Ashwagandha Pregnancy & Breastfeeding Safety 2024

Ashwagandha: enter citation distortion, guidelines confusion, and utter safety categorization chaos! This ancient Ayurvedic herb and popular supplement has been through it all. Can we look at the scientific and traditional literature and come to a final conclusion—are there any founded concerns about using ashwagandha during pregnancy and breastfeeding? The American Herbal Pharmacopeia (AHP) says no. Since 2023, they list ashwagandha root as safe. I cover the full story in this report, providing you with the most up-to-date info so you understand all the hows and whys of ashwagandha safety during pregnancy and breastfeeding. 

Disclaimer: This post is for informational purposes only. None of the information here should be taken as medical advice. Even if a remedy is classified as safe in Herbal Doula blog posts based on the existing evidence, that doesn’t mean it’s safe for you. The classifications in the database are just a general reference point. Follow your body, keep track of your response, and consult an herbalist, holistic practitioner, traditional midwife, or anyone else you feel may help you if you need expert advice. 

Ashwagandha Safety Categorization

Pregnancy Safety:

Safe

Labor Safety:

Unknown

Breastfeeding Safety:

Safe

Since 2022, the Botanical Safety Handbook has categorized ashwagandha as class 1: Herbs that can be safely consumed when used appropriately.

BSH Class 1 means that a herb is generally well-tolerated and suitable for use in herbal products or remedies—including during pregnancy and breastfeeding. The American Herbal Pharmacopeia updated monograph will follow this classification.

Adequate caution is recommended as when using any substance during pregnancy and breastfeeding. However, critical and comprehensive reviews and expert options highlight that ashwagandha is a safe herb with no evidence of abortifacient effects.

The current safety categorization is based on the above-mentioned expert reviews.

Controlled human studies are needed to better determine the safety of ashwagandha in pregnant and breastfeeding populations.

There are no data on ashwagandha use in labor.

If you’re curious about adaptogens, be sure to read my Maca Pregnancy & Breastfeeding Safety Report.

Is Ashwagandha Safe During Pregnancy? 

When Citations Go Wrong

This is going to be a deep dive, so grab a cup of tea or coffee and bear with me. It’s important stuff.

The issue many traditional natural remedies face when it comes to safety classification in pregnancy and breastfeeding is exemplified by the story of ashwagandha. Safety classification confusion with herbs like ashwagandha are the reason I created this database—to make sense of the conflicting information and provide a reference-backed systematization that everyone can understand.

Other health outlets and guidelines would logically want to do the same. Ah, but that’s where the catch is! Many people are citing outdated guidelines that further cite studies that don’t even contain the data they base their conclusions on. Few people chase the citation all the way back. An even bigger issue ensues when authorities do the same and create country-wide bans based on distorted data.

Yet, these outlets are deemed trusted and are considered to be professional and evidence-based. Right? Well, when we come full circle, we realize that a lot of confusion and fear around ashwagandha was created out of… well, thin air. Specifically, a misinterpreted old rat study.

Let’s look at what happened in retrospect.

Danish Ashwagandha Ban 

In 2020, Danish Food Authorities issued a risk assessment of ashwagandha. They recommended against its use due to “purported abortifacient activity.” And so, Denmark banned ashwagandha claiming it was impossible to determine a safe lower limit—the minimal amount of ashwagandha a person can take without risk.

Other European countries followed. Some asked for independent risk assessments. One of the main issues was its safety in pregnancy.

It would make sense to think that the Danish authorities looked at the whole of the available literature and the details of the studies they cited to come to such a big decision to ban an herb with such a long history of use.

Yet, the main reference the Danish authorities gave was an ashwagandha monograph of the World Health Organization (WHO) from 2009. The WHO monograph, in turn, cited the American Herbal Pharmacopoeia (AHP) Ashwagandha Root Monograph and Therapeutic Compendium from 2000. However, the WHO monograph twisted what was in the AHP review.

The AHP review stated “There are conflicting reports regarding the use of ashwagandha in pregnancy. Large but undefined doses have been reported to possess abortifacient activity (Chadha 1976; Svoboda 1992). Of several ayurvedic practitioners consulted, none reported having observed an abortifacient activity clinically. Conversely, ashwagandha has, traditionally and in modern ayurvedic practice, been used to prevent miscarriage and stabilize the fetus (Tirtha 1998).”

