Is It Safe To Take Elderberry Syrup While Pregnant Or Breastfeeding?

in Breastfeeding, Herbs & Spices, Immune System, Infectious Disease, Pregnancy, Supplements

Elderberries are a favorite family remedy for upper respiratory tract infections. However, there have been some rumors about the safety of elderberries. This article covers the safe use of elderberries, the history of elderberry use in pregnancy and lactation, contraindications to elderberry use, and the harm caused by the improper preparation of elderberry products.

Medicinal Uses Of Elderberry Syrup

Elderberry syrup has a long history of use in natural medicine. It has been used to treat coughs and colds, boost the immune system, reduce fever, help with joint problems, reduce allergic/asthmatic symptoms, and help restore the body to health after illness. 

Modern use of elderberry syrup focuses on elderberry’s ability to treat viral upper respiratory infections, like minor coughs, colds, and influenza. Since 2020, there has been increasing research into elderberry’s ability to treat coronaviruses, and though more study is required, elderberry looks like a promising treatment or adjunctive treatment for COVID-19.  

Elderberry syrup is also commonly used as a seasonal immune-strengthening agent for kids and adults. In my practice, I often prescribe Elderberry Elixir as a daily preventative during the fall and winter months for people of all ages. However, when it comes to pregnant and breastfeeding women, I prefer short-term use to err on the side of caution. 

Safety Of Elderberry Syrup In Pregnancy & Lactation
A close up photo of a pregnant woman's belly with her hands resting on her belly.

While pregnant or breastfeeding, it is vital for women to consider the safety of what they consume, as this may affect the long-term health of their children. Given this knowledge, it makes sense to question whether the medications and supplements we commonly use are safe during pregnancy and lactation. 

Unfortunately, we don’t have human trials demonstrating the safety and efficacy of most medications and herbal supplements during pregnancy and lactation. Instead, we have to rely on other evidence, including observational studies of use during pregnancy, case reports, animal studies, knowledge of chemical constituents, and traditional use.  

Many herbalists consider elderberry likely safe for use during pregnancy and lactation given that there have been no adverse effects reported despite regular use by pregnant and lactating women. In addition, elderberries are commonly consumed as part of the usual diet in some cultures, even during pregnancy and lactation. Elderberry doesn’t contain phytochemicals known to increase the risk of miscarriage, cause birth defects, change hormonal function, or reduce breast milk supply. However, animal studies and human studies are lacking so some urge caution. 

Elderberry syrup is traditionally used for short-term (5-7 days) treatment of upper respiratory infections during pregnancy and lactation rather than as a daily immune booster. In my clinical practice, I reserve Elderberry Elixir as a short-term treatment for most moms; instead, I have them take a probiotic and a mushroom based immune enhancer if needed, like Mother’s Immunity Support. As always, speak to your doctor or midwife before taking any supplements during pregnancy or lactation. 

A Case Of Cyanide Toxicity From Raw Elderberries In A Smoothie

Unripe, raw, and unprocessed elderberries contain high levels of phytochemicals called cyanogenic glycosides. The human body easily manages and excretes cyanogenic glycosides in low quantities; however, cyanogenic glycosides can cause cyanide poisoning if consumed in high quantities. Many common foods like almonds, stone fruits, chickpeas, cashews, lima beans, flax seeds, and more contain low levels of cyanogenic glycosides and are safely consumed by humans of all ages. It is only high levels of cyanogenic glycosides that are problematic.

A previous version of this article stated that a review of the past 30 years had found no cases of cyanide poisoning from elderberries. However, in January 2022, a smoothie company used raw elderberries in a frozen smoothie product sold online in Canada, resulting in several cases of mild cyanide toxicity and a recall of the product

The cyanide toxicity from raw elderberries in the 2022 incident was mild and symptoms were confined to the gastrointestinal tract. However, this underscores the importance of purchasing herbal supplements from companies that have true herbal expertise and stringent manufacturing standards.

Note: Dr. Green Mom’s Elderberry Elixir is thoroughly processed and thus safe. For more information about Dr. Green Mom’s manufacturing standards, click the “Why Buy From Us” tab on any of our product pages.

Reasons For Caution With Elderberry Supplements

I hesitate to recommend an elderberry supplement if someone is taking medication to suppress the immune system. Elderberry may make certain immune-suppressing medications less effective so caution is urged. 

Some theorize that elderberry supplements may worsen autoimmune conditions or cause flares as elderberry can stimulate the immune system. However, I have not been able to find any case reports of this occurring and I have not seen it in my practice. For more information, see this article Immune Stimulating vs Immune Modulating vs Immune Tonic (and what that means for cytokine storms, allergies, and autoimmunity) – Dr. Green Mom

Summary

Elderberry has a long history of use by pregnant and breastfeeding women, but human safety trials are lacking. In my practice, I often recommend that pregnant and breastfeeding women take Elderberry Elixir for up to 7 days for the short-term treatment of upper respiratory tract infections. 

Choosing which herbs to take during pregnancy and while breastfeeding is personal and should be guided by a qualified professional who understands herbal medicine.

