Chamomile in Pregnancy: Examining Safety Through a Wider Lens

Chamomile in Pregnancy

I find myself having a conversation about chamomile’s safety during pregnancy at least a couple times each month, which is why I finally sat down to write this as a resource to refer to when this topic comes up.

Chamomile has been used medicinally for thousands of years, including during pregnancy, yet again and again I have people come to me being told to avoid it during pregnancy. Now almost all plants get labeled as “avoid during pregnancy – not enough known about safety” and we have to note that these studies will almost certainly never come.

A. There is no one funding studies on herbs, because you cannot patent and profit off of a single herb so there’s no financial motive to do these studies.

B. It’s not ethical to do studies on pregnant and breastfeeding people – so any studies done would be retroactive recall studies which are highly variable. When a plant carries this length of clinical history though, I do feel some responsibility to step in and provide a thorough examination of the data we do have.

Let me start by saying plainly – I am not blindly advocating that all herbs are safe in pregnancy. They are not. Some herbs have revealed very real dangers through human experience, and those patterns became obvious because harm surfaced repeatedly over time. Many of these herbs were much less commonly used than chamomile, and we still discovered their risks. My goal here is not persuasion. If you feel uneasy about taking an herb while pregnant, that is reason enough to avoid it – being stressed about using an herb is ultimately working against our goals, regardless of any data analysis. My goal is to provide some context and clarity so decisions about your health and risks can be made from a full picture understanding.

A Clinical History

Chamomile appears throughout early medical literature as a gentle botanical used for digestion, inflammation, restlessness, and nausea. Later European herbals continued to position chamomile as appropriate for women and children. Its name stems from matrix, meaning womb, which reflects some of the plant’s association with reproductive care thousands of years ago.

By the nineteenth century, Eclectic physicians in the United States were prescribing chamomile for gastrointestinal irritation and nervous excitability, including in populations considered physiologically vulnerable (pregnant individuals, children, elderly). These practitioners relied heavily on outcome-based observation. Their livelihood depended on whether treatments helped or harmed.

If chamomile posed a consistent danger in pregnancy, we would expect cases to have surfaced long before modern research structures existed. Many herbs far less commonly used have demonstrated their risk through human trial and error. Pennyroyal and blue cohosh are often referenced because adverse outcomes came to light just through observation.

Chamomile does not show that same historical trajectory, and we have over 2000 years of recorded use. A long record of uneventful use does not prove safety, but there absolutely is real data there that should inform how we interpret newer concerns.

How I Evaluate Pregnancy Safety

When I assess whether an herb raises concern in pregnancy, I am not looking at a single study. I look for convergence across several areas:

• Historical use – I like to see at least 100+ years of documented use in a culture
• Pharmacology and mechanism including the chemistry’s ability to hyper accumulate, pass to the placenta, or affect the uterus.
• Case studies and formal lab work if they exist
• Human and animal data
• Dose relevance & preparation differences
• The actual plausibility of harm from the actions the herb is known to have

The Study That Gets Quoted Most Often

The paper that I hear cited the most is a 2009 case report describing premature constriction of the fetal ductus arteriosus following reported maternal consumption of Chamomile tea. The paper reports two cases of premature constriction of the fetal ductus arteriosus that resolved after the pregnant person stopped drinking what the authors call “camomile tea.” Now – fetal ductus arteriosis can be caused by high polyphenol consumption, but is most commonly caused by NSAID use – this is why they don’t recommend ibuprofen during pregnancy.

