**5. Conclusions and recommendations**

#### **5.1. Chinese medicines are not free of risk**

The active ingredients of the Chinese medicines are chemicals that are similar to prescribed drugs. Chinese medicines are not free of risk and they have the same potential to cause adverse effects.

In this overview of Chinese medicines for pregnancy with well-characterized reproductive toxicity, though these Chinese medicines are not commonly used in clinical practice, some of them could result in severe consequences when given in over dosages or even normal dosages. In the communities which use Chinese medicines, special attention should be paid and precautions should be taken to prevent mistaken overdoses of the Chinese medicines.

#### **5.2. International guideline is necessary**

It should be acknowledged that some of the studies from animals may not be comparable to human responses, both referring to Chinese medicines and Western medicines. Despite variations in clinical practice and therapeutic prescription, Chinese medication in Traditional Chinese Medicine should comply with modern pharmacological principles as in Western Medicine. Chinese medicines may be beneficial but may also adversely affect both mothers and fetuses in utero. International regulations have not been designed or specified to categorize the Chinese medicines for use in pregnancy. Until now, no detailed/well-designed reproductive toxicity and pharmacotoxicity studies are available to assess the potential risk of Chinese medicines during pregnancy, as much as true that conventional medications are not well tested in pregnancy too.

Before the detailed studies become available, here we take the initiative in gathering information about the adverse effects and potential toxicity of the Chinese medicines for pregnancy from Chinese Pharmacopeia and the extensive literature studies.

#### **5.3. Recommendations**

We hope more comprehensive and systematic experiments will be carried out. Until more reliable and scientific research data become available, clinicians should appraise both the risk and benefit before recommendations to pregnant women or women who plan to be pregnant. Both Chinese and Western physicians should explicitly elicit and document the history of the use of any Chinese medications. This is to prevent and recognize potential serious problems associated with their use and should encourage their discontinuation. More studies and clinical trials in humans with a larger sample size are obviously mandatory. We do recommend more systematic basic investigation of the safety use of Chinese medicines for pregnancy.
