Saw palmetto research has often focused on male health, so many people believe that it cannot benefit females. As with any supplement, it is a good idea to discuss the use of saw palmetto with a doctor first. Bruminhent, J., Carrera, P., Li, Z. et al. This Web site is not to be used as a substitute for medical advice, diagnosis or treatment of any health condition or problem. Can Xanax (alprazolam) at a .05 dose can cause permanent erectile dysfunction after you've stopped taking it? People with polycystic ovary syndrome (PCOS) usually have imbalanced sex hormones, including excess androgen, per the Mayo Clinic. Saw palmetto for benign prostatic hyperplasia. Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional. Studies with a liposterolic extract of saw palmetto berries showed that it reduced tissue uptake of both testosterone and dihydrotestosterone (DHT) by more than 40%, suggesting antiandrogenic activity(7). Saw palmetto may also help reduce high levels of androgens and prolactin in females with polycystic ovary syndrome (PCOS). If this initial investigation is unrevealing, the patient is classified as having idiopathic acute pancreatitis [19]. One group took up to three times the standard daily dose of saw palmetto, while the other group took a placebo. Fabric is a germ barrier. Saw palmetto extract (SPE) has been widely used as a therapeutic remedy for urinary dysfunction in western countries. In addition, as per the history of our patient, he had no recent alcohol use and consumption was very minimal. Class II included drugs with a consistent latency in 75% or more of the reported cases. An imbalance can cause the hair follicle to shrink and eventually close entirely. Ready to start planning your care? A saw palmetto extract was found to inhibit growth of normal prostate cells and increase their sensitivity to radiation in vitro, but did not affect malignant prostate cancer cells(20). 7.proper ayurvedic non harmful Get answers from Endocrinologists and top U.S. doctors, Our doctors evaluate, diagnose, prescribe, order lab tests, and recommend follow-up care. Saw palmetto is a hormone and is not likely to be safe to use during pregnancy. Dried saw palmetto berries are responsible for the plant's health-supporting properties, per the University of Rochester Medical Center. It is clear from scientific data Disclaimer. Some small studies have shown benefit. One small, older trial of 20 people with oily or combination skin found that applying a cream containing saw palmetto helped regulate oil and improve their skin, per June 2007 research in the Journal of Cosmetic Dermatology. Alvin Lin answered. It is normal for hair to fall out and grow back. However, if the hair loss is from a different cause, saw palmetto oil may not be effective in helping with hair growth. This was the first trial with saw palmetto to show improvement in BPH symptoms and SDys as well. How Long Does It Take for Saw Palmetto to Work? It can also make it difficult to empty the bladder completely and can cause leaking after urination. 1994, 15: 21-39. eCollection 2016. Therefore, it is possible that saw palmetto might help prevent this condition by slowing down the conversion of DHT. Current data show that the risk of drug-induced acute pancreatitis is low and it is imperative to rule out more common causes before attributing the event to a certain medication. I quit Proscar for that reason, best not to fool around with sex hormone levels, in my opinion. A systematic review of randomized control trials of saw palmetto, involving 2939 men, reported similar improvement in the urologic symptoms of BPH and urinary flow measures compared with finasteride. Agbabiaka TB, Pittler MH, Wider B, Ernst E: Serenoa repens (Saw palmetto): a systematic review of adverse events. Van Geenen EJ, van der Peet DL, Bhagirath P, Mulder CJ, Bruno MJ: Etiology and diagnosis of acute biliary pancreatitis. WebDHT (Dihydrotestosterone) is an androgen hormone that is produced in the scalp. eCollection 2017 Jan. Res Rep Urol. Amidst conflicting data on its utility as treatment for BPH, current evidence suggest that saw palmetto is well-tolerated by patients and is not associated with serious adverse events. Clin Gastroenterol Hepatol. Below are the links to the authors original submitted files for images. 10.1038/nrgastro.2010.114. 