Ashwagandha in pregnancy and breastfeeding:
why the answer is still no, but not for the reason you have been reading
Almost everything written in Romanian about ashwagandha and pregnancy rests on a single sentence: that the plant causes miscarriage. We followed that sentence all the way back and ended up at a monograph from the year 2000 which actually said two things at once, and the second one got lost along the way. In the meantime, the first randomised study in pregnant women has also been published. Our conclusion is the same as the authorities': not in pregnancy and not while breastfeeding. But the reason is different from the one doing the rounds, and the difference matters more than it seems.
The short answer:
no, but not because it has been shown to cause harm
Do not take ashwagandha during pregnancy and do not take it while you are breastfeeding. That is the recommendation, and it does not change by the end of the article. What changes is the reason.
The reason circulating in Romanian is that the plant causes miscarriage. The real reason is much simpler and far less dramatic: nobody has tested it enough to know. “It has not been shown to cause harm” and “it has been shown to be safe” are two completely different sentences, and in pregnancy only the second one counts. We do not have the second one.
The difference is not a subtle point of vocabulary. If an article tells you the plant is abortifacient and you later learn that the claim does not hold up, the conclusion you draw is that, therefore, it is fine to take. It is not, but for a different reason, and that reason still stands after the first one falls.
A bad argument for a correct conclusion is still a bad argument. And when it falls, it takes the conclusion with it.
Where the miscarriage story comes from:
a chain of citations that ends in the year 2000
In May 2020, the Danish food authority published a risk assessment that advised against using the plant, citing, among other things, an abortifacient effect. Denmark later banned ashwagandha in supplements, in 2023. The Danish assessment did not produce new data. It cited the World Health Organization monograph from 2009.
The 2009 monograph did not produce new data either. It cited the ashwagandha root monograph published in the year 2000 by an American herbal pharmacopoeia.
And the 2000 monograph, in the original, said two things in the same section: that reports on use in pregnancy are contradictory and that “large but undefined doses” had been reported as having abortifacient activity, but also that the plant had been used traditionally, including in modern Ayurvedic practice, precisely to prevent pregnancy loss and to stabilise the foetus.
The first half travelled on. The second half stopped there.
| Link in the chain | Year | What it says | What it is based on |
|---|---|---|---|
| Articles in Romanian | today | “in higher doses it can induce miscarriage” | no source cited |
| The Danish assessment | 2020 | risk of abortifacient effect | the WHO monograph |
| The WHO monograph | 2009 | repeats the warning | the American monograph from 2000 |
| The American monograph | 2000 | contradictory reports; large undefined doses reported as abortifacient; traditional use to prevent pregnancy loss | ethnobotanical reports |
| The same pharmacopoeia, going public again | 2024 | no traditional or scientific documentation of an abortifacient effect | a re-evaluation of its own literature |
In June 2024, the pharmacopoeia that had published the original monograph went public and said its text had been misrepresented. The phrase used by the organisation's president was “citation distortion”. After reviewing the traditional and scientific literature and consulting experienced Ayurvedic practitioners, they say, no documentation was found, traditional or scientific, of any abortifacient activity. In 2023, the American botanical safety handbook had already moved ashwagandha to class 1, meaning herbs that can be safely consumed when used appropriately.
It is worth saying what this does not mean, too. Class 1 in that handbook is a general-use classification for adults. It is not an approval for pregnancy, and the pharmacopoeia that made the statement is an organisation from the herbal sector, not a regulator. What it dismantled was a claim, not the whole precaution.
What the systematic review found:
“inconclusive” cuts both ways
In 2025 the first systematic review dedicated to exactly this question appeared, later published in Phytotherapy Research by Tallon, Koturbash and Blum. It follows the PRISMA methodology and brings together the available toxicokinetic, toxicodynamic and safety data.
Its conclusions, in the order in which they matter to you:
- historical ethnobotanical reports suggest a possible abortifacient effect, but the authors find citation distortion and a lack of validation in primary sources;
- animal toxicology studies show high tolerance, with no significant reproductive toxicity at doses relevant to human consumption;
- clinical studies in humans have shown no adverse effects on thyroid function, hormonal balance or reproductive health;
- overall, the evidence for significant teratogenic or abortifacient activity remains inconclusive.
That last point is the one the industry has quoted most often, and the one it quotes worst. “Inconclusive” does not mean “clean”. It means the question is still open. The authors themselves close by calling for standardised, high-quality research on fertility and developmental outcomes under controlled conditions. They are asking for what does not exist. And the clinical studies referred to in the third point were carried out in adults who were not pregnant, which is information about a different population.
