Is Dong Quai safe while breastfeeding?

Summary of use during breastfeeding

Dong quai (Angelica sinensis) root contains a number of chemicals, including ligustilide, ferulic acid, angelicide. Dong quai has no generally recognized lactation-related uses, although some midwives in the United States reportedly have used it for postpartum blues or depression.[1] It is often used as part of a postpartum herbal mixture in Asia and is used as a "women's herb" in Chinese medicine for symptoms associated with menstruation and menopause.[2,3] It is also used in some postpartum mixtures as galactogogues.[4,5] Although it is usually well tolerated in general use, it may increase the risk of bleeding in patients taking warfarin and antiplatelet drugs and cause photosensitivity reactions. Dong quai is best avoided during breast feeding.[6]

Dietary supplements do not require extensive pre-marketing approval from the U.S. Food and Drug Administration. Manufacturers are responsible to ensure the safety, but do not need to prove the safety and effectiveness of dietary supplements before they are marketed. Dietary supplements may contain multiple ingredients, and differences are often found between labeled and actual ingredients or their amounts. A manufacturer may contract with an independent organization to verify the quality of a product or its ingredients, but that does not certify the safety or effectiveness of a product. Because of the above issues, clinical testing results on one product may not be applicable to other products. More detailed information about dietary supplements is available elsewhere on the LactMed Web site.

Effects on the breastfed infant

Relevant published information was not found as of the revision date.

Effects on milk supply

A study in Japan compared the use of a mixture of 13 herbs, including dong quai, to ergonovine for their effects on lactation and serum prolactin in postpartum women. The herbal mixture, called Xiong-gui-tiao-xue-yin, was given in a randomized fashion to 41 women in a dose of 2 grams of a dried aqueous extract 3 times daily. A comparable group of 41 women were randomized to receive methylergonovine 0.375 mg daily. Therapy was started on the day of delivery, but the duration of therapy was not specified. Plasma oxytocin and prolactin were measured on days 1 and 6; milk volumes were measured daily, although the method of measuring milk volume was not specified. Serum prolactin was higher on days 1 and 6 in the women who received the herbals; plasma oxytocin was lower on day 1 in the women who received the herbal, but not different on day 6. Milk volumes were greater on days 4, 5, and 6 in women who received the herbal mixture.[7] This study has serious flaws that make its interpretation impossible. First, milk volume measurement is subject to considerable variability depending on the measurement method used, but the method was not specified. Second, methylergonovine has caused decreases in serum prolactin and milk production in some studies.[8,9] Because of the lack of a placebo group, the differences found could be a negative effect of methylergonovine rather than a positive effect of the herbal preparation. Because this study used a multi-ingredient combination product in which dong quai was only one component, the results might be different from studies in which dong quai was used alone.

A randomized controlled study evaluated the efficacy of an herbal galactagogic decoction combined with auricular acupressure in improving lactation outcomes. The decoction was self-formulated consisting of Wang Bu Liu Xing (Vaccaria seeds) 10 grams, Glycyrrhiza glabra (licorice) 6 grams, Astragalus membranaceus 12 grams, Angelica sinensis (dong quai) 12 grams, Atractylodes macrocephala 10 grams, Tongzhi 30 grams, Codonopsis pilosula (dangshen) 12 grams, and Andrographis paniculata (green chiretta) 6 grams. One daily dose was decocted in water to yield approximately 200 mL of liquid, which was divided into 2 oral doses per day. Both groups were treated for 2 weeks. A total of 104 women with postpartum hypogalactia were randomly assigned to a control group (auricular acupressure alone, n = 52) or an intervention group (auricular acupressure plus herbal decoction, n = 52) for 2 weeks. Primary outcomes included milk production and formula supplementation, while secondary outcomes were serum hormone levels (estradiol, progesterone, and prolactin), symptom scores, psychological status, and clinical effectiveness. Compared with the control group, the intervention group demonstrated lower estradiol and progesterone levels, higher prolactin levels, increased milk production, and reduced formula supplementation.[5]

Levels in milk

Maternal Levels. Relevant published information was not found as of the revision date.

Infant Levels. Relevant published information was not found as of the revision date.