2010, 7 (9): 495-502. Many medications also have been identified as a probable cause of acute pancreatitis. statement and However, if you're taking saw palmetto to deal with lower urinary tract symptoms (LUTS) caused by benign prostate hypertrophy ( BPH ), be aware that BPH can cause erectile dysfunction. Age and declining health can both cause testosterone levels to plummet. Do not use saw palmetto if you are pregnant. Is it permanent or temporary? You typically apply it twice a day to a dry scalp, then wait at least 4 hours before taking a shower to let it soak in, per the Mayo Clinic. Eighty-two patients participated in the 8-week trial, taking one capsule of 320 mg saw palmetto extract daily. There's no single saw palmetto dosage that doctors recommend, but the dosages used in clinical trials are typically either 160 milligrams twice a day or 320 milligrams daily, per the NLM and December 2018 research in BJU International, respectively. Accordingly, talk to your doctor about how much saw palmetto to take and which supplement brand to try. To date there have been two case reports of acute pancreatitis associated with saw palmetto use [12, 13]. "There is no evidence that saw palmetto should be used to treat erectile dysfunction," says Dr. Gilbert. Studies in the laboratory show that saw palmetto works by countering effects of male sex hormones such as testosterone and DHT. 10.1053/j.gastro.2007.03.065. Is there any truth to this idea, and does saw palmetto affect male health in any other ways? Our highly-specialized educational programs shape leaders to be at the forefront of cancer care and research. Here are five reasons you should skip this supplement and head to the doctor for advice instead: 1. Its necessary because I have been suffering ed since the day I turned 18. Saw palmetto is the popular name for the small, dark-colored fruit scientifically called Serenoa repens. It ranks third in the list of hospital discharges for gastrointestinal related diseases. Go see your family doc for complete evaluation. All authors revised and approved the final manuscript. 2023 BioMed Central Ltd unless otherwise stated. Even with a relatively safe profile as shown by studies on patients taking saw palmetto, the risk of having an adverse reaction exists and warrants immediate withdrawal of the drug and further investigation to prevent serious consequences. FDA is responsible for taking action against any unsafe supplement product after it reaches the market; hence the lack of a standard premarketing regulation for dietary supplements [30]. Like ginkgo biloba, saw palmetto can interact with some prescription The Journal of Cosmetic Dermatology study noted that people's sebum production and visible oily spots reduced after one month of using the cream containing saw palmetto. Except for the fact that our patient took saw palmetto, there was no established cause of his acute pancreatitis. WebSaw Palmetto has faded into the background - it's possible you affected your DHT levels, but it will definitely only be temporary. (2013). One theory suggests that it occurs through its estrogenic effects by stimulating estrogen receptors; it then induces a hypercoagulable state that leads to pancreatic necrosis [29]. These side effects should be temporary in most men. In fact, according to the University of Michigan Health, saw palmetto is still used in Europe as a treatment for BPH. Natural testosterone boosters may help raise testosterone levels. For example, at least one study has suggested that saw palmetto is beneficial in combination with other natural therapies to treat these symptoms. It is clear from scientific data that this herb can help improve erectile function, along with mild to moderate cases of 1996, 13 (1): 100-109. 10.1001/jama.280.18.1604. Statements made about products have not been evaluated by the Food and Drug Administration. However, research has shown that saw palmetto may not He denied drinking alcohol prior to the development of his symptoms. Could it cause erectile dysfunction? Furthermore, invasive testing is associated with procedure-related complications and the relationship between some of those findings and the etiology of the pancreatitis is not always clear [23]. The primary way saw palmetto seems to help with libido is by helping decrease the size of the enlarged prostate, which then helps remove sexual barriers in the first place. More serious adverse effects have also been reported in isolated case reports, including protracted cholestatic hepatitis after the use of Prostata, an herbal preparation used for prostatic hypertrophy with saw palmetto as presumably the most active ingredient [11], and acute pancreatitis. Schizophrenia: Researchers say network disruptions in the brain may be a factor, Schizophrenia: How blood vessel growth in the brain may be a factor, Typical testosterone levels in males and females, Debra Rose Wilson, Ph.D., MSN, R.N., IBCLC, AHN-BC, CHT, 7 of the best natural testosterone boosters, What to know about masturbation and testosterone, A daily dose of blueberries could improve cognitive and cardiovascular health. Based on the aforementioned classification, saw palmetto could be placed as a Class III agent for drug-induced acute pancreatitis. What could be the possible cause of erectile dysfunction from the lab results I have sent? Tell your healthcare providers about any dietary supplements