry supplement sales (reaching $320 million in 2020) for purported immune benefits has not been accompanied by corresponding safety research in vulnerable populations 4.
- If a newborn develops any unusual symptoms (rash, gastrointestinal changes, lethargy) while the mother is consuming elderberry products, discontinue immediately and evaluate the infant 7.