Is goldenseal safe during pregnancy?

What does the evidence say about goldenseal during pregnancy?

1. Women who are pregnant or breastfeeding should not use goldenseal, and it should not be given to infants, because its berberine constituent can be harmful to newborns. 1
2. Berberine can displace bilirubin from the protein that carries it in the blood, and because bilirubin buildup in a newborn's brain causes damage, most sources recommend avoiding any newborn exposure to goldenseal through breastfeeding or otherwise, even though exactly how much berberine passes to an infant is not established. 2
3. Very little of the berberine in goldenseal is actually absorbed into the bloodstream when taken by mouth, with one study measuring an oral bioavailability well under 1 percent in animal models, a finding researchers attribute to the liver filtering most of it out before it reaches general circulation. 3
4. A metabolomics study of 35 commercial goldenseal supplements found 3 samples had been substituted with a different berberine-containing plant entirely, and separately noted that a goldenseal compound called hydrastine can inhibit two liver enzymes, CYP2D6 and CYP3A4, that are involved in processing other medications. 4
5. In short-term studies goldenseal was given at doses around 3 grams a day without serious harm, but researchers say the safety of taking it for longer periods is uncertain, and some commercial products have tested as containing other herbs or ingredients not listed on the label. 1

Is goldenseal safe in each trimester?

• First trimester. There is no established safe window for goldenseal in pregnancy, so avoiding it from the start, including in cold-and-immune combination products that pair it with echinacea, is the straightforward approach.
• Second trimester. The guidance does not loosen in the second trimester. If a cold or sinus symptom has you reaching for an immune blend, check the label for goldenseal or its constituent berberine before taking it.
• Third trimester. Because berberine is specifically flagged as a risk to newborns and not only to a fetus, the concern carries through to delivery and into any postpartum breastfeeding plans, not just the pregnancy itself.