There are some problems right away with this paper. The paper states that the tea was “made from the leaves of Camellia sinensis.” now Camellia sinensis is not chamomile. It is the plant that we make classic green, black, or oolong tea from. Chamomile comes from Matricaria chamomilla or Chamaemelum nobile, neither of which we use the leaves of or has leaves resembling Camellia sinensis. You can see this error at the very beginning of the paper here: https://obgyn.onlinelibrary.wiley.com/doi/full/10.1002/uog.6453

I’m left unsure if this is just a typo, or if this whole paper is on another plant altogether. High doses of polyphenol-rich teas like Camellia sinensis are already known to be associated with reversible ductus arteriosus constriction in late pregnancy, through inhibition of prostaglandin synthesis, so it’s my instinct to think that that is actually what they were studying, but it’s quite bold that they put Chamomile in the title of their paper and they got such a major point wrong (It’s also spelled wrong throughout). It’s also important to note that this is a study on two individuals reporting use at home back to their physicians so it doesn’t seem to be very precise what tea they were drinking. This study is really all over the place. As we go on, later in the study they start to talk about “camomile tea (Camellia sinensis) root extract” – we don’t use the root of either Chamomile or the tea plant – so what exactly are they looking at here? Despite all of this, the paper has been repeatedly cited as evidence that Chamomile causes ductal constriction and is even the basis for the guidelines that come up when you google “Is Chamomile safe in pregnancy”.

This misinformation then got propagated into reviews, databases, and clinical summaries without being questioned. When you look at this study, I’m not sure that it’s about Chamomile at all, and the broader literature does not show a repeating pattern of this outcome with Chamomile exposure – something that thousands and thousands of pregnant people are consuming every day.

The Polyphenol Concern

Polyphenols often enter this conversation because extremely high intake has been explored as a theoretical contributor to altered fetal ductal flow. The key word here is high use. Research suggests that daily use needs to be exceeding 1,000 mg per day to see even a slight statistical increase. A strong 16oz cup of Chamomile tea typically lands somewhere between 50 and 100 mg. of polyphenols.

For perspective:

• One apple often contains 100-300 mg
• A cup of blueberries may provide 300 to 550 mg
• An ounce of dark chocolate can reach 400 to 600 mg

Dose always determines physiological impact. Without this context, we can always find a dose of any herb (or food for that matter) that can be dangerous – you drink enough quarts or extract an herb out to a highly concentrated dose and yes – we will find a point of danger. None of this dismisses possible concern, there is risk with everything, but we have to put things into biologically reasonable frameworks.

What About Studies?

This section I’ll look at all the studies I can find on chamomile being unsafe in pregnancy:

One retrospective study in 2015 observes an association between regular Chamomile consumption in the third trimester and higher rates of preterm birth along with lower birth weight. These studies are really broad. They rely on self-reported intake after delivery, often without clear dose, preparation, or timing data. The biggest issue is that Chamomile is grouped together with other herbs, topical oils, or supplements, making it impossible to isolate its effect. Given how commonly chamomile is consumed, some level of overlap is statistically expected in any large population dataset and I think it’s interesting to note that when this same study was controlled for other confounding factors – no statistical risk of low birth weight was assessed. https://pubmed.ncbi.nlm.nih.gov/22516883/

The concern of Uterine Stimulation

The next concern is the risk of uterine stimulation which is always something I’m looking at when evaluating herb safety during pregnancy. We don’t want to stimulate the uterus while we are trying to grow a baby so anything with this action would just be working against what are goals are during this time. Chamomile contains flavonoids such as apigenin alongside volatile oils like bisabolol. These constituents are part of its anti-inflammatory, antispasmodic, and gentle calming effects. Mechanistically, nothing about this herb’s chemical profile strongly predicts uterine stimulation especially at tea-level dosing. If anything, its smooth muscle effect trends toward relaxation, not stimulation. Apigenin (one of the dominant flavonoids) interacts with GABA-A receptors and has muscle-relaxing properties. There is no strong pharmacologic pathway suggesting chamomile meaningfully increases oxytocin signaling or coordinated uterine contractility.

https://pmc.ncbi.nlm.nih.gov/articles/PMC5301993/? – This one here they tried to induce labor with chamomile extract capsules taken every 8 hours and found a 30% increase of labor induction in post term pregnant individuals – so people who were already at term with their pregnancy had an increase in starting labor within one week of taking these capsules regularly vs people at the same stage who did not take the capsules. This does not tell me that chamomile causes uterine contractions in any sort of aggressive way, these were people who were ready to give birth- could we consider the possibility that chamomile is helpful in relaxing a pregnant person to the point where labor could begin on it’s own?