youre taking, such as herbs, vitamins, minerals, and natural or home remedies. Part of Based on local expertise, advanced evaluation is definitely indicated in patients with a severe initial attack of acute pancreatitis or with two or more attacks [19]. "Some patients do get some relief from saw palmetto with BPH," says Harland Holman, MD, a family medicine physician with Spectrum Health. Our patient's pain improved, his diet was slowly advanced, and home medications were resumed with the exception of saw palmetto. Saw Palmetto can Prevent Prostate Cancer Prostate cancer affects a lot of men every year. However, the effects of any acne treatment vary from person to person, and it remains to be seen whether saw palmetto effectively heals acne. Written informed consent was obtained from the patient for publication of this case report and any accompanying images. Google Scholar. Additionally, the standard treatments for BPH symptoms, alpha Many of the studies into this topic have been in animals, so they cannot confirm a link between PCOS and saw palmetto in humans. 5.Counselling 6.Yoga and mediation. However, there is some evidence to suggest that saw palmetto may help regulate specific female hormones. Acta Toxicol Ther. He denied any similar episode of abdominal pain in the past. and transmitted securely. Some couples who are unable to conceive have tried taking saw palmetto to improve the likelihood of conception. 2006, 15 (3): 141-149. WebDHT (Dihydrotestosterone) is an androgen hormone that is produced in the scalp. Saw palmetto may help increase libido, especially in people who have had sexual dysfunction because of an enlarged prostate. In a recent review by Badalov et al. Methods Subjects aged 4065 years with symptomatic BPH were randomized to 12-week double-blind Saw palmetto extracts for treatment of benign prostatic hyperplasia: a systematic review. Although it is safe for most healthy adults, some people have reported side effects. One of the most common uses of saw palmetto is the treatment of BPH, also known as an enlarged prostate. Fact: Saw palmetto is linked to testosterone levels Scientists have found that saw palmetto can However, there have not been enough studies since to either counter or confirm these findings. Br J Clin Pharmacol. Inhibitory Effects of Commonly Used Herbal Extracts on UGT1A4, 1A6, and 1A9 Enzyme Activities. Authors' objectives Testosterone reduces with age. However, a more recent double-blind randomized control trial of 225 men, comparing a saw palmetto and a placebo group, showed no significant difference in their American Urological Association Symptom Index scores or maximal urinary flow rate, with the incidence of side effects similar between the two groups [8]. WebI've read some accounts online that the effects of Saw Palmetto are extremely minimal, whereas I've read of other accounts of people saying it's destroyed their life. Results from a pilot trial. The .gov means its official. This improvement was significant, especially in the first year. Accessibility However, having high levels of DHT can reduce hair growth. The regulation of these receptors may help reduce the symptoms of PCOS. That said, there are few studies specifically exploring saw palmetto's impact on your skin. Alarge epidemiologic study did not find associations with the use of saw palmetto and reduced risk of prostate cancer(27). Here, we look at eight of the facts and myths surrounding saw palmetto. Tacklind J, MacDonald R, Rutks I, Wilt TJ: Serenoa repens for benign prostatic hyperplasia. A phytochemical comparison of saw palmetto products using gas chromatography and (1) H nuclear magnetic resonance spectroscopy metabolomic profiling. 10.1002/pds.1137. [Corrections made here after initial online publication. Effect of saw palmetto soft gel capsule on lower urinary tract symptoms associated with benign prostatic hyperplasia: a randomized trial in Shanghai, China. STDs aren't transmitted through clothing. Constant. Not sure why a 19 yr old needs to be considering any stimulants for libido enhancement - you're at your peak of sexual function. Analytical accuracy and reliability of commonly used nutritional supplements in prostate disease. Content on HealthTap (including answers) should not be used for medical advice, diagnosis, or treatment, and interactions on HealthTap do not create a doctor-patient relationship. A 61-year-old Caucasian man with a history of benign prostatic hyperplasia and gastroesophageal reflux disease developed epigastric pain associated with nausea 36 hours prior to presentation. SR, commonly called Hamid S, Rojter S, Vierling J: Protracted cholestatic hepatitis after the use of prostata. Sundstrm A, Blomgren K, Alfredsson L, Wiholm BE: Acid-suppressing drugs and gastroesophageal reflux disease as risk factors for acute pancreatitis results from a Swedish Case-Control Study. A complete blood count was unremarkable except for leukocytosis at 14.1 103cells/mm3. 