Aviva Romm

Date of Award

9-1-2009

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Errol Norwitz

Second Advisor

Mark Cullen

Abstract

Abstract: Blue Cohosh: Science, Safety, And Patterns of Midwife Prescribing Of A Potentially Fetotoxic Herb Aviva Jill Romm (Sponsored by Errol Norwitz) Department of Obstetrics and Gynecology, Yale University School of Medicine Background: Blue cohosh (Caulopyhyllum thalictroides) has been used traditionally and historically as an obstetric aid for labor induction, to assure a prompt delivery, to relieve childbirth pain, and to induce abortion. Officially listed in the United States Pharmacopoeia from 1882-1905 and in the National Formulary from 1916-1950 for labor induction, its use remains popular. Maternal ingestion has been implicated in acute nicotinic toxicity, neonatal heart failure, perinatal stroke, and multiorgan ischemia. Hypothesis and Aims of the Study: This study evaluates blue cohosh use patterns amongst midwives and asseses the relationship between maternal ingestion in pregnancy and adverse neonatal outcomes. Methods: (1) A systematic review of the literature was conducted in major computerized databases (MEDLINE, CAB Abstracts, CINAHL, BIOSIS, and Cochrane Library) using the subject headings pregnancy AND blue cohosh; pregnancy and Caulophyllum thalictroides; blue cohosh; and Caulophyllum thalictroides; and (2) a formal structured survey was devised and implemented to evaluate midwife use of this herb. Results: 1) A systematic review of the literature identified 10 published pharmacology papers from 1954-2008, 2 abstracts, a college senior paper; 1 teratogenicity study, 4 independent case reports, 2 general papers, 1 review of blue cohosh associated risks, and 6 published letters. 2) Survey: Blue cohosh was the most popular labor induction agent amongst the 90 midwife-respondents to the survey. The rate of adverse effects was 22%. Conclusions: While the pharmacology of blue cohosh supports the adverse outcomes with which use of this herb has been associated, the case reports do not demonstrate causality. While midwives report an increased incidence of adverse effects with use of this herb, confounding factors may be responsible. Nonetheless, the pharmacology of the herb and the ease with which it is available over the counter is cause for concern. Prospective and retrospective studies of use in pregnancy must be conducted to adequately determine safety. First trimester use and use as a partus preparator must be avoided; use for labor induction and augmentation should only occur with the guidance of a trained obstetric care provider, if at all.

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