Drug interaction

There is also a case report of a woman taking the blood thinner warfarin who developed significant bleeding after using chamomile products, with testing showing her blood was clotting more slowly than intended. Researchers believe this may have occurred because she was consuming chamomile and chamomile contains natural compounds that could enhance the effect of anticoagulant medications, a concept known as pharmacodynamic synergy, where two substances push the body in the same direction – Kind of like stacking drugs with the same effect. Importantly, this risk appears most relevant for people already on blood thinners, and there isn’t good evidence that chamomile alone causes problematic bleeding in otherwise healthy individuals.

Preparation Matters

Preparation is an important thing to think about

A tea is a relatively mild water extraction.

Alcohol extracts concentrate chemistry.

Standardized capsules and essential oils are a totally different thing – in many cases are functioning much more like a drug than an herb at that point.

Many historical and traditional safety assumptions that we have are built around taking chamomile as an infusion (a tea) because that was historically how chamomile was consumed. Comparing a lab made extract to a cup of tea is just not the same thing.

We also have to know if we were talking about the same plant in many old texts than the plant we use today. Older herbals did not always separate plants with the precision we have today and c ommon naming conventions sometimes grouped aromatic plants together. There is an old German herbal that describes a theoretical uterine stimulation affect because the plant has an affect on smooth muscle tissue. This text is not even referring to the same chamomile we have today and the risk is theoretical only – I don’t think someone’s theory on a different plant hundreds of years ago is relevant to consider in the face of how much cultural use we have.

Why Do I Even Care?

I care because chamomile can be a helpful ally for many pregnant people who have very few options to turn to. Pregnancy often brings digestive discomfort, nausea, disrupted sleep, and heightened nervous system activation, and chamomile has a long history of use as a carminative and antispasmodic that helps relax digestive tension. Its flavonoid content, including apigenin, is associated with gentle calming effects, and while I always want to highlight that Chamomile is not a true sedative, many people experience a nice relaxation effect that can support sleep and overall resilience.

So with all of this wide spread use – we have something that rarely comes up in herbalism – we actually do have some formal research of chamomile’s benefits – Here is a randomized clinical trial showing effectiveness for nausea as well as other herbal remedies https://ijogi.mums.ac.ir/article_11969_en.html?

This does not serve as a blanket safety declaration, but it does remind us that chamomile exposure in pregnancy has occurred within controlled settings without catastrophic outcomes becoming the headline.

Supportive, however, does not mean universally appropriate.

• I become more conservative with very high daily intake or concentrated extracts, particularly later in pregnancy.
• I always avoid internal use of essential oils due to their concentrated chemistry
• And of course always consider allergies and other medications.

Anyone with an Asteraceae allergy should avoid chamomile altogether, and higher-risk pregnancies always warrant individualized guidance. ALL herb use in pregnancy deserves careful consideration, but my real questioning in this article is of the blanket unsafe label chamomile has been given. I hope this gives a peak into how my risk assessment actually works in practice. Safety depends on dose, preparation, timing, physiology, and the nuances of the person sitting in front of me.

Where I Land Clinically

We see centuries of widespread use without a solid pattern of risk

Modern studies even when extensive, don’t reliably point to concern

The phytochemistry reflects a low risk

Mechanistic action is in alignment

There are some real benefits to working with chamomile during pregnancy

Clinical nuance always matters as does individual risk factors. All that said my opinion is that in normal low risk pregnancies the statement that chamomile will cause harm is not backed by a wide picture analysis of herb safety consideration.

Again, if you are uncomfortable with an herb, you do not need anyone’s opinion to justify skipping it.

I do feel the call to do this review though becuase Chamomile has been doing steady, reliable work alongside humans for a very long time. My responsibility is not to convince anyone to use it. My responsibility is to keep the conversation anchored in evidence and critical reasoning and to think about this in an objective way to help you decide what you’re comfortable with.