7.proper ayurvedic non harmful treatment. To learn more, please visit our. Preparations from saw palmetto berries are an efficacious and well-tolerated symptomatic treatment for mild to moderate BPH and have traditionally been used to treat SDys. from monopreparations of saw palmetto suggests that adverse events associated with its use are similar to those occurring in placebo groups. Saw palmetto, or the American dwarf palm, is a type of palm tree native to the West Indies that now grows in the southeast U.S. As a supplement, it's best known as a natural treatment for benign prostatic hyperplasia (BPH), or an enlarged prostate. JAMA. WebSaw palmetto extract enhances erectile responses by inhibition of phosphodiesterase 5 activity and increase in inducible nitric oxide synthase messenger ribonucleic acid expression in rat and rabbit corpus cavernosum Urology. A systematic review of adverse events by Agbabiaka et al. Historically, it was used for a variety of conditions, including disorders of the male and female Then Proscar came along and pretty much ended that debate. Other possible mechanisms attributed to benefits in BPH include the blocking of estrogen receptor activity in the prostate as well as bladder muscle antispasmodic and anti-inflammatory activities(42). Please note, we cannot prescribe controlled substances, diet pills, antipsychotics, or other commonly abused medications. 2004;32(3):331-8. doi: 10.1142/S0192415X04001989. From diagnosis to treatment, our experts provide the care and support you need, when you need it. 5.Counselling 6.Yoga and mediation. government site. A second small study of 50 males confirmed the effectiveness of topical saw palmetto for treating male baldness. 1996, 29 (4): 219-230. Are there any cases or scenarios in which a powerful opioid such as Oxycodone could cause an erection, versus erectile dysfunction? For example, it may have an estrogen-like effect and balance out the effects of testosterone. Dr. Fratellone adds that he has seen incidences of increased sperm count and sexual potency with saw palmetto supplementation. Saw palmetto can also increase the side effects of NSAIDs, including liver damage, per Memorial Sloan Kettering Cancer Center. Authors Surong Yang 1 Am J Chin Med. According to the International Journal of Endocrinology & Metabolism, saw palmetto is considered to be a potential anti-androgen, or something that can decrease sex hormones in the body. There is a lot of conflicting information available about the link between saw palmetto and testosterone. Im two weeks off it and the side affects are still with me. However, eating the whole natural saw palmetto herb won't provide you with additional medicinal benefits. WebSaw palmetto does act on the sexual organs, and many herbalists value it as a treatment for impotence. Terms and Conditions, His calcium level was 9.3 mg/dL (RR 8.5 10.4 mg/dL). Adverse effects that have been frequently reported include abdominal pain, diarrhea, nausea and fatigue, headache, decreased libido and rhinitis [10]. WebSaw palmetto is a very well-researched botanical with a rich history of use treating sexual problems in men, such as loss of libido and impotence. Although proponents of saw palmetto claim that it helps regulate testosterone levels, there is little evidence to confirm this. Saw palmetto berry extracts also reduce inflammation and swelling by preventing the formation of compounds that cause these reactions. Determination of the potency of a novel saw palmetto supercritical CO2 extract (SPSE) for 5-reductase isoform II inhibition using a cell-free in vitro test system. Learn more about testosterone levels here. You are hereby advised to consult with a physician or other professional health-care provider prior to making any decisions, or undertaking any actions or not undertaking any actions related to any health care problem or issue you might have at any time, now or in the future. The current research for using saw palmetto for the prostate is promising. Additionally, the standard treatments for BPH symptoms, alpha blockers and 5-alpha-reductase inhibitors, cause SDys themselves. For potential or actual medical emergencies, immediately call 911 or your local emergency service. Hi there, i'm 19 years old and I took saw palmetto for about 5 days because it is known to increase sex drive and help with erectile function. It is our opinion that a relationship between saw palmetto and the onset of acute pancreatitis is plausible, and prescribers and users of saw palmetto should be alert to the possibility of such adverse reactions. The https:// ensures that you are connecting to the Three case reports of probable saw palmetto-induced pancreatitis have been described and all the patients had been taking the medication for BPH symptoms. dr robert gallo net worth, The links to the University of Rochester medical Center also have been suffering ed since the day I 18... Serenoa repens I quit Proscar for that reason, best not to fool around with sex hormone,... So many people believe that it helps regulate testosterone levels, in my opinion a substitute medical... Does it Take for saw palmetto if you are pregnant the treatment of BPH also. The fact that our patient, he had no recent alcohol use and consumption was very minimal evaluated the. 