Improperly treated pregnancy hypertensive disorders can have dire consequences to the mother and baby. It is not recommended that pregnant women attempt self-medication for pregnancy hypertension, nor that this be done by inexperienced practitioners. The best treatment is obstetric medical care accompanied, when appropriate, by prudent use of herbal medicines as adjunct therapy, under the guidance of an herbalist, nat-uropath, or midwife trained in the use of botanical medicines in pregnancy. Although popular for the treatment of hypertension in the nonpregnant population, herbal diuretics such as dandelion leaf (Taraxacum officinale) are not appropriate for the treatment of pregnancy hypertensive disorders, and may potentially cause exacerbation. The herbs discussed in the following are those commonly used for treating gestational and chronic hypertension that are considered generally safe for use during pregnancy. Botanical treatment for preeclampsia is not recommended and has not been investigated.
Cramp Bark and Black Haw
Cramp bark and black haw have been used by midwives as part of herbal antihypertensive protocol for gestational hypertension. Traditionally, they have been used as mus-culoskeletal relaxants during pregnancy, and to treat irritable uterus, prevent premature labor, and relieve incoordinate uterine contractions. They are taken in tincture form, either alone or more typically with relaxing nervines and hawthorn, for this purpose in Table 15-3.
Botanical Treatment Strategies for Hypertension in Pregnancy
|Therapeutic Goal||Therapeutic Activity||Botanical Name||Common Name|
|Reduce blood pressure||Antihypertensives||AHium sativum||Garlic|
|Viburnum spp.||Cramp bark, black haw|
|Stress reduction, relaxation||Nervines||Lavandula officinalis||Lavender|
|Passiflora incarnata||Passion flower|
|Viburnum spp.||Cramp bark, black haw|
Garlic has mild antihypertensive properties and inhibits platelet aggregation and inflammation. No studies have evaluated the efficacy or safety of garlic use for pregnancy hypertension. Garlic is a common food used during pregnancy worldwide, and in modest doses is not expected to cause any adverse effects. The German Commission E gives no contraindication to its use during pregnancy, nor does the Botanical Safety Handbook, which does however provide a caution about use during lactation because of active constituents passing through the breast milk. (McKenna et al. note that the dose of constituents received through breast milk is actually quite small.) A randomized control study of 100 primigravid women given either 800 mg / day of garlic tablets or placebo during third trimester pregnancy to evaluate the effect of garlic supplementation on preeclampsia found that pregnancy outcomes were comparable in both groups. There were no reports of side effects in the garlic group other than garlic body odor, and nausea, nor reports of an incidence of adverse fetal outcomes or spontaneous abortion. Garlic odor was identifiable in the amniotic fluid of a small group of pregnant women taking garlic supplements. It is commonly recommended that because of its antithrombotic effects, garlic use should be discounted 7 days prior to surgery. A recent Cochrane review evaluating the effects of garlic on preeclampsia and its related complications concluded that there is insufficient evidence to recommend increased garlic intake for preventing preeclampsia and its complications, and that side effects have not been reported with its use in pregnancy. Although the actual risk of bleeding is uncertain, it is prudent to discontinue the medicinal use of garlic 3 weeks prior to the due date to minimize any increased risk of bleeding, as women with hypertensive disorders during pregnancy are more likely to enter labor early.
Hawthorn has been used for treating a variety of cardiovascular conditions, and has noted antioxidant effects and antiplatelet aggregating effects, which may be of benefit in preventing pregnancy hypertension. Other noted actions are an increase in the integrity of blood vessel wall, improvement in coronary blood flow, and positive effects on oxygen use. There are no known contraindications or restrictions to the use of this herb during pregnancy or lactation.
Although not classically used for the treatment of hypertension in pregnancy, it is worth mentioning that the medicinal mushroom Ganoderma lucidum has demonstrated positive results in research looking at its anti-hypertensive effects, as well as effects against diabetes and hyperlipidemia. One interesting study looked at the effects of reishi on glomerular function, and found that it was able to improve hemodynamic flow in glomerular disease and reduce proteinuria. The beneficial effect of Ganoderma lucidum appears to be multifac-torial, including the modulation of immunocirculatory balance, antilipid, vasodilator, antiplatelet, and improved hemodynamics. Together with vitamins C and E, this herb helped to neutralize oxidative stress and suppress the toxic effect to the glomerular endothe-lial function. Extracts of reishi polysaccharides have demonstrated significantly improved basal nitrous oxide (NO) release and endothelium-dependent relaxation but without affecting endogenous nitrous oxide synthase (NOS) activity. These results suggest that this herb has the potential to improve endothelium-dependent relaxation in mineralocorticoid hypertension. In a study evaluating the clinical effects of lyophilized G. lucidum extract, 53 patients were divided into two groups: Group I consisted of essential hypertensive patients, and Group II consisted of mild hypertensive or normo-tensive patients. The patients were instructed to take six tablets containing 240 mg of the extract per day. Biochemical and hematologic examination were performed for 21 test items, and the following results were obtained. In regard to hypertension, blood pressure significantly decreased in Group I, but did not in Group II, thus showing that G. lucidum has an ameliorating effect on hypertension. In regard to biochemical and hematologic effects, the oral intake did not result in any change in the values of any of the 21 test items beyond the normal range, except that total cholesterol decreased slightly and fibrinogen increased slightly. It was therefore concluded that G. lucidum has blood pressure lowering effect on patients with essential hypertension and will not have any side effects on patients with essential or border line hypertension during 6 months oral intake. No safety data on use during pregnancy was identified. Reishi may be taken alone or in combination with other herbs, and may be taken as a liquid extract or in solid (pill) form (Box Protocol for Chronic or Gestational Hypertension).
Protocol for Chronic or Gestational Hypertension
Tincture Formula for Cardiovascular Support
Hawthorn Crataegus oxyacantha 40 mL Cramp bark or black haw Viburnum spp. 30 mL Passion flower Passiflora incarnata 30 mL
Total: 100 mL
Dose: 5 mL twice daily Also:
Garlic: One clove fresh garlic daily or garlic capsules (dose according to specific product)
Reishi: 2 mL tincture twice daily Daily supplementation:
• 1000 mg vitamin C
• 400 IU vitamin E
Diet: Emphasize a heart healthy diet of fresh fruits, especially dark colored berries rich in vascular protective, antioxidant anthocyanidin; vegetables, whole grains, and legumes, nuts, fresh fish, and poultry. Avoid high fat, fried, and processed foods.
Exercise: 30 minutes walking daily (unless otherwise prohibited)
Relaxation: Daily yoga, meditation, or biofeedback exercises.
Warm (not hot) baths: 2 to 3 times / week with ¼ cup Epsom salts and 5 to 10 drops lavender essential oil added to the bath.