The same journal also published a second paper, titled “Is ashwagandha an abortifacient?”, by Brendler, which shows fairly well how open the discussion is in the specialist literature right now.
There is one study in pregnant women. One.
70 women, second trimester, twelve weeks
In 2026, Frontiers in Global Women's Health published the first randomised study to give ashwagandha root extract to pregnant women. It appears nowhere in the Romanian articles, even though it completely changes what can be said on the subject.
What it did: it enrolled 70 women in the second trimester, 63 of whom completed the study. One group received 300 mg of root extract twice a day, on top of standard treatment for anaemia. The other received standard treatment only. Duration: 12 weeks. The study is registered in the Indian clinical trials registry.
| What was measured | Extract group | Standard group | Difference |
|---|---|---|---|
| Rise in haemoglobin | 1.06 g/dl | 0.78 g/dl | 0.28 g/dl, p = 0.003 |
| Mean corpuscular haemoglobin concentration | in favour of the extract | 0.73 g/dl, p = 0.017 | |
| Red cell distribution width | in favour of the extract | minus 0.57%, p < 0.001 | |
| Red blood cell count and haematocrit | favourable trend | not significant | |
| Perceived stress score | minus 10.50 | minus 5.35 | p < 0.001 |
| Adverse events | none reported in either group | none serious | |
| Liver, kidney and thyroid tests | no changes to the detriment of the extract | stable | |
The figures are real and we read them in the original. What follows does not dispute them, it puts them in context.
The study was open-label. Nobody was blinded, neither the participants nor the people taking the measurements. The comparator was not a placebo but the absence of any extra capsule. And the two most striking results, perceived stress and sleep quality, are questionnaires filled in by the participants, which is exactly the type of outcome that moves when you know which group you are in. The haematological part is harder to influence that way, because it is measured in a laboratory, but even there the difference between the groups is 0.28 g/dl.
The primary outcome was haematological: haemoglobin and red cell indices in pregnant women in the second trimester, a population in which anaemia is common. The secondary outcomes were perceived stress, sleep quality and a set of safety tests: liver, kidney, cardiac and thyroid. On all of these the study reported results in favour of the extract group or, for safety, no differences to its detriment. No adverse events were recorded.
It did not measure the first trimester, which is the window in which the organs form and in which the question of birth defects makes sense. It did not measure exposure before conception. The published abstract does not report birth outcomes: weight, gestational age, birth defects. It did not follow the children after birth. And it did not include breastfeeding women, who are a completely separate population.
Because a pregnancy safety study is not judged by what it found, but by what it could have found. With 32 exposed women and zero events, the result “nothing happened” is compatible with a risk of up to roughly 9 per cent. That is not a criticism of the authors, who state clearly that it is an open-label study on a small sample. It is a criticism of the way it is going to be quoted.
The arithmetic nobody does:
what a study of 32 women can and cannot see
There is a simple rule in medical statistics, known as the rule of three. If no event occurs among a given number of participants in a study, the upper limit of the 95 per cent confidence interval for the frequency of that event is roughly three divided by the number of participants.
Thirty-two women received extract. Three divided by thirty-two is 9.4 per cent. In other words, if the effect being looked for occurred in one woman in eleven, a study of this size could still report, perfectly correctly, zero events.
This is not speculation and it is not an opinion about the study's authors. It is division.
Why “but it has been used for thousands of years” does not make up for it. Traditional use is information about habits, not about measured outcomes. Nobody counted the pregnancies in India over the last three thousand years, recorded who took the root and in what amount, and compared the outcomes. The lack of that count is precisely why the claim about an abortifacient effect was able to circulate for twenty-five years without a source. The same lack works in the other direction too.
Breastfeeding is a separate question:
and there the figure is not small, it is zero
This part is quick. The American database dedicated to drugs and breastfeeding, the one used by doctors and lactation consultants, has an entry for Withania somnifera. It says three things.
First: the plant is sometimes used in Ayurvedic medicine to stimulate milk production, but no valid clinical study supports this use.
Second, word for word: there are no data on the transfer of any component of the plant into breast milk, nor on its safety or efficacy in nursing mothers or infants.
Third, which is the entry's conclusion: because there is no published experience in breastfeeding, the plant should be avoided, especially when nursing a newborn or a preterm infant.
This is not a precaution borrowed from pregnancy. It is a separate assessment with its own conclusion, and that conclusion is firmer than the one for pregnancy precisely because it has absolutely nothing to rest on in the other direction.
