Melatonin Use and Pregnancy: What Pregnant Women Should Consider

‍78% of pregnant women experience sleep problems, and insomnia worsens as pregnancy progresses. Many pregnant women may wonder whether melatonin can serve as a safe solution for their sleepless nights. With sleep difficulties increasingly common and 4% of pregnant women use melatonin supplements, understanding the science and safety profile of this hormone is essential. Natural alternatives to sleep medication and better sleep guide can help pregnant women make informed decisions. Here is what evidence indicates regarding melatonin use during pregnancy.

The Natural Role of Melatonin During Pregnancy

Melatonin levels rise naturally during pregnancy, and concentrations begin rising steadily after week 24, peaking during the third trimester. This natural increase in melatonin plays important biological functions that go beyond sleep. The hormone is central to circadian rhythm regulation and helps establish the body's sleep-wake cycle throughout the gestational period.

Melatonin has been shown to cross the placenta and blood-brain barrier from the maternal circulation to the fetus, and throughout pregnancy melatonin receptors can be found in developing fetuses, even in the earliest weeks of pregnancy. Melatonin is important for establishing healthy circadian rhythms and encourages neurodevelopment in the developing fetus.

Interestingly, the placenta produces melatonin, especially during the first trimester, which suggests that melatonin may be a key hormone in maintaining a healthy pregnancy. This endogenous release of melatonin during pregnancy supports placental health and could also account for the anti-inflammatory properties of melatonin in high-risk pregnancy complications, and its association with healthy fetal development. Research has shown that melatonin's antioxidant properties help protect against oxidative stress, which can negatively impact both maternal and fetal health. By reducing oxidative stress at the cellular level, melatonin may contribute to better pregnancy outcomes and protect developing tissues.

The Evidence for Safety: What Clinical Studies Indicate

While animal studies may suggest otherwise, melatonin is probably safe during pregnancy and breastfeeding. An extensive scoping review found no major safety issues or adverse events in clinical trials. However, it's important to note that the Food and Drug Administration has not specifically approved melatonin supplements for use during pregnancy, as these products are classified as dietary supplements rather than medications. Melatonin vs prescription sleep aids can help inform decision-making.

Research Spotlight: A randomized controlled trial of 180 pregnant women with hyperglycemia received either melatonin (10mg daily from weeks 15-33) or quercetin supplementation. The group taking melatonin had significantly lower newborn complication rates. Three serious complications (hypoglycemia, stillbirth/neonatal death, and birth injury) were completely absent in the melatonin group. Additionally, mothers had improved glycemic control throughout pregnancy. This study is particularly significant for women with gestational diabetes, as it suggests melatonin supplements may offer protective benefits for this population.

Melatonin prevents gestational diabetes complications and improves maternal blood pressure regulation. Women with gestational diabetes showed improvements in metabolic markers and reduced risk of birth complications. Melatonin supports women with gestational diabetes, representing an important area of ongoing investigation, though more research is needed to establish clear clinical guidelines.

Nevertheless, this encouraging data has some important limitations. There are no randomized controlled trials looking at efficacy and safety using melatonin as a therapeutic option for sleep disorders in pregnancy. Most studies have evaluated its antioxidant properties as opposed to promoting sleep. The National Center for Complementary and Integrative Health notes that while melatonin research shows promise, comprehensive safety data specifically for sleep issues remains limited. Melatonin's effects and side effects is crucial for making informed decisions.

Dr. Michael Grandner, Sleep Expert and Professor of Neuroscience and Physiological Sciences, explains: "While there is preliminary research that looks promising in terms of melatonin's safety profile during pregnancy, we need to be cautious recommending it for insomnia in pregnant women because there haven't been any good clinical trials looking specifically at sleep disorders." 11 ways to sleep better can provide pregnant women with safer alternatives.

Potential Risks and Contraindications

During pregnancy, melatonin does increase naturally, so the predominant risk associated with supplementation could be too much melatonin being introduced. Common supplement doses (1-10 mg) could increase melatonin levels 20 times higher than normal circadian levels.

Animal models suggest safety at very high doses for developing fetuses; however, there have not been studies evaluating the impact of high melatonin levels on human fetal development. Some animal models have suggested there may be reduced birth weight and altered circadian rhythm development in juvenile animals. Studies examining embryo quality and early developmental outcomes are still in preliminary stages.

Another emerging risk has to do with melatonin's influence on labor timing. Research has established a positive association between melatonin levels during pregnancy and uterine contractions in women after 35 weeks of pregnancy. This relationship supports the notion that supplemental melatonin may be a potential influence on the timing of labor initiation, possibly affecting preterm birth risk, but more studies are needed to elucidate clinical implications.

Considerations for Breastfeeding Mothers

For women who are breastfeeding, understanding melatonin's presence in breast milk is important. Melatonin naturally appears in breast milk, with concentrations varying throughout the day to help establish infant sleep-wake cycles. Breast milk melatonin levels are lowest during daytime hours and highest at night, which helps signal appropriate sleep timing to nursing infants.

