Blue Cohosh - Possible dangers

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Blue Cohosh Linked to Newborn's Stroke

By Serena Gordon

HealthDay Reporter

WEDNESDAY, July 14 (HealthDayNews) -- Just as expectant mothers need

to be careful about what medications they take, they should also

exercise caution when taking herbal supplements.

That's the conclusion of a case study, which appears in a letter in

the July 15 issue of the New England Journal of Medicine (news - web

sites). The letter details the story of a baby who had a stroke,

possibly because its mother drank blue cohosh tea to induce labor.

" Blue cohosh has been known to stimulate uterine contractions, and

was a folk remedy used to initiate labor if a mother was past her due

date, " said Dr. Finkel, one of the doctors who reported the

case and an associate clinical professor in pediatrics and neurology

at Children's Hospital of Philadelphia. When this happened, Finkel

was a consulting pediatric neurologist at Littleton Adventists

Hospital in Littleton, Colorado.

Blue cohosh is from the plant Caulophyllum thallictroides, according

to Mark Blumenthal, executive director of the American Botanical

Council.

" Blue cohosh is not a widely sold herbal dietary supplement in the

U.S., " he said. " Blue cohosh contains teratogenic compounds and the

herb has been viewed as relatively toxic, thereby reducing its use in

the general market over the past five-plus years. "

It should not be confused with the more commonly used herb known as

black cohosh, which is used to help control the symptoms of menopause.

According to the research letter, the woman was a healthy 24-year-old

in her 40th week of pregnancy. Her obstetrician recommended that she

drink a tea made with blue cohosh to hopefully stimulate contractions

that would begin her labor. She did so, and did go into labor, Finkel

said.

He said the baby initially looked healthy, but then started having

seizures. Since a common cause of seizures in infants is stroke, a CT

scan was ordered, which confirmed that the infant had, in fact, had a

stroke.

When an infant has a stroke, Finkel said there are routine tests

doctors run to try to figure out the cause of the stroke, and one of

them is a toxicology screen. The results of the toxicology screen on

this baby showed a metabolite of cocaine. The test, said Finkel,

can't test for cocaine, but instead checks for the compounds that

cocaine breaks down into as the body metabolizes it.

When he asked the mother how she thought the baby may have been

exposed to cocaine, he said she adamantly denied any drug use and

said the only substance she had taken was the blue cohosh tea.

They then tested her bottle of blue cohosh, and it tested positive

for cocaine metabolites. Then, Finkel said, the neonatalogist

involved in the case purchased a different brand of blue cohosh, and

again they found cocaine metabolites in the product.

Finkel said he contacted the U.S. Food and Drug Administration (news -

web sites), but because it was an herbal dietary supplement, not a

medication, the federal agency " didn't have the authority to follow

up. " He said if it had been a medication, procedures are in place to

report and follow-up on adverse events.

In a search of the medical literature, Finkel said he found another

case where blue cohosh was implicated in a bad outcome for an infant.

In this case, the infant had a heart attack.

The doctors weren't able to find out if blue cohosh does break down

into cocaine metabolites, or if the product had been contaminated

somehow with cocaine.

" It remains important to determine if blue cohosh produces a positive

assay for cocaine use. Finding cocaine metabolites in the baby and in

two different blue cohosh products tends to rule out product

adulteration and strongly suggests that the assay results were

falsely positive, as they are inconsistent with the known chemistry

of blue cohosh, " said Dentali, vice president of scientific

and technical affairs for the American Herbal Products Association.

However, Dentali also noted that while most herbal dietary

supplements are safe, " there are known concerns regarding [blue

cohosh's] use in pregnancy. Not all herbs will be devoid of side

effects. Pregnant women should be taking safe, non-toxic herbal

supplements. "

While they weren't able to positively link blue cohosh to the baby's

stroke, Finkel said he suspects it played a role.

" Blue cohosh shouldn't be taken in pregnancy, " he stressed. " If it's

being recommended to initiate labor, women should know that it may

not be entirely safe. "

More information

To learn more about herbs and pregnancy, go to the American Pregnancy

Association.