Black and Blue Cohosh in Pregnancy: What You Need to Know

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Written by Amy Kaczor RDN

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Black and blue cohosh are fragrant flowers that many claims can help improve women’s reproductive health and hormone balance or increase fertility. This article will cover if these claims are true and if cohosh is safe to consume during pregnancy. 

Overall, it is best to avoid both black and blue cohosh during pregnancy because of the lack of scientific evidence to support its safety. Unfortunately, cohosh can also potentially induce labor and promote miscarriage; therefore, pregnant women should avoid it in any form, including teas and herbal supplements.  

This article will cover the safety of black and blue cohosh, what to do if you accidentally have some, and some potential risks of consuming black cohosh. Read on to learn more. 

Is Black Cohosh Safe During Pregnancy? 

Unfortunately, black cohosh (also known as Cimicifuga racemosa or Actaea racemosa) is not deemed to be safe during pregnancy in any form, including herbal supplements, pills, tea, root extract, and more. 

A 2006 systematic literature review found that black cohosh can stimulate the uterus and therefore induce labor, especially in the first trimester of pregnancy (The Canadian Journal of Clinical Pharmacology).

Inducing labor this early and without medical supervision is dangerous because it can contribute to a miscarriage — more on this below!

black cohosh flowers

Additionally, in more recent studies, a 2021 study confirmed that traditional medicinal plants, including black cohosh extract, should be avoided during pregnancy simply because there are not enough studies that have been performed to determine their safety (Phytotherapy Research).

It is often considered unethical to do scientific experimental studies on pregnant women and their unborn babies, which is likely why research is lacking in so many areas. Therefore, this recommendation also includes any form of black cohosh, including herbal supplements. 

It is important to note that dietary supplements are not regulated for safety or effectiveness by the United States Food and Drug Administration (also known as the FDA) until they are already on the market for purchase by consumers (source: FDA).

On the other hand, the FDA’s regulation begins once the product is on the shelves for you to purchase. In other words, there is no knowing for sure if a dietary supplement is entirely safe for you during pregnancy without speaking with your doctor.

Therefore, taking any dietary supplement, including black cohosh, during your pregnancy should be approved by your physician.

When it comes to tea, avoid black cohosh tea, and make sure that if you are consuming an herbal tea blend, make sure you are checking the ingredients list and nutrition label for black cohosh. 

Is Blue Cohosh Safe When Pregnant? 

Like black cohosh, blue cohosh should also be avoided during pregnancy due to severe safety concerns. Unfortunately, consuming blue cohosh while pregnant has been linked to perinatal stroke, acute myocardial infarction or heart attack, congestive heart failure, multi-organ injury, and more (source: The Canadian Journal of Clinical Pharmacology). 

Since all forms of blue cohosh should be avoided, the same recommendations above apply regarding consuming dietary supplements, herbal tea blends, and any other product that contains blue cohosh.

I Took Black Cohosh When Pregnant – What Should I Do?

If you have accidentally consumed black cohosh while you are pregnant, it is important to stay calm and not to panic – the odds of causing harm are low, overall. However, it would be best if you also remained alert for any symptoms. 

Monitor yourself for any unusual adverse effects, such as abdominal pain, diarrhea, shortness of breath, nausea, headache, tremors, and more (source: Mount Sinai School of Medicine). To ease worry, you can also contact your physician if you have accidentally consumed a small amount of black cohosh, such as in an herbal tea blend.

If you consumed a large amount of black cohosh (such as a supplement) or you are in your first trimester of pregnancy, it is best to contact your healthcare provider for guidance. Since black cohosh consumption during pregnancy can cause contractions, contact emergency medical services immediately if you do notice any contractions.

Can Black Cohosh Cause Miscarriage? 

Black cohosh can potentially cause a miscarriage when used during pregnancy because it stimulates the uterus (source: The Canadian Journal of Clinical Pharmacology). 

Therefore, it is important to emphasize here that black cohosh should be avoided during pregnancy unless you have approval and supervision from a physician. 

black cohosh dried roots in mortar and pestle

Can Black Cohosh Induce Labor? 

Due to the uterine stimulating effects mentioned above, homeopathic practitioners may recommend black cohosh to induce labor if you are at or past term (source: Mount Sinai School of Medicine).

However, it is not recommended to follow this practice unless you are under the direct supervision of a trained physician, due to the potential for unwanted side effects and other factors.

Can Black Cohosh Help You Get Pregnant? 

While many believe that black cohosh can increase fertility when trying to get pregnant, scientific studies simply are too inconsistent and unreliable to allow researchers to determine if black cohosh can actually help with fertility (source: National Center for Complementary and Integrative Health [NCCIH]). 

Mainly, black cohosh has been studied extensively for its benefits to menopausal symptoms. However, even in this area of research, the studies are very inconsistent in dosage, concentration, and more, leading to the need for more research to be conducted (source: National Institutes of Health [NIH]). 

Overall, black and blue cohosh should be strictly avoided during pregnancy due to the severe health risks.

I hope this article was helpful in breaking down this recommendation for your pregnancy, but if you are in any doubt, please do contact your health provider, too.