Based on this, everyone started claiming that ashwagandha root is potentially unsafe in pregnancy.

This is called citation distortion! The citation is correct, but the interpretation is wrong.

Potential abortifacient effects were also reported in the first edition of the Botanical Safety Handbook (BSH; McGuffin et al. 1997). The handbook classified ashwagandha as 2b: Not to be used in pregnancy unless otherwise recommended by a qualified health care practitioner. It contained a “Notice” as an abortifacient. The 2b classification remained in the second edition of the handbook but the abortifacient Notice was removed due to the lack of evidence.

Safety Classification Revision 

The Botanical Safety Handbook safety classification was revised in 2022 to the current safety classification of 1: Herbs that can be safely consumed when used appropriately. BSH Class 1 means that a herb is generally well-tolerated and suitable for use in herbal products or remedies. An upcoming revision of the AHP Monograph and Therapeutic Compendium will reflect this as well.

AHP explains that while adequate caution when using any substance during pregnancy is warranted, based on a critical and comprehensive review of the traditional and modern literature, as well as the opinion of most experts, there is no evidence of an abortifacient effect of ashwagandha root.

A paper published in the Journal of Ayurveda and Integrative Medicine also criticized Denmark’s decision. In the paper, five Indian academics say that the original Danish report suffers from “technical, scientific, and ethical pitfalls,” does not seem to be peer-reviewed, and “contradicts itself at several points.” They also point out that “the credentials of the authors, funding sources and conflict of interests are not disclosed”.

They also explain that, although the Danish mandate concerns ashwagandha roots, it draws conclusions from studies on whole plants, stems, leaves, fruits/berries that are not relevant to the case. The authors say that “banning Ashwagandha roots based on the data on the toxicity of leaves or berries is akin to banning apples because their seeds contain amygdalin which is a precursor to cyanide.”

Experts concluded that ashwagandha is a well-known, safe herb. Rather than restricting its use, authorities should focus on preventing low-quality, contaminated products from reaching the market.

Summary

High-quality ashwagandha root is likely safe in pregnancy. A 2020 Danish assessment misinterpreted the data on the safety of ashwagandha, leading to criticism. The Botanical Safety Handbook safety classification of ashwagandha was revised in 2022 to class 1: herbs that can be safely consumed when used appropriately. The American Herbal Pharmacopeia concludes that there is no evidence of an abortifacient effect of ashwagandha root. 

Sources:

Nutraingredients-AHP response

American Herbal Pharmacopoeia (AHP) Press Release: AHP Responds to Claims of Ashwagandha Abortifacient Effects June 25, 2024

Pathwardan, 2024

Claims in popular literature and blogs

In Botanical Medicine for Women’s Health (2009), Aviva Romm explains that some herbs seem to be classified as contraindicated based on theoretical reasons. She gives ashwagandha as an example since it’s used in Ayurveda to prevent miscarriage but is commonly contraindicated on the basis that it might cause uterine contractions based on a single anecdotal report. The report in question doesn’t specify duration of use, mode of use, or dose (Aviva Romm, Botanical Medicine for Women’s Health-Churchill Livingstone, 2009).

Some websites claim that “Pregnant women should avoid ashwagandha as it may induce abortion at higher doses” but link to scientific reviews that focus on antioxidant effects like this one (Shukla et al., 2012).

The review in question says “While large doses of ashwagandha may possess abortifacient properties and it can act as a mild central nervous system (CNS) depressant, in most cases ashwagandha appears to be very safe, with an LD50 of a 50% alcohol extract determined to be 1 g/kg in rats.” The review further cites a rat toxicity study and a Chinese study that can’t be accessed.

Other blogs claim that ashwagandha could endanger pregnancy “because one of the mechanisms in which it works is by decreasing the stress hormone cortisol.” They claim that a woman’s body needs higher levels of cortisol to sustain pregnancy. This is an example of far-fetched theorizing. No clinical or scientific data back it up.

