Botanicals for Pregnancy, Lactation, and Post Partum Flashcards
Q1: Which of the following is NOT a physiological change in pregnancy that affects how botanical medicines are metabolized?
a) Reduced gastrointestinal motility
b) Hemodilution (leading to an increase in blood volume)
c) Increased albumin concentrations
d) Increased GFR and renal blood flow
Correct: C. Albumin concentrations generally decrease in pregnancy due to hemodilution, which increases blood plasma volume.
Incorrect:
a) Reduced gastrointestinal motility is correct as pregnancy hormones slow motility.
b) Hemodilution is a key physiological change affecting drug metabolism.
d) Increased GFR and renal blood flow alter renal clearance.
Q2: Which factor increases the likelihood of a botanical medicine or its constituents passing into breast milk?
a) Reduced blood flow
b) Lipid solubility
c) Increased GFR and renal blood flow
d) Herbal extraction
Answer: b) Lipid solubility
Correct: Lipid-soluble compounds are more likely to pass into breast milk due to their affinity for fat content.
Incorrect:
a) Reduced blood flow decreases the transfer of substances.
c) Increased GFR affects renal excretion, not breast milk transfer.
d) Herbal extraction refers to preparation, not pharmacokinetics.
Q3: Considering botanical medicines in pregnancy, which of the following is LEAST safe for use?
a) Arctium lappa (Burdock)
b) Caulophyllum thalictroides (Blue cohosh)
c) Panax ginseng
d) Allium sativum (Garlic)
Answer: b) Caulophyllum thalictroides (Blue cohosh)
Correct: Blue cohosh has abortifacient and teratogenic potential.
Incorrect:
a) Arctium lappa (Burdock) is considered safer (Category B1).
c) Panax ginseng has potential hormone-modulating effects but is less concerning than Blue cohosh.
d) Allium sativum (Garlic) is Pregnancy Category A and widely regarded as safe.
Q4: When does nausea of pregnancy most commonly peak and resolve?
a) Peaks in week 6; resolves by week 12
b) Peaks in week 9; resolves by week 20
c) Peaks in week 12; resolves by week 30
d) Peaks in week 20; resolves by week 35
Answer: b) Peaks in week 9; resolves by week 20
Correct: Studies indicate that nausea of pregnancy typically peaks around week 9 and resolves by week 20 in most cases.
Incorrect:
a) Symptoms peak later than week 6.
c) Week 12 and beyond is too late for the peak.
d) Week 20 to 35 does not align with typical symptom resolution.
Why Does Nausea Peak in Week 9 and Resolve by Week 20?
Nausea of pregnancy (also known as nausea and vomiting of pregnancy, or NVP) is thought to result from hormonal and physiological changes. Here’s why it typically follows this trajectory:
Hormonal Changes:
Human Chorionic Gonadotropin (hCG): Levels of hCG rise rapidly in early pregnancy, peaking around weeks 9–11. hCG is believed to play a role in the onset of nausea, as its peak corresponds closely to the peak of NVP symptoms.
Estrogen and Progesterone: These hormones increase during pregnancy, slowing gastrointestinal motility and potentially contributing to nausea.
Thyroid Hormone Interaction: Elevated hCG can mimic TSH (thyroid-stimulating hormone), influencing thyroid function, which may also contribute to symptoms.
Evolutionary Perspective:
Some researchers suggest that NVP may protect the fetus by discouraging the mother from consuming foods that could contain harmful pathogens or toxins during critical periods of organogenesis (weeks 5–12).
Symptom Resolution:
By around week 20, hCG levels stabilize and gastrointestinal adaptation occurs, leading to the resolution of symptoms for most women. The placenta takes over hormone production, reducing the physiological stress on the mother’s body.
Which of the following is NOT an expected action of botanical medicines used as partus preparators?
a) Improves uterine tone
b) Improves effectiveness of contractions
c) Improves/accelerates postpartum recovery
d) Improves postpartum production of breast milk
Answer: d) Improves postpartum production of breast milk
Correct: Partus preparators primarily target uterine tone and labor, not lactation.
Incorrect:
a), b), and c) are all valid actions of botanical medicines used to prepare for labor and recovery.
What are the Pregnancy Categories
* Pregnancy category A: “No proven increase in the frequency of malformation or other harmful effects on the fetus despite consumption by a large number of women.”