References:

Wieland, L. S., Piechotta, V., Feinberg, T., Ludeman, E., Hutton, B., Kanji, S., Seely, D., & Garritty, C. (2021). Elderberry for prevention and treatment of viral respiratory illnesses: a systematic review. BMC complementary medicine and therapies, 21(1), 112. https://doi.org/10.1186/s12906-021-03283-5

Hawkins, J., Baker, C., Cherry, L., & Dunne, E. (2019). Black elderberry (Sambucus nigra) supplementation effectively treats upper respiratory symptoms: A meta-analysis of randomized, controlled clinical trials. Complementary therapies in medicine, 42, 361–365. https://doi.org/10.1016/j.ctim.2018.12.004

Brendler, T., Al-Harrasi, A., Bauer, R., Gafner, S., Hardy, M. L., Heinrich, M., Hosseinzadeh, H., Izzo, A. A., Michaelis, M., Nassiri-Asl, M., Panossian, A., Wasser, S. P., & Williamson, E. M. (2021). Botanical drugs and supplements affecting the immune response in the time of COVID-19: Implications for research and clinical practice. Phytotherapy research : PTR, 35(6), 3013–3031. https://doi.org/10.1002/ptr.7008

Stich, L., Plattner, S., McDougall, G., Austin, C., & Steinkasserer, A. (2022). Polysaccharides from European Black Elderberry Extract Enhance Dendritic Cell Mediated T Cell Immune Responses. International journal of molecular sciences, 23(7), 3949. https://doi.org/10.3390/ijms23073949

Kinoshita, E., Hayashi, K., Katayama, H., Hayashi, T., & Obata, A. (2012). Anti-influenza virus effects of elderberry juice and its fractions. Bioscience, biotechnology, and biochemistry, 76(9), 1633–1638. https://doi.org/10.1271/bbb.120112

Mocanu, M. L., & Amariei, S. (2022). Elderberries-A Source of Bioactive Compounds with Antiviral Action. Plants (Basel, Switzerland), 11(6), 740. https://doi.org/10.3390/plants11060740

Przybylska-Balcerek, A., Szablewski, T., Szwajkowska-Michałek, L., Świerk, D., Cegielska-Radziejewska, R., Krejpcio, Z., Suchowilska, E., Tomczyk, Ł., & Stuper-Szablewska, K. (2021). Sambucus Nigra Extracts-Natural Antioxidants and Antimicrobial Compounds. Molecules (Basel, Switzerland), 26(10), 2910. https://doi.org/10.3390/molecules26102910

Holst, L., Havnen, G. C., & Nordeng, H. (2014). Echinacea and elderberry-should they be used against upper respiratory tract infections during pregnancy?. Frontiers in pharmacology, 5, 31. https://doi.org/10.3389/fphar.2014.00031 

Tiralongo, E., Wee, S. S., & Lea, R. A. (2016). Elderberry Supplementation Reduces Cold Duration and Symptoms in Air-Travellers: A Randomized, Double-Blind Placebo-Controlled Clinical Trial. Nutrients, 8(4), 182. https://doi.org/10.3390/nu8040182  

Elderberry Clinical Guide https://web.archive.org/web/20201123005917/http://abc.herbalgram.org/site/DocServer/Elderberry-scr.pdf?docID=165 

Elderberry: Health Benefits, Side Effects, Uses, Dose & Precautions

Appenteng MK, Krueger R, Johnson MC, Ingold H, Bell R, Thomas AL, Greenlief CM. Cyanogenic Glycoside Analysis in American Elderberry. Molecules. 2021 Mar 4;26(5):1384. doi: 10.3390/molecules26051384. PMID: 33806603; PMCID: PMC7961730. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7961730/ 

Elderberry. (2021). In Drugs and Lactation Database (LactMed). National Library of Medicine (US).

Alrumaihi, F., Almatroudi, A., Allemailem, K. S., Rahmani, A. H., Khan, A., & Khan, M. A. (2020). Therapeutic Effect of Bilsaan, Sambucus nigra Stem Exudate, on the OVA-Induced Allergic Asthma in Mice. Oxidative medicine and cellular longevity, 2020, 3620192. https://doi.org/10.1155/2020/3620192 

Jabbari, M., Hashempur, M. H., Razavi, S. Z., Shahraki, H. R., Kamalinejad, M., & Emtiazy, M. (2016). Efficacy and short-term safety of topical Dwarf Elder (Sambucus ebulus L.) versus diclofenac for knee osteoarthritis: A randomized, double-blind, active-controlled trial. Journal of ethnopharmacology, 188, 80–86. https://doi.org/10.1016/j.jep.2016.04.035

Harnett, J., Oakes, K., Carè, J., Leach, M., Brown, D., Cramer, H., Pinder, T. A., Steel, A., & Anheyer, D. (2020). The effects of Sambucus nigra berry on acute respiratory viral infections: A rapid review of clinical studies. Advances in integrative medicine, 7(4), 240–246. https://doi.org/10.1016/j.aimed.2020.08.001

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