Others yet say that ashwagandha can cause the early onset of menstruation and could “increase the risk of miscarriage in pregnant women.” Again regurgitating unfounded abortifacient claims, probably coming from the reports that we debunked above.

Research 

The mouse study that’s often cited found no evidence of ashwagandha’s toxicity in pregnant rats or their offspring even at mega-high doses (up to 2000 mg/day, which is a LOT for rats). Rats received ashwagandha between days 5 and 19 of pregnancy, which is a sensitive time due to rat fetus organs and tissues being formed during that time. There were no changes in body weight, implantations, or viable fetuses in pregnant rats and no external, skeletal, or visceral malformations in the rat fetuses (Prabu & Panchapakesan, 2015).

Traditional Use

Ashwagandha is traditionally used in Ayurvedic medicine to prevent miscarriage. It’s also used as an aphrodisiac and is considered a Rasayana—an important rejuvenating, revitalizing tonic. In Ayurveda, ashwagandha is valued for its adaptogenic properties that help the body better manage stress. It’s even considered a longevity herb by some (Mikulska et al., 2023).

Ayurvedic practitioners may recommend ashwagandha for stress management, more restful sleep, enhancing mood, relaxation, boosting stamina, and supporting reproductive health (Mikulska et al., 2023).

Real-world Use/Anecdotal 

Many women report taking ashwagandha either by accident or on purpose while pregnant. Those who took ashwagandha accidentally are concerned about the risks to their baby. Others report taking ashwagandha throughout pregnancy, recommended by herbalists or by their own decision.

Women mention taking ashwagandha during pregnancy to:

• Boost mood
• Reduce stress and anxiety
• Get better sleep
• Reduce chronic fatigue
• Boost memory and improve brain fog

Some women claim that ashwagandha is taken during pregnancy in India, but say that it’s warming and that its heating properties need to be balanced, recommending a 50/50 blend of ashwagandha and shatavari. This is purely anecdotal.

The biggest issue is that women have no trusted source of information about the safety of this herb during pregnancy. People cite different blog posts on forums that contradict each other, leaving women concerned and confused.

Summary

Ashwagandha is an adaptogen traditionally used in Ayurveda to increase stamina and vitality and to balance stress and mood. 

Ashwagandha Before Pregnancy & for Fertility

Ashwagandha is popular as a fertility supplement and often used before pregnancy in women trying to conceive (TTC). Aside from potentially boosting fertility, ashwagandha may have libido-boosting and hormone-balancing effects.

According to a 2018 review, ashwagandha may improve reproductive system function in both men and women, but more research is needed  (Azgomi et al., 2018).

Ashwagandha extract reduced infertility among men by enhancing semen quality and combating oxidative stress. In animals, ashwagandha extract increased luteinizing hormone (LH) and follicular stimulating hormone (FSH), which are important for fertility and healthy egg development in women (Azgomi et al., 2018).

Some studies also found potential spermicidal and infertility effects in men, suggesting that more studies are needed to understand how ashwagandha affects reproductive health and fertility in both men and women (Azgomi et al., 2018).

All in all, given ashwagandha’s overall safety, it’s likely safe to take before pregnancy and in the preconception period. Ideally, your preconception journey should also include a healthy, nutrient-rich diet, stress reduction, and a healthy movement practice.

Other herbs like maca are also a great choice for women who want to support their fertility, so be sure to read up about maca for women in this post.

Ashwagandha Breastfeeding Safety

Official Guidelines

Since the Botanical Safety Handbook now classifies ashwagandha as class 1: Herbs that can be safely consumed when used appropriately—this should carry over to ashwagandha’s use while breastfeeding. Class 1 herbs are generally well-tolerated and suitable for use.

The Botanical Safety Handbook mentions that ashwagandha is traditionally used to promote lactation in Ayurvedic medicine.

In Herbal Medicines in Pregnancy and Lactation, the safety of ashwagandha is listed as unknown, with the following note: “There are no reports in the scientific literature of ashwagandha being either safe or contraindicated during lactation.”

As always, some caution should be warranted since everyone responds differently to herbal products.

Expert options and blogs

Aviva Romm, MD considers adaptogens like ashwagandha safe to use during breastfeeding.