* Pregnancy category B1: “No increase in frequency of malformation or other harmful effects on the fetus from limited use in women. No
evidence of increased fetal damage in animal studies.”
* Pregnancy category B2: “No increase in frequency of malformation or other harmful effects on the fetus from limited use in women. Animal studies are lacking.”
* Pregnancy category B3: “No increase in frequency of malformation or other harmful effects on the fetus from limited use in women. Evidence of increased fetal damage in animal studies exists, although the relevance to humans is unknown.”
- Pregnancy category C: “Has caused or is associated with a substantial risk of causing harmful effects on the fetus or neonate without causing malformations.”
- Pregnancy category D: “Has caused or is associated with a substantial risk of causing fetal malformation or irreversible damage.”
- Pregnancy category X: “High risk of damage to the fetus.”
What are the Lactation Categories
* Lactation category C: Compatible with breastfeeding.
* Lactation category CC: Compatible with breastfeeding but use caution.
* Lactation category ND: No data available.
* Lactation category SD: Strongly discouraged in breastfeeding.
* Lactation category X: Contraindicated in breastfeeding
Remember each ends with X and they progress in alphabetical order eaning Pregnancy starts with A to D then X, starting with can you use in pregnancy:
A- absolutely
B- Barely
C-Caution d/t substantial risk of causing harmful effects on fetus or neonate without causing malformations
D- Don’t use; substantial risk of causing fetal malformation or irreversible damage
X - eXplicably don’t use High risk of damage to the fetus
Lactation:
C- Can use
CC - can use but with caution
ND - No data
SD - strongly discouraged
X - eXplicably don’t use
I hope this helps
Which botanical is categorized as safe to use only in the third trimester of pregnancy?
A. Cimicifuga racemosa
B. Mitchella repens (patridgeberry)
C. Rubus ideaus (red raspberry leaf)
D. Ricinus communis (Castor oil )
B. Mitchella repens
Correct: Mitchella repens (partridgeberry) is safe for use only in the third trimester due to its uterine-toning properties, which might stimulate contractions if used earlier.
A. Cimicifuga racemosa
Incorrect: While Cimicifuga racemosa is a uterine tonic, its use is generally restricted to the late third trimester and for labor induction, not throughout the third trimester.
C. Rubus ideaus
Incorrect: Rubus ideaus (red raspberry leaf) is safe in the second and third trimesters, making it more versatile than Mitchella repens.
D. Ricinus communis
Incorrect: Castor oil (Ricinus communis) is used solely for inducing labor, typically after 40 weeks of gestation.
What is the primary caution associated with Cimicifuga racemosa in pregnancy?
A. Constipation
B. Estrogen-dependent tumors
C. Iron deficiency anemia
D. Diarrhea
B. Estrogen-dependent tumors
Correct: Cimicifuga racemosa has estrogen-modulating effects, which could potentially worsen estrogen-dependent conditions, such as certain types of breast cancer.
A. Constipation
Incorrect: Constipation is not a recognized caution for Cimicifuga racemosa.
C. Iron deficiency anemia
Incorrect: This herb is not associated with worsening or improving anemia.
D. Diarrhea
Incorrect: While mild gastrointestinal upset can occur, diarrhea is not a primary caution.
More information:
Agonistic Effect: In some tissues, it may mimic estrogen by binding to estrogen receptors and activating them, potentially increasing estrogen-like activity.
Antagonistic Effect: In other contexts, it may block estrogen receptors, reducing the effects of natural estrogen.
This modulation can impact conditions like estrogen-dependent tumors, such as certain types of breast cancer. Tumors classified as “estrogen-dependent” grow in response to estrogen stimulation. If a substance like Cimicifuga racemosa enhances estrogen activity, it could theoretically fuel the growth of these tumors, worsening the condition.
While some research suggests Cimicifuga racemosa has a selective or mild estrogenic effect, its precise impact varies depending on the tissue type and individual factors. This is why its use in estrogen-sensitive conditions remains controversial and should be carefully considered with clinical guidance.
Which part of Rubus ideaus is used as a uterine tonic during pregnancy?
A. Root
B. Leaf
C. Flower
D. Berry
B. Leaf
Correct: The leaf of Rubus ideaus contains fragarine, which tones the uterus and supports efficient contractions.
