Is kava safe during pregnancy?

What does the evidence say about kava during pregnancy?

1. A 2024 case report describes a newborn who developed a severe, fish-scale-like skin rash along with seizures and infections after the mother used kava daily throughout pregnancy; the rash resolved by day 22 of life, and the authors point to kava as the likely cause after ruling out other exposures. 1
2. NCCIH states that kava may have special risks if taken during pregnancy or while breastfeeding because of the presence of harmful pyrone constituents, on top of its general liver-injury risk. 2
3. Long-term use of high doses of kava outside of pregnancy has been linked to kava dermopathy, a condition involving dry, scaly, flaking skin, a pattern with a notable resemblance to the newborn skin reaction described in the 2024 case report. 2
4. Kava-related liver injury is rare, estimated at fewer than 1 in 1,000,000 daily doses, but reported cases have ranged from jaundice to fulminant liver failure requiring a transplant, with symptoms typically appearing 2 to 24 weeks after starting use. 3
5. Kava's active compounds, called kavalactones, are cleared through liver enzymes that they can also inhibit, one of the mechanisms researchers point to for kava's liver-injury risk, and dedicated reproductive toxicity studies were still pending as of a recent review. 4

Is kava safe in each trimester?

• First trimester. Kavalactones are small molecules expected to cross the placenta, so first-trimester exposure reaches the developing baby directly. With zero human or animal safety studies in pregnancy at any stage, there's no dose or timing considered lower-risk.
• Second trimester. The same lack of safety data applies through the second trimester. If you're using kava for anxiety or sleep, talk to your provider about pregnancy-appropriate options instead of continuing on your own.
• Third trimester. The 2024 case report involved kava use through the full pregnancy, with the newborn's skin reaction appearing days after birth. Stopping before delivery doesn't have established safety data behind it either, which is another reason to work with your provider rather than self-manage.