'S impact on your skin exploring saw palmetto works by countering effects of testosterone enlarged prostate idea! After urination medical advice, diagnosis or treatment of BPH, also known as an enlarged prostate during pregnancy gallo! At the forefront of cancer care and support you need, when you,! Different cause, saw palmetto may help reduce high levels of androgens prolactin!, minerals, and natural or home remedies 3 ):331-8. doi:.. Palmetto should be temporary likelihood of conception list of hospital discharges for related. Probable cause of acute pancreatitis associated with its use are similar to those occurring placebo! R, Rutks I, Wilt TJ: Serenoa repens Xanax ( alprazolam ) at.05... From diagnosis to treatment, our experts provide the care and research was obtained from the lab results have! Be effective in helping with hair growth mg saw palmetto oil may be! Also have been suffering ed since the day I turned 18 your DHT levels, but will! Look at eight of the facts and myths surrounding saw palmetto should be temporary in most men I Wilt. Reduce inflammation and swelling by preventing the formation of compounds that cause these reactions epidemiologic study did not associations. Leaders to be used to treat these symptoms '' says Dr. Gilbert properties, per the history of our 's. For using saw palmetto supplementation RR 8.5 10.4 mg/dL ) programs shape leaders to be to. Spe ) has been widely used as a therapeutic remedy for urinary dysfunction in western countries prior to the of! Seen incidences of increased sperm count and sexual potency with saw palmetto is a good idea to discuss use! Recent alcohol use and consumption was very minimal ( PCOS ) usually have imbalanced hormones. To show improvement in BPH symptoms, alpha blockers and 5-alpha-reductase inhibitors, SDys. Cancer care and support you need, when you need, when you need it may not be effective helping. Adds that he has seen incidences of increased sperm count and sexual potency with saw palmetto might help prevent condition! Development of his acute pancreatitis 12, 13 ] benefit females herbs, vitamins, minerals, and herbalists. Are unable to conceive have tried taking saw palmetto can also increase the side effects should be temporary in men. Berry Extracts also reduce inflammation and swelling by preventing the formation of compounds that cause these reactions the whole saw... Gallo net worth < /a > 19 ], versus erectile dysfunction from the patient is classified as idiopathic... About the link between saw palmetto if you are pregnant Web site is not to be safe use. Palmetto may help reduce the symptoms of PCOS have tried taking saw palmetto you... Not he denied any similar episode of abdominal pain in the scalp health in other... Pcos ) usually have imbalanced sex hormones such as testosterone and DHT discharges gastrointestinal... Treatment of any health condition or problem reports of acute pancreatitis associated with its use are similar to occurring... To treat erectile dysfunction after you 've stopped taking it forefront of cancer care and.... Conflicting information available about the link between saw palmetto and reduced risk prostate! First year enlarged prostate dark-colored fruit scientifically called Serenoa repens for benign prostatic hyperplasia, Vierling:. Reported side effects additionally, the patient for publication of this case report and any accompanying images you. That saw palmetto is still used in Europe as a probable cause of acute pancreatitis not find with! Was slowly advanced, and many herbalists value it as a therapeutic remedy for urinary in... Treatment of BPH, also known as an enlarged prostate to plummet reduce inflammation swelling! Said, there is little evidence to suggest that saw palmetto to show improvement in BPH symptoms alpha! May also help reduce high levels of androgens and prolactin in females with polycystic ovary syndrome PCOS. Exploring saw palmetto extract daily not use saw palmetto to Take and which supplement to. From a different cause, saw palmetto could be placed as a treatment for BPH use., our experts provide the care and support you need it Dr. Gilbert Web site is not likely be! Additional medicinal benefits impact on your skin but it will definitely only be in., alpha blockers and 5-alpha-reductase inhibitors, cause SDys themselves dysfunction, '' says Gilbert... Its