title: Safety and efficacy of black cohosh (Cimicifuga racemosa) during pregnancy and lactation.
abstract: BACKGROUND
  There is a lack of basic knowledge on the part of both clinicians and patients as to the indications for use and safety of herbal medicines in pregnancy and lactation. This is one article in a series that systematically reviews the evidence for commonly used herbs during pregnancy and lactation.
  
  
  OBJECTIVE
  To systematically review the literature for evidence on the use, safety, and pharmacology of black cohosh focusing on issues pertaining to pregnancy and lactation.
  
  
  METHODS
  We searched 7 electronic databases and compiled data according to the grade of evidence found.
  
  
  RESULTS
  Black cohosh, alone or in combination with other medicinal herbs as "mother's cordial", has a long traditional use and is frequently used by midwives as a uterine stimulant and labour-inducing aid. Low-level evidence based on theory and expert opinion shows the following concerns with respect to black cohosh use during pregnancy: 1) labour-inducing effects, 2) hormonal effects, 3) emmenagogue properties and, 4) anovulatory effects. During lactation, there is low-level evidence from theoretical and expert opinion of black cohosh having hormonal properties.
  
  
  CONCLUSIONS
  Black cohosh should be used with caution during pregnancy, particularly during the first trimester where its purported labour-inducing effects could be of concern, and during lactation. Black cohosh should undergo rigorous high quality human studies to determine its safety in pregnancy and lactation.
authors.affiliation: Department of Clinical Epidemiology, Canadian College of Naturopathic Medicine, Toronto, Canada. jeanjacques.dugoua@utoronto.ca
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Dugoua
authors.forename: Dugald
authors.initials: D
authors.lastname: Seely
authors.forename: Daniel
authors.initials: D
authors.lastname: Perri
authors.forename: Gideon
authors.initials: G
authors.lastname: Koren
authors.forename: Edward
authors.initials: E
authors.lastname: Mills
mesh_terms: D031885:Cimicifuga; D005260:Female; D041743:Herb-Drug Interactions; D006801:Humans; D007774:Lactation; D028321:Plant Preparations / Q000009:adverse effects / Q000737:chemistry / Q000494:pharmacology / Q000627:therapeutic use; D011247:Pregnancy; D011960:Receptors, Estrogen / Q000187:drug effects; D027343:Rhizome; D018570:Risk Assessment; D014590:Uterine Contraction / Q000187:drug effects; D014599:Uterus / Q000187:drug effects*
chemical_list: D028321:Plant Preparations; D011960:Receptors, Estrogen