Can You Creatine While Pregnant? (Is It Safe?)

Creatine is widely researched and found to be a safe and effective supplement. However, while you are pregnant, it makes sense to be careful of consuming supplements that can impact your pregnancy. So, should you take creatine while they are pregnant?

Although randomized control trials on creatine usage during pregnancy are limited, there may be benefits to taking creatine for both the mother and the infant. It is, however, a good idea to discuss your supplement regime with your doctor or dietitian to determine if there are individual factors you need to consider.

Because creatine is so widely researched, its safety and lack of adverse side effects have been proven in several studies. Let’s dissect the possible benefits of creatine during pregnancy and what you should be considering if you take creatine during pregnancy.

Should Pregnant Women Take Creatine?

Creatine plays a crucial role in cellular energy production and energy storage for use in the body’s tissues.

Its primary function is to convert adenosine diphosphate (ADP) back into adenosine triphosphate (ATP) in tissues with high and varying energy needs.

About half of the daily creatine requirement for adults comes from a diet rich in fresh fish, meat, and dairy products, while the body synthesizes the rest from amino acids, the building blocks of proteins ^[1].

While intervention studies on pregnant women using creatine are virtually non-existent, numerous studies show the potential benefits of creatine for pregnant women and the fetus.

If that is the case, you may ask, why have intervention studies not been done on pregnant women?

Firstly, doing intervention studies on populations like pregnant women comes with a lot of ethical red tape, and this area of research is relatively new as well. 

Research on animals has shown the potential of creatine to protect the developing fetal brain from harm when given to pregnant mothers.

In individuals who are not pregnant, studies focusing on children recovering from traumatic brain injury and adults facing neurodegenerative conditions have yielded encouraging findings.

These results suggest that creatine could protect the brain ^[1]. Crucially, these studies have provided reassurance by not identifying any adverse effects of creatine supplementation ^[1].

Why Creatine Can Benefit The Mother And Baby

Pregnancy involves increased metabolic activity, leading to increased needs for nutrients and anti-oxidative substances for the mother ^[2].

Traditionally, discussions on this topic focus on the transfer of oxygen, glucose, and essential amino acids through the placenta ^[3].

However, recent preclinical research indicates that the production and metabolism of maternal creatine may also play a crucial role in maintaining a healthy pregnancy ^{[4, 5]}.

The potential benefits of creatine supplementation during pregnancy are particularly relevant to women at risk of conditions leading to preterm birth, such as preeclampsia (high blood pressure during pregnancy) and gestational diabetes mellitus (diabetes during pregnancy) ^[6].

Preeclampsia is a common condition during pregnancy and usually manifests after 20 weeks of gestation ^[7].

It affects about 5% of pregnancies ^[8], contributes to around 50% of preterm births ^[9], and increases oxidative stress in both the mother and the fetus ^[10].

Gestational diabetes mellitus, affecting around 7% of women, is also linked to increased oxidative stress and a higher risk of preterm birth ^[11]. Creatine may be a viable protective supplement to treat these conditions.

Additionally, various obstetric conditions require conservative management.

Such as cervical incompetence (the inability of the cervix to retain a pregnancy, often leading to premature dilation and potentially causing preterm birth or pregnancy loss), preterm premature rupture of membranes (PPROM), partial placental abruption (a condition where part of the placenta separates from the uterine wall before delivery), and placenta previa (when the placenta partially or completely covers the cervix, potentially causing bleeding and complications during labor) ^[6].

These conditions can lead to fetal complications like oxygen deprivation and low blood sugar ^[6]. 

The current approaches, like bed rest, low-dose aspirin, and standard nutrient supplements, have only limited success in decreasing health issues and deaths during childbirth ^[6].

Adding creatine to a pregnant woman’s diet aligns with the careful management of high-risk cases and doesn’t disrupt the standard monitoring procedures ^[6].

Why Creatine Can Benefit A Preterm Baby

A preterm baby is one who is born too early (before 40 weeks).

One way preterm infants can benefit from maternal creatine supplementation is the possibility of preterm infants becoming creatine-depleted due to their underdeveloped capacity to make creatine themselves and inadequate reabsorption through the kidneys ^[6].

The infant gets creatine via the mother’s placenta until they develop appropriate renal and liver function, but the exact time of this development is still unknown.

A recent study on preterm infants (32–35 weeks) and very preterm (28–29 weeks) infants showed that there was a buildup of a substance called guanodinoacetic acid (GAA) in their urine ^[12], which suggests a lack of proper conversion to creatine, which may lead to a shortage of creatine in their body.

Because breast milk and formula don’t provide enough creatine, pregnant mothers need to consider taking creatine supplements to support the development of their babies ^[13].

Taking creatine during pregnancy might protect the preterm infant by reducing the activity of a kidney enzyme called “AGAT .”

This can lower levels of GAA in the blood, which can harm the baby’s brain, leading to intellectual disability, movement disorders, and epilepsy. So, creatine supplements may help prevent these issues in preterm babies ^{[14, 15]}.

Is It Safe To Take Creatine While Pregnant?

As mentioned, clinical trials on pregnant women are very sparse. However, clinical trials have indicated that prolonged use of creatine is well-tolerated and safe for various population groups, including patients with various diseases.

It slows the accumulation of glutamate in the brains of those with early-onset Huntington’s Disease ^[16] and shows no serious side effects over years in Parkinson’s Disease patients ^[17].

Additionally, creatine improves both short-term and long-term outcomes for children recovering from traumatic brain injury ^[18].

Recent studies have expanded the neuroprotective roles of creatine, demonstrating its positive effects on cognitive function in normal and elderly individuals, enhancing cognitive and motor skills in sleep-deprived subjects ^[19].