A. Root
Incorrect: The root is not used for this purpose.
C. Flower
Incorrect: The flower has no known uterine-toning effects.
D. Berry
Incorrect: The berry is nutrient-rich but lacks uterine-toning properties.
Which botanical is contraindicated except for induction of labor?
A. Chamaelirium luteum
B. Ricinus communis (Castor Oil)
C. Oenothera biennis
D. Urtica dioic (Stinging Nettle)
B. Ricinus communis
Correct: Castor oil (Ricinus communis) is used strictly for inducing labor due to its strong laxative effect, which can stimulate uterine contractions.
A. Chamaelirium luteum
Incorrect: This herb is primarily a hormone modulator and uterine tonic, not used for labor induction.
C. Oenothera biennis
Incorrect: Evening primrose oil (Oenothera biennis) is often used in the weeks leading up to labor to ripen the cervix, not solely for labor induction.
D. Urtica dioica
Incorrect: Stinging nettle (Urtica dioica) is a nutritive herb and not used specifically for labor induction.
Which intervention has been shown to significantly reduce cesarean delivery rates during labor?
A. Nipple stimulation
B. Sexual intercourse at term
C. Acupuncture starting at 36 weeks
D. Ricinus communis (Castor Oil)
A. Nipple stimulation
Correct: Nipple stimulation releases oxytocin, which promotes stronger and more regular contractions, potentially reducing cesarean rates.
B. Sexual intercourse at term
Incorrect: While intercourse can release oxytocin and prostaglandins, its direct impact on cesarean rates is less conclusive.
C. Acupuncture starting at 36 weeks
Incorrect: Acupuncture may prepare the body for labor but has not been definitively shown to reduce cesarean rates.
D. Ricinus communis
Incorrect: Castor oil is primarily used for labor induction, not for reducing cesarean rates.
Which botanical may cause mild gastrointestinal upset as a side effect?
A. Caulophyllum thalictroides (Blue cohosh)
B. Cimicifuga racemosa (Black cohosh)
C. Mitchella repens (Patridge Berry)
D. Rubus ideaus (Red Raspberry)
B. Cimicifuga racemosa (Black cohosh)
Cimicifuga racemosa, or black cohosh, is known to potentially cause mild gastrointestinal upset as a side effect in some individuals. This can include symptoms like nausea, bloating, or an upset stomach, particularly when taken in higher doses or on an empty stomach. These effects are generally mild and temporary.
Explanation for the other options:
A. Caulophyllum thalictroides (Blue cohosh): While it has other side effects (e.g., nausea or vomiting in higher doses), gastrointestinal upset is less commonly associated compared to black cohosh.
C. Mitchella repens (Partridge Berry): Typically considered mild and safe, with no significant reports of gastrointestinal upset.
D. Rubus idaeus (Red Raspberry): Generally well-tolerated and often used for digestive health; mild side effects like nausea are rare but possible.
What is the dosing recommendation for Cimicifuga racemosa tincture for preparation of labor starting at 40 weeks?
A. 1-2 mL once daily
B. 4-8 mL once daily
C. 1-2 g thrice daily
D. 4-8 g thrice daily
A. 1-2 mL once daily
Correct: This is the standard dosing recommendation in late pregnancy.
B. 4-8 mL once daily
Incorrect: This is a higher dose than recommended for labor preparation.
C. 1-2 g thrice daily
Incorrect: Dosage in grams refers to dried herb, not tincture.
D. 4-8 g thrice daily
Incorrect: This is too high for late pregnancy use.
According to research, what percentage of midwives reported using blue cohosh as a labor-inducing aid? Notes from 2025 3rd year 2nd semester
A. 42%
B. 54%
C. 64%
D. 74%
C. 64%
Correct: A study found 64% of midwives use Caulophyllum thalictroides (blue cohosh) for labor induction.
A. 42%
Incorrect: This is too low based on surveys.
B. 54%
Incorrect: This percentage underestimates its usage.
D. 74%
Incorrect: This overestimates its usage.
What is a key finding from the study on castor oil’s effect on labor?
A. It is effective only in pregnancies under 40 weeks.
B. It reduces cesarean delivery rates to zero.
C. 57.7% of women receiving castor oil began labor within 24 hours.
D. It is recommended as an over-the-counter remedy for inducing labor.
C. 57.7% of women receiving castor oil began labor within 24 hours.
Correct: This was a finding in studies on castor oil’s effectiveness.
