St. John’s wort (Hypericum perforatum) is an herbal preparation which has been shown, in some studies, to be effective for the treatment of mild to moderate depressive symptoms. St. John’s wort is now one of the most commonly used herbal products in the United States and is widely used in Europe.

Despite the prevalence of its use, there remains little data on the safety of this agent when used during pregnancy. In fact, the literature includes only one case report of a 38 year old mother who started taking St. John’s wort at 24 weeks of gestation and delivered a normal, healthy baby at full term.

Animal studies (reviewed by Duqoua and colleagues at the Motherisk program) are typically of limited utility in making clinical decisions regarding the use of medications during pregnancy. These studies have yielded conflicting results regarding the teratogenicity of St. John’s wort.

While many feel greater comfort in using agents that are perceived to be “natural”, this is no guarantee that these agents are safe and the data regarding the use of most herbal preparations during pregnancy is sparse. At this point there are more data regarding the use of conventional antidepressants during pregnancy. Pending further information regarding the efficacy of St. John’s wort and the reproductive safety of this herbal preparation, conventional antidepressants, particularly the selective serotonergic reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs), remain the first line of treatment for depression during pregnancy.

Ruta Nonacs, MD PhD

Read more:

Taking St John’s wort during pregnancy (Canadian Family Physician)

Dugoua JJ, Mills E, Perri D, Koren G. Safety and efficacy of St. John’s wort (hypericum) during pregnancy and lactation. Can J Clin Pharmacol. 2006 Fall;13(3):e268-76. Epub 2006 Nov 3.

Grush LR, Nierenberg A, Keefe B, Cohen LS. St John’s wort during pregnancy. JAMA 1998;280:1566.