After birth, sedation is not a minor detail. Drowsiness appears among the plant's common effects in the American professional monograph and among the effects reported in the French nutrivigilance file. An adult who falls asleep more easily is a neutral observation. A woman who breastfeeds at night and sleeps with a newborn in the house is a different context, and the product has no study behind it that has measured exactly that context.
What the authorities say, country by country:
and why they do not all say the same thing
There is no single European position. There are national decisions taken in different years, on different grounds, and some of them rest on the very chain of citations from chapter two.
| Who | When | What they decided |
|---|---|---|
| Denmark | 2020, then 2023 | a risk assessment by the Technical University of Denmark, which could not establish a safe lower intake limit, followed by a ban on the plant in supplements |
| France, ANSES | April 2024 | a nutrivigilance opinion and a recommendation to avoid it in pregnant women, breastfeeding women and people with endocrine conditions |
| Poland | 2020 | a maximum of 3 g of root powder per day and a maximum of 10 mg of withanolides per daily dose, with a ban for children, in pregnancy and while breastfeeding |
| European Union | in force | zero authorised health claims for ashwagandha, which is a matter of demonstrated efficacy, not of safety |
| United States, professional monograph | updated | notes that some experts recommend avoiding it in pregnancy because of reports of miscarriage and, in the same paragraph, that the pharmacopoeia cited has stated its report was misrepresented |
The French opinion is worth looking at in detail, because it is the most recent and the most concrete. It rests on eight reports of adverse effects received since 2009, six of which were analysed for causality and four classified as “likely”, among them a case of acute hepatitis. Four of the consumers concerned had a medical history and were taking at least one medicine.
For Romania, we found no specific national restriction on ashwagandha in pregnancy beyond the general rules for food supplements. That is not permission. It is an absence, and in the absence of a local rule, what stands are the manufacturer's recommendations on the label and the advice of the doctor monitoring your pregnancy.
The risks that have nothing to do with pregnancy:
the liver, sedation and the rest of the list
Even if the miscarriage question were closed tomorrow with a clear no, ashwagandha would remain a plant with an open safety file on other fronts. And in pregnancy and breastfeeding the tolerance threshold for any unknown is lower, not higher.
The common effects reported are loose stools, nausea and drowsiness, generally mild. The serious part is the liver. The American professional monograph describes cases in people who had taken between 450 and 1,350 mg per day, with jaundice, itching, nausea, lethargy, abdominal discomfort and raised bilirubin. The database dedicated to drug-induced liver injury counts around 23 published cases up to 2024, with onset 2 to 12 weeks after starting, a cholestatic or mixed pattern, and resolution within one to four months of stopping. Fatal cases or cases requiring a transplant are rare and occur mainly in people with pre-existing liver disease.
The signs that call for a consultation, not an internet search. Itching without a skin rash, dark urine, yellowing of the skin or the whites of the eyes, new fatigue and nausea that does not go away. The window in which the published cases appeared is 2 to 12 weeks after starting the product. If they appear, stop the product and see a doctor.
There is one more thing the American monograph lists explicitly: possible interactions with diabetes medicines, blood pressure medicines, immunosuppressants and sedatives. Pregnancy is the period in which the first two categories appear most often, through gestational diabetes and pregnancy-induced hypertension. We have written separately about which supplements should not be taken together and at what time and about ashwagandha and the thyroid, which is the other endocrine question the French opinion places alongside pregnancy.
If you have taken ashwagandha and only just found out you are pregnant:
what is useful to do and what is not
This is the chapter most people actually come to articles like this for, and it is the chapter missing from all of them.
What is useful:
- stop the product;
- write down exactly what you took, meaning the form, how many milligrams of extract, at what percentage of withanolides, how many times a day and for how many days;
- take the packaging with you to your next appointment, because products differ enormously from one another and “I took ashwagandha” is not medical information;
- tell your doctor or midwife, even if it seems trivial to you.
What is not useful: searching for hours on end. In the published literature there is no documented case of harm caused in humans by the usual supplement doses in pregnancy. There is no proof of the opposite either, and that is what this whole article is about. The two things sit side by side, and neither is a reason for retrospective panic.
An exposure that has already happened is not corrected by worrying. It is corrected by telling someone who is monitoring your pregnancy.
Five claims doing the rounds:
and what happens when you look for their source
There is no published case in humans and no study showing this. The chain of citations stops in the year 2000, at a monograph which, in the same paragraph, also said the plant was used traditionally to prevent pregnancy loss. In 2024, the monograph's authors stated publicly that they had found no documentation of an abortifacient effect, and the 2025 systematic review found citation distortion and a lack of validation in primary sources. The correct verdict is not “false”, it is “not supported by evidence”.
