Managing Stress and Sleep Before, During, & After Pregnancy

The Sleep–Hormone Connection

Sleep plays a big role in your health before, during, and after pregnancy — and the great news is, it’s something you can improve! Even just a few nights of poor sleep (think: tossing and turning, waking up a lot, or dealing with restless legs) may influence your hormone balance and how your body handles stress, which in turn may play a role in fertility and pregnancy health. The same hormones that help you sleep — like cortisol and melatonin — also help with reproduction. So really, it’s all connected!

Breaking Sleep Down, Stage by Stage

Fertility

Most of the research on fertility and sleep has been around sleep patterns in shift work or people whose profession has them working unconventional hours overnight or in extreme stretches. However, many pathways by which sleep disturbances impact fertility are emerging, including the direct and indirect impact on hormones (1, 2).

For instance, thyroid function is directly impacted by sleep. If you remember from our article on thyroid health, it plays a pivotal role in fertility and supporting a healthy pregnancy, especially in the earliest days after conception. 

Research has found links between increased levels of thyroid-stimulating hormone (TSH) and women who are sleep deprived, impacting the ability of our body to support a healthy pregnancy (3, 4). 

Sleep disturbances can also disrupt follicle-stimulating hormone (FSH) and progesterone levels, which are essential in supporting healthy ovarian function. One study revealed that women who slept less (short sleepers) had 20% lower FSH levels than those who slept more (long sleepers, averaging more than 8 hours per night) (30). 

Progesterone is a hormone that plays a key role in preparing your body to support a healthy pregnancy. It helps during the phase when your body gets ready for a fertilized egg to implant and grow. Doctors watch progesterone levels closely because low levels can make it harder to get or keep a pregnancy.

Interestingly, poor sleep can affect progesterone, too. When your sleep is disturbed, like waking up often or struggling to fall asleep, it can impact  your hormone balance, including progesterone. So getting good rest isn’t just important for feeling your best. t also supports the hormones that help with pregnancy (3).

Not getting enough sleep can sometimes cause your body to react with inflammation. This can make it harder for your body to fight off harmful molecules called free radicals, which can damage cells. Keeping a healthy balance between these damaging molecules and your body’s natural defenses (called antioxidants) is important for overall health and fertility. This balance is especially delicate in the female reproductive system, so good sleep helps support it (5).

Pregnancy & Birth

During pregnancy, especially during the first trimester, sleep needs increase due to physical discomfort and emotional and hormonal changes. You are, after all, building an entirely new organ for your baby (the placenta). Despite increased needs, quality sleep can be difficult even when we make a conscious effort. Though it may take some adjustments, good sleep hygiene, adjusting your sleep position, and managing sleep disturbances can support your pregnancy in several ways, such as:

1. Maintaining healthy blood sugar levels | Sleep is critical to glucose metabolism. Studies show that both overly long or short sleep durations can impact blood sugar levels in pregnant women, with the risk increasing significantly with more than 10 hours of sleep per night (6, 7).
2. Mood support | In a study evaluating sleep duration in mid to late pregnancy, researchers found that sleep disturbances were linked to higher levels of cytokines (messengers from our immune system), which can impact mood and mental resilience (8).
3. Labor duration | Some studies show women averaging less than 6 hours of sleep per night during the last month of pregnancy had significantly longer labor durations (9).
4. Discomfort during labor | Less sleep before being admitted to the hospital may be linked to more pain and discomfort during labor, according to a study on sleep patterns before birth. (10).

Postpartum 

As a new mother, getting a good night's rest can be even more difficult. Decreased estrogen, progesterone, and thyroid hormones can severely impact sleep. These changes and external sleep disruptions from your new baby may also impact your mood, making it nearly impossible to get the rest you need (11, 12). 

Research suggests that not getting enough sleep may be linked to higher levels of inflammation in the body (13, 14, 15). While more studies are needed, poor sleep quality might affect how well someone recovers after giving birth. This can sometimes create a challenging cycle, where recovery difficulties impact sleep, and sleep issues make recovery harder.

The Hidden Link Between Pregnancy Stress, Hormones, and Sleep

Let’s face it. Some stress during pregnancy is natural. There is, after all, a LOT of significant change happening quickly. But prolonged or excessive stress can impact both you and baby during pregnancy and postpartum. For instance, stress hormones like cortisol, epinephrine, and norepinephrine interact with hormones that directly influence the production of estrogen and progesterone, leading to less and poorer quality sleep.

Breaking Stress Down, Stage by Stage

Fertility

Long periods of stress may affect various stages of fertility, including menstruation, ovulation, implantation, and placental development. While research is ongoing, some studies suggest that stress can play a role throughout the reproductive cycle. For example, one study measuring stress markers like cortisol and alpha-amylase found that women with higher levels of alpha-amylase in their saliva after their menstrual cycle were less likely to become pregnant in a given month compared to those with lower levels. However, more research is needed to fully understand these connections (16).

Pregnancy, Birth, Postpartum & Beyond

Pregnant moms who experience stress are more likely to get sick because their immune system reacts to it (17). Both stress and infection can further impact the immune system during pregnancy (18, 19). Likewise, higher stress hormones can impact labor and contractions (20).

Recent studies suggest that managing mom’s stress can have benefits that span generations, including:

• Increased mental resilience in infants | Exposure in the womb can affect the development of baby’s stress response, impacting their developing nervous system and creating lasting effects on their behavior and physiology (21, 22). This is of particular interest as studies show that this can be connected to emotional temperament later in life (23, 24)
• Healthy infant growth | Managing stress during pregnancy may promote healthy infant growth and development (25, 26)
• Healthy behavioral development | Emerging preclinical studies in animals have shown that mom’s stress levels impact the development of learning and memory during pregnancy (27)

Four Ways to Support Sleep & Stress

There’s no magic formula for the right amount of sleep. Still, there are a few simple lifestyle modifications that you can implement to optimize & manage stress during preconception, pregnancy, and postpartum.

1. Limit blue light exposure

Blue light from electronics suppresses melatonin, a hormone that helps control the sleep-wake cycle and is necessary to support egg quality, healthy menstrual cycles, and progesterone production. Limit blue light exposure using blue blockers, orange filters, or glasses, OR stop scrolling. :) We’re all guilty.

2. Breathe. No, really, breathe.

Numerous studies have shown that relaxation techniques can effectively calm the nervous system. Progressive Muscle Relaxation (PMR) is a deep relaxation technique that promotes relaxation and better manages stress. The simple practice involves tensing or tightening one muscle group at a time, holding it, and releasing the tension. Box breathing is another technique used to focus on slow, deep breaths, which arouses the parasympathetic system, producing a calming effect in both the mind and the body.

3. Get Moderate Exercise

Getting enough movement is vital for fertility. However, too much exercise can activate the stress response system. Exercising at a moderate intensity is ideal and pairs well with restorative exercise types of movement like yoga and pilates.

4. Probiotics for a Healthy Stress Response

Managing stress is vital for reproductive health.

Certain probiotic strains, including e L. paracasei (Lpc-37) ®, have been studied for their role in supporting a healthy stress response and general emotional mental well-being (28).* Its effects can vary depending on factors like your stress levels and gender, with the study indicating that L. paracasei (Lpc-37) ® reduced perceived stress in women, but not men. (28).

Some studies also suggest that L. rhamnosus (HN001)™ may play a role in supporting general emotional well-being in the postpartum period (29).* Although the exact mechanisms behind these positive effects are still being explored, the initial findings are promising (28).