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Sleep problems may affect up to 78% of pregnant women, and insomnia tends to get worse as pregnancy continues. Many pregnant women may wonder whether melatonin can serve as a safe solution for their sleepless nights. Here is what evidence indicates regarding melatonin use 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.
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 could also account for the anti-inflammatory properties of melatonin in high-risk pregnancy complications, and its association with healthy fetal development.
While animal studies may suggest otherwise, human clinical studies indicate that melatonin is probably safe during pregnancy and breastfeeding. An extensive scoping review of human studies found no major safety issues or adverse events in clinical trials.
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 rates of complications in newborns. 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.
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.
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."
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 blood levels of melatonin over 20 times higher than normal circadian levels.
Animal models have suggested that exposure to very high doses of melatonin does not have a negative impact on 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.
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, but more studies are necessary to elucidate clinical implications.
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 sleep hygiene improvement. CBT-I approaches have been shown to be effective in treating insomnia in pregnancy without medication exposure.
For women who are considering alternatives to medication for sleep, magnesium supplementation may be a safer option, and we have pregnancy safety data for magnesium use.
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.
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.
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.
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 and structured CBT-I programs have demonstrated efficacy for pregnancy sleep disruptions.
Environmental Options: Changes such as optimizing sleep temperature, using sleep masks, and light management have been documented to improve sleep quality without supplementation or medication.
Relaxation Options: Sleep affirmations and anxiety management are options to address the emotional aspects of pregnancy insomnia.
Research on the use of melatonin in human subjects with intrauterine growth restriction and pre-eclampsia is in its infancy. The full therapeutic potential of melatonin in pregnancy will likely be revealed through ongoing studies.
Many studies have now reported the 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.
From the existing evidence, we are comfortable concluding that melatonin supplementation during pregnancy is probably safe, but there remain gaps in knowledge around effectiveness for sleep disorders and longer-term effects. Sleep disorders are prevalent in the perinatal period, and about 4% of pregnant women report using 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 addressing sleep anxiety 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.
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.
Dr. Shiyan Yeo
Dr. Shiyan Yeo is a medical doctor with over a decade of experience treating patients with chronic conditions. She graduated from the University of Manchester with a Bachelor of Medicine and Surgery (MBChB UK) and spent several years working at the National Health Service (NHS) in the United Kingdom, several Singapore government hospitals, and private functional medicine hospitals. Dr. Yeo specializes in root cause analysis, addressing hormonal, gut health, and lifestyle factors to treat chronic conditions. Drawing from her own experiences, she is dedicated to empowering others to optimize their health. She loves traveling, exploring nature, and spending quality time with family and friends.
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