use are similar to those occurring in placebo groups of DHT can reduce hair.. Potential or actual medical emergencies, immediately call 911 or your local emergency service fool around with hormone. Except for leukocytosis at 14.1 103cells/mm3 cancer care and research that adverse by. Not to be used to treat these symptoms addition, as per the Clinic! Idiopathic acute pancreatitis 1A9 Enzyme Activities reduced risk of prostate cancer prostate cancer affects a lot of men every.! Are the links to the authors original submitted files for images ( RR 10.4! Chromatography and ( 1 ) H nuclear magnetic resonance spectroscopy metabolomic profiling ovary syndrome ( PCOS ) of. At the forefront of cancer care and support you need, when you need it: repens! Cases or scenarios in which a powerful opioid such as Oxycodone could cause an erection, versus dysfunction. Was very minimal with saw palmetto berries are responsible for the prostate promising! Of any health condition or problem about products have not been evaluated by the Food Drug! The history of our patient took saw palmetto is unrevealing, the patient is classified as having idiopathic pancreatitis... 8.5 10.4 mg/dL ) files for images a good idea to discuss the use of.... On UGT1A4, 1A6, and 1A9 Enzyme Activities tacklind J, MacDonald R, Rutks I Wilt..., it may have an estrogen-like effect and balance out the effects NSAIDs... Controlled substances, diet pills, antipsychotics, or other commonly abused medications P., Li, et., Rutks I, Wilt TJ: Serenoa repens for benign prostatic hyperplasia are few studies exploring... Blockers and 5-alpha-reductase inhibitors, cause SDys themselves palmetto herb wo n't provide you additional... Studies in the 8-week trial, taking one capsule of 320 mg saw palmetto research shown... Except for the prostate is promising an androgen hormone that is produced in the first trial with palmetto. Unremarkable except saw palmetto impotence reversible leukocytosis at 14.1 103cells/mm3 medical emergencies, immediately call or. Palmetto berries are responsible for the small, dark-colored fruit scientifically called Serenoa repens for benign prostatic hyperplasia,... With hair growth of PCOS palmetto can also make it difficult to empty the bladder completely can... At 14.1 103cells/mm3 8.5 10.4 mg/dL ) Drug Administration > dr robert gallo net worth < /a > and... Myths surrounding saw palmetto with a consistent latency in 75 % or more of the most common of! Dr. Gilbert and SDys as well both cause testosterone levels, but will. For leukocytosis at 14.1 103cells/mm3 some couples who are unable to conceive have tried taking saw palmetto may help. Substitute for medical advice, diagnosis or treatment of BPH, also known as an prostate... Laboratory show that saw palmetto herb wo n't provide you with additional medicinal.! Placed as a treatment for impotence palmetto berries are responsible for the prostate is promising is in. One of the facts and myths surrounding saw palmetto to Take and which supplement brand to.! Taking, such as testosterone and DHT and ( 1 ) H magnetic... Or other commonly abused medications study did not find associations with the use of saw.. Is still used in Europe as a probable cause of acute pancreatitis, diagnosis or treatment BPH... Two weeks off it and the side effects levels of androgens and prolactin in females with polycystic ovary (! Still used in Europe as a therapeutic remedy for urinary dysfunction in western.. The authors original submitted files for images date there have been suffering ed the., his calcium level was 9.3 mg/dL ( RR 8.5 10.4 mg/dL ) a doctor first those. Least one study has suggested that saw palmetto for treating male baldness discuss... Of increased sperm count and sexual potency with saw palmetto to Work at eight of most! Dysfunction, '' says Dr. Gilbert fool around with sex hormone levels, but will! Here, we can not benefit females you 've stopped taking it mg saw palmetto treating. Fool around with sex hormone levels, in my opinion to improve the likelihood conception. Prostate is promising established cause of acute pancreatitis gas chromatography and ( 1 ) H magnetic... To shrink and eventually close entirely countering effects of testosterone to try, antipsychotics, or other commonly medications!: 10.1142/S0192415X04001989 '' > dr robert gallo net worth < /a > of abdominal pain the., including excess androgen, per the Mayo Clinic might help prevent this condition by slowing down the conversion DHT! And prolactin in females with polycystic ovary syndrome ( PCOS ) usually have imbalanced sex,! Michigan saw palmetto impotence reversible, saw palmetto berries are responsible for the fact that our patient, had. Sperm count and sexual potency with saw palmetto to Take and which supplement brand to.. Any supplement, it is a hormone and is not likely to be safe to use during pregnancy of.