Natural origin tells you nothing about safety. The same plant has around 23 published cases of liver injury, is banned in supplements in Denmark and has a legal dose cap in Poland. And in pregnancy the question is not whether a substance is natural, but whether it has been measured in pregnant women. Here, it has been measured in thirty-two.
There is one study. Randomised, but open-label, with no placebo, in 70 women in the second trimester, 32 of whom actually received extract, for 12 weeks. It reported no adverse events, which is good news and a start. It is not a demonstration of safety, because a sample of this size can only rule out risks greater than roughly 9 per cent.
These are two different questions. A supplement can be sold without having any authorised health claim, and ashwagandha has none. And legal sale in one member state means neither demonstrated safety nor harmonisation: Denmark has banned it in supplements, Poland has capped the dose and explicitly banned it in pregnancy and breastfeeding, and France has recommended avoiding it in the same groups.
Traditional use as a milk booster is real, but the American database dedicated to breastfeeding states explicitly that no valid clinical study supports it and that there are no data either on the transfer of any component into breast milk or on safety for the infant. The entry's conclusion is that the plant should be avoided while breastfeeding, especially with a newborn or a preterm infant.
Why you will not find
a buy button here
ROOTFUL sells gummies with KSM-66 ashwagandha extract. This article has no link to them, and that is not an oversight, it is a decision. A text about pregnancy and breastfeeding has no business sitting next to a buy button.
If you are pregnant or breastfeeding, the answer remains the one in the first line: no. Not because it has been shown to cause harm, but for the reason explained in the chapters above. Talk to the doctor monitoring your pregnancy, and if your question was really about sleep or tiredness, there are things there you can safely discuss with them.
We will come back to ashwagandha in another article, for those who are not in this situation.
Frequently asked questions
There is no published evidence showing this in humans. The claim has been circulating since 2020, when the Danish authority cited the World Health Organization monograph from 2009, which in turn had cited an American monograph from the year 2000. The original text said that reports were contradictory, that large but undefined doses had reportedly been described as abortifacient and, in the same sentence, that the plant had been used traditionally to prevent pregnancy loss. The second half got lost along the way. In 2024, the monograph's authors stated publicly that they had found no traditional or scientific documentation of an abortifacient effect.
Because “it has not been shown to cause harm” and “it has been shown to be safe” are two different things, and we do not have the second one. There is a single randomised study in pregnant women, open-label, with 70 participants in the second trimester, over 12 weeks. A study of this size can only rule out large risks. In addition, Denmark has banned the plant in supplements, and the French authority recommended in 2024 that pregnant and breastfeeding women avoid it.
Published in 2026, it included 70 women in the second trimester, 63 of whom completed it. One group received 300 mg of root extract twice a day plus standard treatment for anaemia, the other standard treatment only. Haemoglobin rose by 1.06 g/dl compared with 0.78 g/dl, a difference between the groups of 0.28 g/dl. No adverse events were recorded, and liver, kidney and thyroid tests remained unchanged. However, the study was open-label, with no placebo, so everyone knew who was getting what.
The American database dedicated to drugs and breastfeeding is categorical: there are no data on the transfer of any component of the plant into breast milk, nor on its safety or efficacy in nursing mothers or infants. The same entry notes that the plant is sometimes used traditionally to increase milk production, but that no valid clinical study supports this use, and it recommends avoiding it, especially with a newborn or a preterm infant.
Stop the product and tell your doctor or midwife exactly what you took: the form, how many milligrams of extract, at what percentage of withanolides and for how many days. Take the packaging with you, because products differ a lot from one another. What is useful to know in the meantime: in the published literature there is no documented case of harm caused by the usual supplement doses in pregnancy. There is no proof of the opposite either. The decision about what to monitor from here belongs to your doctor, not to a search engine.
Because nobody has submitted, or got through, a dossier convincing enough. The European rule is that a health effect can only be attributed to a nutrient with an authorised claim, and only if the product contains a significant amount of it. Ashwagandha has none, just like apple cider vinegar, kombucha, berberine and collagen. This says nothing about the plant's safety. It only says that nobody, including us, is allowed to write in a commercial text that it does something specific.
Note: the information in this article is for educational purposes. It does not replace personalised medical advice, nor the conversation with the doctor or midwife monitoring your pregnancy or breastfeeding. Ashwagandha has no authorised health claims in the European Union, and this article does not attribute any health effect to it. Food supplements are not medicines and are not intended to diagnose, treat or prevent disease. Do not exceed the recommended daily dose. Keep out of the reach of children.
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