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Safe to take melatonin while pregnant?

Research indicates that melatonin could be a promising natural supplementary aid.

IF you’re pregnant and reading this, congratulations. Motherhood is an exciting and rewarding journey that many  women cherish,  despite  having  to  overcome  certain issues  during pregnancy,  such  as  morning sickness, unusual cravings and sleep disturbances. Most of you might brush the latter off as common fatigue due to pregnancy, but it is very important to monitor your sleep cycle, as it has an effect on the development of that precious life growing in your womb. Many women experience some degree of sleep disturbance during pregnancy. A 1998 poll by the National Sleep Foundation in the Unites States found that 78% of pregnant women experienced disturbance in their sleep patterns.

In some cases, the disruption might be so severe that some form of medical intervention is required. Pregnant women are wary – and rightly so – of taking any kind of drugs during pregnancy, hence why many with sleep problems are keen to know more about the use of “natural” agents, such as melatonin supplements, a popular natural remedy for sleep problems.

Circadian rhythm

The body actually produces melatonin. It is a hormone secreted by the pineal gland, a pea-sized endocrine gland behind the brain, which is involved in regulating normal sleep-wake cycles. The circadian rhythm helps the body adapt to the daily cycle of day and night. Essentially, it is our body’s internal clock that monitors functions like cell regeneration, hormone production and sleep. The sleep-wake cycles of the mother are seemingly highly important in programming the foetal clock, either via the melatonin signal and/or by other means.

This being the case, it is imperative that during pregnancy, and perhaps especially during the last trimester, pending mothers maintain a regular sleep/wake and light to dark cycle. The light to dark cycle is especially important because unusual exposure to light at night should be avoided as it causes melatonin suppression. There is a large amount of experimental and clinical data showing that disturbances caused by these processes have untoward consequences for the foetus.

The regulated release of melatonin serves as a signal in a pregnant woman’s body to initiate uterine contractions that lead to childbirth. The majority of parturitions (births) occur at night. This is attributed to the synergy between the larger amounts of nocturnal melatonin and the oxytocin hormone. Such synergy between the two types of hormones appears to be vital to forceful contractions in a late-term pregnancy. Without stability in the circadian rhythm, a pregnant woman will be more susceptible to birth complications, or run the risk of a miscarriage.

Hence, it is very important that expecting mothers maintain a regular sleep/wake and light/dark cycle, especially in the third trimester, when you are most vulnerable. Try to avoid work that requires irregular shifts or exposes you to bright lights at night, as this can result in melatonin suppression.

Reducing oxidative damage

Oxidative stress results in an imbalance of the body’s ability to fight free radicals, which are highly-charged, unstable by-product molecules of our internal system. Free radicals can react with other cells in the body, stealing valuable electrons from our DNA, lipid and proteins, and leading to tissue damage. In the last decades, there have been some very interesting studies with regard to melatonin and pregnancy. Night-time concentrations of melatonin increase steadily in pregnant women after 24 weeks of gestation.

Lab studies show that melatonin, which is present all over a developing foetus from the earliest phases, has been attributed with reducing oxidative damage. Interestingly, the placenta also produces melatonin, and this source of melatonin is thought to be important to a normal, healthy pregnancy. So, what do the experts say about taking melatonin supplements to counter sleep disruption during pregnancy? Is it safe?

Currently, the impact of having high levels of melatonin during pregnancy is still inconclusive. That being said, research on the benefits of the right amounts of melatonin in your body during pregnancy looks quite promising. A study done at the Ritchie Centre, Monash Institute of Medical Research, Monash University, Australia, found that a mother’s melatonin level was not associated with adverse foetal effects, but in fact, provides benefits to the foetus.

Supplementation with melatonin decreases the risk of pre-eclampsia, intrauterine growth retardation (IUGR) and preterm birth. Pre-eclampsia is a pregnancy condition believed to be caused by poor nutrition, high body fat and/ or poor blood circulation to the uterus.

Pre-eclampsia causes the mother to experience high blood pressure and high amounts of protein in the urine. Although the condition usually subsides after pregnancy, there are instances where it puts both mother and baby at risk.

IUGR is a term to describe inadequate foetus growth in a mother’s womb, resulting in low birth weight and other developmental problems. IUGR complicates 5–10% of pregnancies and is associated with increased risk of preterm birth, mortality and long-term neurodevelopmental impairments.

There is currently no intervention that can improve the integrity of a foetus’ brain with IUGR symptoms, and IUGR is associated with an increased risk of hypertension when the baby reaches adulthood.

Pre ecclampsia and IUGR, are two common pregnancy complications. Because sleep patterns and cardiovascular functions in a baby are closely linked, the antioxidant-friendly, toxic-free melatonin has been regarded as having a high potential to treat both pregnancy conditions.

Preventing birth defects

No one likes to think of the possibility that something can go wrong with their pregnancy, but a small percentage of pregnancies are vulnerable to preterm birth, mortality and long-term impairments in brain function. According to Ritchie Centre director Prof Euan Wallace, melatonin can also reduce oxidative stress and damage to the developing foetal brain. Currently, pioneer clinical trials have started in the Australian state of Victoria after researchers discovered that melatonin, a naturally occurring hormone, may prevent brain injuries in unborn babies.

If successful, melatonin supplements are something that may become a routine part of pregnancy care in the future, like folic acid, which prevents spinal tube defects. Pregnancy should be a wonderful journey in every woman’s life, and everyone deserves to experience it in the most pain-free and stress-free manner as possible. In some countries, melatonin is also sold over-the-counter as a dietary supplement and is a popular natural remedy for sleep problems. If you do consider the possibility of adding melatonin during your pregnancy to help you sleep better, please be sure to consult your obstetrician beforehand.

The Star Malaysia 1 Nov 2015
By Datuk Dr Nor Ashikin Mokhtar