2017 Volume 69 Issue 2 Pages 119-125
To date, there has been no published report about migration of an herbal medicine ingredient from the mother to the fetus. This is the first report confirming the migration of a metabolite of an herbal medicine ingredient from mother to fetus. We report the clinical course of the case, with review of the literature. A 35-year-old primipara spontaneously delivered a female baby weighing 3222g at 39 weeks and six days of gestation. The mother had been treated for depression, epilepsy, and Hashimoto’s disease before becoming pregnant, and had taken yokukansan, risperidone, and levothyroxine from 21 weeks and three days of gestation until delivery. Routine umbilical cord blood test showed leukocytosis (26000 /µl), neutrophilia (18070/µl), and increased cortisol (269 ng/ml), in spite of a normal C-reactive protein level. However, the laboratory abnormalities spontaneously normalized by 119 hours after delivery. The leukocytosis, neutrophilia, and increased cortisol were suspected to be caused by glycyrrhetinic acid, a metabolite of licorice in the herbal medicine. Liquid chromatography-mass spectrometry detected glycyrrhetinic acid in the umbilical cord blood. However, glycyrrhetinic acid was not detected in three umbilical cord blood specimens of infants born to mothers who were not taking herbal medicine during pregnancy. In addition, glycyrrhetinic acid in the present case was not detected at 119 hours after delivery. These results suggest that glycyrrhetinic acid is associated with leukocytosis, neutrophilia, and increased cortisol. [Adv Obstet Gynecol, 69(2) : 119-125, 2017 (H29.5)]