When mothers take melatonin supplements while breastfeeding, melatonin concentrations increase in breast milk beyond natural levels. While current evidence suggests this is likely safe, the American Academy of Sleep Medicine recommends that breastfeeding women discuss any supplement use with their healthcare provider. The long-term effects remain unclear on infant development and sleep pattern formation, warranting a cautious approach.

Expert Perspectives on Sleep for Pregnant Patients

Dr. Suzanne Gorovoy, Sleep Expert, Clinical Psychologist, and Behavioral Sleep Medicine Specialist, emphasizes: "Because we have limited information about melatonin supplementation to assist with sleep-related issues during pregnancy, I primarily recommend evidence-based behavioral interventions such as CBT-I (Cognitive Behavioral Therapy for Insomnia) as first-line treatment for pregnant women who are experiencing sleep challenges."

Instead of automatically beginning sleep medicines, pregnant patients may wish to try natural sleep aids and hygiene. CBT-I is effective for pregnancy insomnia treatment without medication exposure. CBT-I addresses sleep difficulties effectively without introducing supplements or medications into the pregnancy. How CBT-I transforms sleep is well-documented for insomnia treatment.

For women who are considering alternatives to medication for sleep, magnesium-rich foods improve sleep may be a safer option, and we have pregnancy safety data for magnesium use. Addressing sleep problems through multiple modalities can provide relief while minimizing potential risks.

Clinical Considerations for Practitioners

Studies have not been done to see if taking melatonin supplements can increase the chance of other pregnancy-related problems such as preterm delivery or low birth weight. This gap in research calls for practitioners to consider weighing the potential benefits against unknown risks. Home remedies for insomnia and improving sleep hygiene can be valuable non-pharmacological approaches.

Dr. Areti Vassilopoulos, Sleep Expert, Pediatric Health Psychologist, and Assistant Professor of Child Psychology, states: "Because of the lack of sufficient safety data, we need to develop individualized decisions regarding treatment, given the severity of the sleep problem, stage of pregnancy, and other treatment options prior to establishing melatonin supplementation."

When we think about melatonin, clinical trials have generally used dosing that starts around the second trimester at a dose of anywhere from 4-10 mg daily. However, we typically counsel the women we treat that while we recognize that melatonin is being used in some pregnant women, medications with better characterized reproductive safety profiles are preferred. Particular attention should be given to women in their third trimester, when natural melatonin levels peak.

No consideration of melatonin supplementation for sleep disorders in pregnancy should overlook the fact that sleep compression therapy and sleep restriction methods are behavior-based options with established safety profiles. Sleep restriction therapy works effectively as a safe alternative.

Alternative Sleep Strategies in Pregnancy

Prior to considering the use of a dietary supplement, there are several different evidence-based options pregnant women can implement in their lifestyle:

Behavioral Options: Sleep coaching transforms your nights and structured CBT-I works for insomnia demonstrating efficacy for pregnancy sleep disruptions. These approaches target the underlying causes of sleep problems and provide lasting improvements in sleep quality. Measure and improve sleep quality to track progress over time.

Environmental Options: Changes such as optimizing sleep temperature, using sleep masks, and boosting circadian rhythm have been documented to improve sleep quality without supplementation or medication. For women experiencing frequent nighttime awakenings, stop waking up at night can be particularly beneficial.

Relaxation Options: Managing sleep anxiety and breaking sleep anxiety cycles are options to address the emotional aspects of pregnancy insomnia. 5 tips for natural sleep patterns can also provide relief without medication.

Future Research Directions

Research on melatonin for intrauterine growth restriction and pre-eclampsia is still early. Melatonin's therapeutic potential in pregnancy will likely be revealed through ongoing studies, particularly in understanding how gestational diabetes outcomes might be improved through targeted supplementation.

Many studies report positive effects of melatonin supplementation in pregnancy, but we must conduct well-designed studies to investigate potential clinical outcomes, and the possible use of melatonin supplementation in pregnancy.

The research agenda is to focus on designing studies that will define optimal dosing and melatonin use in pregnancy, to investigate which complications may be potentially alleviated by melatonin supplementation, and produce useful sleep outcomes for this population.

Melatonin During Pregnancy

From the existing evidence, we are comfortable concluding that melatonin is probably safe during pregnancy, but there remain gaps in knowledge around effectiveness for sleep disorders and longer-term effects. Sleep disorders are prevalent perinatally, and about 4% of pregnant women use melatonin.

In light of the above, mothers-to-be will benefit by using the first-line options that have existing evidence for improving sleep quality and sleep anxiety recovery roadmap with behavior-based interventions. For women who do choose to explore melatonin supplementation options, it should be with a healthcare provider who has experience in both sleep medicine and obstetric care for the best outcomes for maternal and fetal health and sleep. 5 effective ways to improve sleep naturally before considering supplementation.

If you're on medication or supplements and want to understand the potential side effects, read more about supplements like l-theanine or melatonin and what a melatonin hangover means as well as medication like ambien, dayvigo and quviviq. Or if you're ready to try Sleep Reset's unique CBT-I based program, take our free sleep assessment now to begin!

Always consult with your healthcare provider prior to starting any supplement while pregnant. This article is meant for educational purposes and should not be used as medical advice.