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H erbal Products N ot recommended i n Preg nancy or Breastfeeding Many herbal products have not been evaluated for their safety in pregnancy and breastfeeding. Some supplements are known to have adverse effects in pregnancy, such as starting uterine contractions. Products taken by a breastfeeding mother have the potential to be passed to the baby in breast milk. Please check with your healthcare provider before beginning any herbal or botanical supplements. This list may not represent all of the herbal products unsafe for pregnancy or breastfeeding. Agnus Castus Aloe Angelica Apricot Kernal Asafoetida Aristolchia Avens Blue Flag Bogbean Boldo Boneset Borage Broom Buchu Buckhorn Burdock Calamus Calendula Chamomile, (German or Roman) Chaparral Cohosh, (Black or Blue) Cola Colstfoot Comfrey Cottonroot Cornsilk Crotalara Damiana Devil's Claw Dong Quai Dogbane Ephedra Eucalyptus Eupatorium Fenugreek Feverfew Foxglove Franfula Fucus Gentian Germander Finseng Golden Seal Ground Ivy Grounsel Guarana Hawthorne Heliotropium Hops Horehound Horsetail Hydorcotyle Jamaica Dogwood Juniper Liferoot Licorice Lobelia Mandrake Mate Male Fern Meadowsweet Melliot Mistletoe Motherwort Myrrh Nettle Osha Passionflower Pennyroyal Petasites Plantain Pleurisy root Podohyllium Pokeroot Poplar Prickly Ash Pulsatilla Queen's Delight Ragwort Raspberry Red Clover Rhubarb Rue Sassafrass Scullcap Shepard's Purse Skunk Cabbage Stephania Squill St. John's Wort Tansy Tonka Bean Uva-Ursi Vervain Wild Carrot Willow Wormwood Yarrow Yellow Duck Yohimbe Prenatal Vitamins and Omega-3 Supplements Some women are more sensitive to prenatal vitamins and may experience slight nausea or constipation from prenatal vitamins. There are tips at the bottom of page 2 to help with these side effects. You may use any brand of prenatal vitamin of your choosing. Feel free to bring your vitamins with you to any appointment if you have questions or concerns regarding quality. Iron: 30mg/day. Foods high in iron should be included in the prenatal diet. In addition, you may be advised to start taking an oral, low-dose iron supplement. Do not take iron supplements unless directed to do so by your provider. Strict vegetarians need to make special efforts to get adequate iron in their diet. Sources: eggs, lean red meat, liver, beans, fortified cereals, leafy greens. Folate: 400 to 800 mcg/day. Although adequate folate intake is easily achieved with dietary sources, supplementation is recommended to reduce the risk of neural tube defects associated with intakes less than 400 mcg per. Day. For women who have a child with a neural tube defect, supplementation of up to 4g per. day is recommended. Sources: dark leafy green vegetables, citrus fruits, beans and other legumes, wheat bran, pork, poultry and shellfish. Calcium: 1500 mg/day. Most prenatal vitamins contain limited amounts (200-250 mg) of calcium. By including 3-4 servings of calcium-rich foods per. day, requirements can be met. If dietary intake is low, a separate calcium supplement should be taken. Since calcium and iron compete for absorption, they are best taken at separate times. Sources: low-fat dairy, enriched soy products, fortified juices, and leafy greens. * If you begin to experience leg cramps during pregnancy a calcium supplement that contains magnesium would be recommended to ease the frequency/intensity of cramping.* Omega-3 fatty acids: This nutrient is not found in your standard prenatal vitamin. These are fats that are essential to human health; but cannot be manufactured by your body. Current research is inconclusive as to whether or not dietary supplements provide the same health benefit as eating foods high in omega-3 fatty acids. The FDA has not established a minimum daily value nor has it approved health statements associated with omega-3 fatty acid supplementation and pregnancy. Omega-3 fatty acids come primarily from fish oils (EPA and DHA) and plant oils (ALA). Choose high-fat, cold- water fish such as salmon, mackerel, halibut, sardines, and herring over supplements. Plant sources of omega-3 fats include flaxseeds/oil, canola oil, soybeans/oil, pumpkin seeds/oil, walnuts/oil, however, your body is inefficient at converting plant oils (ALA) into the omega-3 powerhouse DHA, so it is theorized that you will get more benefit from the omega-3 fats coming from animal versus plant sources. Also widely available at the grocery store are omega-3 enriched eggs (found with the regular eggs). If you choose to take an Omega-3 supplement, make sure it is mercury free and contains between 200-300mg of DHA, such as Expecta Lipil. Omega- 3 fatty acid supplements should be used cautiously by people who bruise easily, have a bleeding disorder, or who take blood-thinning medications. Please discuss this with your provider before starting an omega-3 supplement. Constipation: Prenatal vitamins contain increased amounts of minerals that may contribute to constipation. Dietary changes such as more water, exercise and fiber may help. In addition, you may benefit from an over-the-counter stool softener such as Docusate Sodium (Colace). Nausea: Many women complain of nausea after taking their prenatal vitamin. Try taking vitamins with a meal or just before with a light snack. *If you have continued nausea/vomiting with no relief from light snacks, taking prenatal at recommended times, and or other recommended techniques, please discuss this issue with your provider. Medications may need to be prescribed to ease nausea and or vomiting.*