Welcome to the weekly ZIP - your Zenith Informed Pregnancy!
Read on for a quick zip through 3 of the week’s most popular pregnancy questions, and the evidence behind them. Plus - bonus content on the latest & greatest in the world of pregnancy research.
This week's top pregnancy questions:
1️⃣ Are melatonin or other sleep aids safe during pregnancy?
2️⃣ What’s SPD? How is it different from other pelvic aches or pains?
3️⃣ Can I keep using my red light face mask?
Are melatonin or other sleep aids safe during pregnancy?
With insomnia and sleep issues being some of the most prominent (and disruptive!) pregnancy experiences, it’s especially frustrating to hear the dreaded “it hasn’t been studied well” about melatonin or other supplements that moms might turn to as a fix. Here’s what has been studied, what we don’t know yet, and what the evidence shows as the most safe and effective approaches with trouble sleeping during pregnancy.
📚The tl;dr from the evidence: Human studies are unfortunately limited, but generally reassuring - so far, research has not shown an increased risk of birth defects or other major safety concerns with melatonin use in pregnancy. However, there are no large/high-quality randomized controlled trials looking at melatonin, so most guidelines recommend caution due to a lack of data (rather than evidence of harm).
Melatonin is actually a hormone your body already produces naturally, and those levels increase normally during pregnancy - the main question with supplementation for sleep is what effect the higher-than-naturally-occurring levels of melatonin have on the developing baby. This is where more research is needed to better understand the impact on mom and baby.
Some antihistamine-based sleep aids, like Unisom (doxylamine) have a longer history of safety data in pregnancy and are considered safe when used occasionally and as directed. Other popular sleep aids are often combination products, including melatonin along with other ingredients such as magnesium, L-theanine, or herbal ingredients. As with any supplement, it’s important to look at each ingredient individually to understand how well it’s been studied in pregnancy and if there are any potential concerns – in combination products, some ingredients may be pregnancy-safe while others have known risks.
Given the lack of clarity from the existing body of research, non-medication/supplement approaches like improving sleep hygiene, meditation and relaxation techniques, or comfort measures like support pillows are often recommended as first steps to try before deciding to try supplements or medicinal sleep aids.
👀 Read Penny’s full summary of the evidence for more on melatonin & other sleep aids
What’s SPD? How is it different from other pelvic aches or pains?
Pelvic pain or discomfort is very common in pregnancy, and is one of those symptoms that can kick off an almost endless Google or social media rabbit hole. SPD comes up often in said rabbit holes, leaving moms even more confused about whether their symptoms are “normal” aches and pains or something more specific. SPD does have distinct causes and approaches to manage it, so here’s what the evidence shows about telling it apart.
📚The tl;dr from the evidence: SPD, or Symphysis Pubis Dysfunction, happens as a result of the ligaments that typically keep your pelvis aligned and stabilized becoming too stretchy. This relaxation of the ligaments causes increased movement or instability at the joint at the front of your pelvis (the pubic symphysis), resulting in pain. The exact causes can be varied, but hormonal changes are a key culprit in the ligament relaxation – which biologically is important to prepare your pelvis for childbirth, but can have the unpleasant result of too much stretching/movement in some cases and lead to SPD.
Compared to “normal” pelvic discomfort during pregnancy (generalized aches as your pelvis adjusts to accommodate your growing baby), SPD is more intense, sharper, and severe - specifically focused right at the front of the pelvis. Some of the signs include pain when walking, going up stairs, standing on one leg, or experiencing a clicking/popping sensation in your pelvic area.
SPD is treatable, so if you’re experiencing any of the specific signs, you can work with your doctor to diagnose or rule out SPD. You may also be referred to a pelvic health physical therapist to help, and treatment options include support belts as well as physiotherapy and gentle exercises.
👀 Read Penny’s full summary of the evidence for more on SPD
Can I keep using my red light face mask?
Red light masks, and light therapy generally, have been exploding in popularity – they’re everywhere! After some of the basics (like what foods, drinks or OTC meds to avoid), skincare tools and skin exposures have become a hot topic in early pregnancy. To what extent has red light actually been studied in pregnancy, and what does the data show?
📚The tl;dr from the evidence: No strong evidence shows that red light therapy is harmful during pregnancy, and high-quality (FDA-cleared) at-home face masks are generally considered low risk. The caveat is that there has not been a sufficient amount of pregnancy-specific research done to clearly confirm safety. In scenarios like this, where there’s no strong evidence of harm but also no conclusive evidence of safety, professional/clinical recommendations often tend towards an abundance of caution.
From what we do know about red light, there’s no biological reason to believe it’s harmful – it doesn’t penetrate deeply enough to reach the fetus, and red light therapies do not use UV light (which has some known harms/risks). One side effect that may occur is due to increased skin sensitivity in pregnancy generally, which could result in skin irritation using your mask that you hadn’t experienced pre-pregnancy.
The very lowest risk use of red light is considered to be after the first trimester (once the baby's organs have formed) and using it only on your face, avoiding areas like the belly or lower back.
👀 Read Penny’s full summary of the evidence for more on red light therapy
🤓 Zenith's top read of the week
Bonus: what the Zenith team found interesting this week. Think cool pregnancy research or recently published studies, news in pregnancy health and policy, and more!
Tracking the deadly & unpredictable postpartum hemorrhage (Leah Shaffer, WashU St Louis) - We were very excited to read about innovation happening in how we identify postpartum hemorrhage much earlier, by establishing a more accurate way to identify excessive blood loss using a wearable device that fits right on the wrist!
Postpartum hemorrhage, or excessive bleeding, is a leading cause of maternal illness and death across the world, but is surprisingly hard to accurately measure today from visual cues alone (not least of which – birth already involves a ton of bleeding). The wearable under development would use a light-based sensor to measure cardiovascular features like hemoglobin and blood flow, and determine how the measurements are actually correlated with blood loss through statistical and machine-learning algorithms. Earlier detection can allow for known, effective interventions - even things as simple as massaging the uterus - that can stop the bleed.
This is super promising and it’s awesome to see thoughtful innovation in the basic, yet critically important, areas of childbirth that can really make a difference in maternal health and safety.
Key excerpt:
“Counting bloody rags or collecting blood in calibrated drapes may seem simplistic but remains one of the few ways to warn of excessive blood loss. A more accurate and continuous early warning system could potentially prevent 50% to 90% of those maternal deaths from hemorrhage when paired with adequate treatment."