Fetal safety of medicinal herbs and food ingredients during pregnancy: Recommendations from traditional Korean medicine based on expert opinions

Objectives: This study aimed to establish and provide reliable information for general public, based on expert consensus, on the risks of misuse of medicinal herbs for food and pure food ingredients for the fetus during pregnancy.Methods: A panelist of seven traditional Korean medicine (TKM) gynecologists responded to a questionnaire summarizing the fetal safety literature for twenty-five medicinal herbs for food and pure food ingredients derived from medicated diet (藥膳, Yaksun) recipes during three online Delphi rounds anonymously.Results: Ginkgonis Semen (Ginkgo nut), Illici Veri Fructus (Star anise), lavender, bitter gourd, and parsley were agreed at the level 1 of “Do not consume”. These five ingredients were recognized as having significant risks both in the literature evidence and in expert opinion. Rosemary, Citri Unshius Pericarpium, Discoreae Rhizoma, lemongrass, Schisandrae Fructus, Cassiae Semen, Foeniculi Fructus, Mori Fructus, Cinnamomi Cortex, and Astragali Radix were agreed at the level 2 of “consultation with TKM practitioner is required”.Conclusion: Based on the consensus of a seven-member expert panel of TKM gynecologists, consumption of Ginkgonis Semen (Ginkgo nut), Illici Veri Fructus (Star anise), lavender, bitter gourd, and parsley should be avoided by pregnant women. For Rosemary, Citri Unshius Pericarpium, Discoreae Rhizoma, lemongrass, Schisandrae Fructus, Cassiae Semen, Foeniculi Fructus, Mori Fructus, Cinnamomi Cortex, and Astragali Radix, the level 2 advisory may be recommended to use with caution and to consult a TKM practitioner for advice on consumption, dose, and duration.