Some lactation databases voice concerns over ashwagandha’s potential liver toxicity. However, liver toxicity has not been reported with any quality ashwagandha supplements nor in decades-long human research (Padwardhan et al., 2024).

Liver toxicity may be an issue with methanolic preparations or products that contain the above-ground parts of the plant. It may also be an issue with low-quality products that may contain contaminants and other impurities.

Research

In one study, 40 women who complained of an insufficient milk supply at 5 days postpartum were given a combination herbal supplement containing wild asparagus, ashwagandha, fenugreek, licorice, and garlic. By day 4, their milk supply improved and no babies needed supplemental formula. However, this study used a combination of herbs, not only ashwagandha, so it’s uncertain how much ashwagandha contributed (LactMed®).

It would be great to see large, high-quality studies about the effects of ashwagandha in breastfeeding moms and their babies.

If you’re struggling with breast milk supply, please consult a lactation consultant and get support. Galactagogue herbs are not meant as a replacement for adequate breastfeeding.

Traditional Use

Ashwagandha is traditionally used as a galactagogue—an herb that boosts breast milk supply—in Ayurveda (LactMed®).

Real-world Use

Women widely use ashwagandha and other adaptogens during the postpartum period and while breastfeeding. Some of the benefits they mention taking it for include:

• Supporting breast milk supply
• Increasing energy
• Boosting mood
• Stress reduction
• Increasing libido
• Preventing burnout
• Supporting sleep

These benefits are anecdotal but are in line with most traditional uses.

Summary

Based on its categorization as a Class 1 herb, ashwagandha root is likely safe to use while breastfeeding when used properly. The data available is sparse, so some caution is recommended.

Ashwagandha Side Effects & Precautions

Side Effects

Overall, most people tolerate ashwagandha well. As mentioned, it’s considered a safe herb when used at the recommended dose and formulation.

Possible side effects include diarrhea, gastrointestinal upset, nausea, and vomiting. However, these adverse effects are rare with typical doses.

Heavy Metal Content 

It’s important to find a high-quality, third-party-tested ashwagandha supplement since heavy metal contamination and other types of impurities can pose a danger in the case of untested, low-quality products.

Drug Interactions

Ashwagandha can interact with several medications, including:

• Antidiabetes drugs
• Blood pressure drugs
• Sedatives
• Immuno-suppressants
• Thyroid hormones, and others

If you take any drugs, be sure to consult a doctor or pharmacist before taking ashwagandha.

Disease Interactions

Some sources recommend against taking ashwagandha in people with thyroid and autoimmune disorders like Hashimoto. Some herbalists, however, consider that it should not be contraindicated in people with these conditions and that it may even be beneficial thanks to its hormone- and immune-balancing potential.

If you’re not sure about whether ashwagandha is right for your condition, be sure to consult an expert herbalist or other care provider who may have herbal and disease knowledge.

Ashwagandha Dosage & Formulations

A typical dosage of ashwagandha root is 3 to 5 g of the dried herb in capsule/ day or 1 to 4 mL (20 to 80 drops) of tincture in water 3x/day.

What Is the Bottom Line?

• Ashwagandha has been incorrectly classified as unsafe to use during pregnancy by Danish authorities, leading to a ban on products containing it in Denmark in 2020
• Expert herbal authorities in the US, India, and other countries criticized the ban and pointed to flaws in the report and mistakes in the way ashwagandha safety data was analyzed
• Herbal associations and experts mostly agree that ashwagandha is a safe herb with a long history of traditional and clinical use that’s likely safe to use during pregnancy and breastfeeding 
• As with any herb, it’s recommended to use ashwagandha with adequate caution if you’re pregnant or breastfeeding, follow the recommended dosage and formulations, and consult a healthcare provider if you take medications to avoid drug or disease interactions  
• If you decide to supplement, do your research to find a high-quality, organic ashwagandha supplement. Low-quality supplements may contain contaminants and impurities that likely are a bigger risk during breastfeeding and pregnancy than any naturally present plant component in quality ashwagandha supplements 

>>>>> Read the report on chaga safety in pregnancy and breastfeeding.

Did you use ashwagandha?

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