Is dong quai safe during pregnancy?

What does the evidence say about dong quai during pregnancy?

1. LactMed, the NIH database on drugs and lactation, states dong quai is best avoided during breastfeeding and separately documents that the herb can raise bleeding risk when combined with warfarin or other anticoagulant and antiplatelet drugs. 1
2. NCCIH states that very little research has been done on dong quai, so no firm conclusions can be drawn about its effects, and separately flags a possible interaction with the blood-thinning drug warfarin. 2
3. A peer-reviewed toxicology review of herbal abortifacients notes that dong quai is commonly used alongside other herbs in self-managed abortion attempts and confirms it contains coumarin compounds, though the review states dong quai's own mechanism has not been clearly established and that confirmed bleeding-complication reports are absent from the literature. 3
4. A clinical report lists dong quai among the herbs with reasonably well-documented interactions with coumarin-type anticoagulant drugs, alongside St. John's wort, danshen, ginseng, and ginkgo. 4
5. A pharmacology review of botanicals for women's health reports that dong quai's proposed active compound, Z-ligustilide, actually inhibited uterine contractions in laboratory research rather than stimulating them, and states that whether dong quai has any estrogenic activity at all remains scientifically unresolved, with no randomized controlled trials establishing its effects in humans. 5

Is dong quai safe in each trimester?

• First trimester. No dedicated first-trimester studies exist for dong quai. Given its coumarin content and the complete lack of established pregnancy safety data, avoiding it from the start of pregnancy is the more cautious choice.
• Second trimester. Research remains just as thin for this stage. The same coumarin-related bleeding-risk concern and lack of pregnancy safety data continue to apply, so avoidance is still the recommended default.
• Third trimester. Extra caution applies here because dong quai's documented interaction with anticoagulant and antiplatelet drugs raises bleeding-risk questions that carry more weight as delivery approaches.