A. It is effective only in pregnancies under 40 weeks.
Incorrect: Castor oil is generally reserved for post-term pregnancies.
B. It reduces cesarean delivery rates to zero.
Incorrect: No intervention eliminates cesarean deliveries entirely.
D. It is recommended as an over-the-counter remedy for inducing labor.
Incorrect: Castor oil should only be used under professional guidance due to potential risks.
Which of the following herbs is commonly used to support perineal healing postpartum?
a) Achillea millefolium (Yarrow)
b) Ricinus communis (Castor bean)
c) Matricaria recutita (Chamomile)
d) Foeniculum vulgare (Fennel)
Correct Answer: a) Achillea millefolium (Yarrow)
Explanations:
a) Achillea millefolium (Yarrow): Correct. Yarrow is known for its vulnerary (wound-healing) and hemostatic (stops bleeding) properties, making it effective for perineal healing.
b) Ricinus communis (Castor bean): Incorrect. Castor bean is not typically used for wound healing but is better known for its laxative effects and topical uses like reducing pain and inflammation.
c) Matricaria recutita (Chamomile): Incorrect. While chamomile is soothing and anti-inflammatory, it is more commonly used for calming the digestive system and nervous system than for perineal healing.
d) Foeniculum vulgare (Fennel): Incorrect. Fennel is primarily a galactagogue (enhances milk production) and is not indicated for wound healing.
Which herb is a demulcent and may be used topically for cracked nipples during breastfeeding?
a) Althea officinalis (Marshmallow)
b) Symphytum officinale (Comfrey)
c) Calendula officinalis (Calendula)
d) Lavendula officinalis (Lavender)
Correct Answer: a) Althea officinalis (Marshmallow)
Explanations:
a) Althea officinalis (Marshmallow): Correct. Marshmallow is a demulcent, meaning it soothes and protects irritated tissues. It is recommended for topical use on cracked nipples and inflamed mucous membranes.
b) Symphytum officinale (Comfrey): Incorrect. Comfrey is also a vulnerary, but it is not typically used for cracked nipples due to safety concerns regarding its pyrrolizidine alkaloids.
c) Calendula officinalis (Calendula): Incorrect. Calendula is a vulnerary and anti-inflammatory but is more suited for general wound healing than specific nipple care.
d) Lavendula officinalis (Lavender): Incorrect. Lavender has soothing and antimicrobial properties but is not a primary choice for cracked nipples.
What is the primary action of Arctostaphylos uva-ursi in the urinary tract?
A. Immune system stimulation
B. Urinary antiseptic and astringent
C. Anti-parasitic
D. Hepatic detoxification
Correct Answer: B. Urinary antiseptic and astringent
Explanation:
A. Immune system stimulation: Incorrect. Uva-ursi is not primarily known to stimulate the immune system but acts on the urinary tract.
B. Urinary antiseptic and astringent: Correct. Uva-ursi has antiseptic and astringent properties, making it effective against lower urinary tract infections like cystitis and urethritis.
C. Anti-parasitic: Incorrect. This herb does not target parasites.
D. Hepatic detoxification: Incorrect. While it involves metabolic processes in the liver, its primary action is on the urinary tract, not detoxification.
Which botanical is NOT commonly used for perineal healing postpartum?
a) Achillea millefolium (Yarrow)
b) Hamamelis virginiana (Witch hazel)
c) Aloe spp. (Aloe)
d) Capsella bursa-pastoris (Shepherd’s purse)
Correct Answer: c) Aloe spp. (Aloe)
c) Aloe spp. (Aloe): Incorrect. Aloe is not typically used for perineal healing in postpartum contexts due to its laxative potential and limited topical use in this scenario.
a) Achillea millefolium (Yarrow): Correct. Yarrow is used for its anti-inflammatory and astringent properties, aiding in wound healing.
b) Hamamelis virginiana (Witch hazel): Correct. Witch hazel is astringent and soothing, making it a common choice for perineal healing.
d) Capsella bursa-pastoris (Shepherd’s purse): Correct. Shepherd’s purse is used for its hemostatic properties to reduce bleeding and promote healing.