Moreover, creatine consumption has been linked to improved glucose tolerance in sedentary males and enhanced muscle performance in elderly men and postmenopausal women ^[20].

Based on its impact on osteoblasts in laboratory settings, creatine has been suggested as a potential treatment for osteoporosis in women ^[21].

Animal studies provide strong evidence supporting the idea that administering creatine to mothers could be a straightforward, cost-effective, and efficient way to offer neuroprotection to the fetus ^[1].

A recent review consolidating experimental (mostly animal) studies on creatine supplementation during pregnancy suggests that considering the current evidence, this treatment should be assessed as a preventative therapy ^[6].

Additionally, it found that creatine has the potential to enhance fetal and neonatal well-being and decrease mortality in high-risk human pregnancies by safeguarding the brain and possibly preventing damage to other organs ^[6].

Yet, without data from randomized controlled trials, there is still uncertainty regarding the comparative advantages and disadvantages of taking creatine while pregnant, even though current data suggest that it should be completely safe.

It is recommended that you speak to a doctor or dietitian about your supplement regime when you are pregnant.

How Much Creatine Do Pregnant Women Need?

Because no intervention studies have been done on pregnant women taking creatine, there are no specific guidelines for pregnant women.

Current suggestions are to take either a loading dose of 20 g spread throughout the day in 5 g doses for 5 – 7 days, followed by a maintenance period where you take 3 – 5 g daily.

Alternatively, a more conservative approach will be to take 3 – 5 grams daily, which might take longer to saturate your creatine stores (up to 4 weeks) ^[22]. For individual advice, consult a doctor or dietitian.

Summary

Even though intervention studies on pregnant women taking creatine do not yet exist, there are mechanistic and animal-based studies that show potential benefits when creatine is taken while pregnant.

Creatine is safe in various healthy and clinical populations, and current data suggest we can extrapolate these findings to pregnant women.

However, because no intervention studies exist yet, you should talk to your doctor and/or dietitian before taking creatine to assess individual needs and the factors involved.

References

1. Dickinson, H., et al. (2014). Creatine for women in pregnancy for neuroprotection of the fetus. *Cochrane Database Syst Rev, 2014*(12), Cd010846.
2. Butte, N.F., et al. (2004). Energy requirements during pregnancy based on total energy expenditure and energy deposition. *Am J Clin Nutr, 79*(6), 1078-87.
3. Resnik, R. (2002). Intrauterine growth restriction. *Obstet Gynecol, 99*(3), 490-6.
4. Rousseau, M., et al. (2019). Associations Between Dietary Protein Sources, Plasma BCAA and Short-Chain Acylcarnitine Levels in Adults. *Nutrients, 11*(1).
5. Muccini, A.M., et al. (2021). Creatine Metabolism in Female Reproduction, Pregnancy and Newborn Health. *Nutrients, 13*(2).
6. Dickinson, H., et al. (2014). Creatine supplementation during pregnancy: summary of experimental studies suggesting a treatment to improve fetal and neonatal morbidity and reduce mortality in high-risk human pregnancy. *BMC Pregnancy Childbirth, 14*, 150.
7. Lowe, S.A., et al. (2009). Guidelines for the management of hypertensive disorders of pregnancy 2008. *Australian and New Zealand Journal of Obstetrics and Gynaecology, 49*(3), 242-246.
8. Payne, B., Magee, L.A., & von Dadelszen, P. (2011). Assessment, surveillance and prognosis in pre-eclampsia. *Best practice & research Clinical obstetrics & gynaecology, 25*(4), 449-462.
9. Meis, P.J., et al. (1998). The preterm prediction study: risk factors for indicated preterm births. *American journal of obstetrics and gynecology, 178*(3), 562-567.
10. Roberts, J.M., & Hubel, C.A. (1999). Is oxidative stress the link in the two-stage model of pre-eclampsia? *The Lancet, 354*(9181), 788-789.
11. Chen, X., & Scholl, T.O. (2005). Oxidative stress: changes in pregnancy and with gestational diabetes mellitus. *Current diabetes reports, 5*(4), 282-288.
12. Lage, S., et al. (2013). Arginine-guanidinoacetate-creatine pathway in preterm newborns: creatine biosynthesis in newborns. *J Pediatr Endocrinol Metab, 26*(1-2), 53-60.
13. Hülsemann, J., et al. (1987). Die Zufuhr von Kreatin und Kreatinin mit Frauenmilch und Säuglingsmilchpräparaten. *Klinische Pädiatrie, 199*(04), 292-295.
14. Leuzzi, V., et al. (2013). Inborn errors of creatine metabolism and epilepsy. *Epilepsia, 54*(2), 217-27.
15. Mercimek-Mahmutoglu, S., et al. (2006). GAMT deficiency: features, treatment, and outcome in an inborn error of creatine synthesis. *Neurology, 67*(3), 480-484.
16. Bender, A., et al. (2006). Creatine supplementation in Parkinson’s disease: a placebo-controlled randomized pilot trial. *Neurology, 67*(7), 1262-1264.
17. Bender, A., et al. (2005). Creatine supplementation lowers brain glutamate levels in Huntington’s disease. *J Neurol, 252*(1), 36-41.
18. Sakellaris, G., et al. (2006). Prevention of complications related to traumatic brain injury in children and adolescents with creatine administration: an open label randomized pilot study. *J Trauma, 61*(2), 322-9.
19. Cook, C.J., et al. (2011). Skill execution and sleep deprivation: effects of acute caffeine or creatine supplementation – a randomized placebo-controlled trial. *J Int Soc Sports Nutr, 8*, 2.
20. Gotshalk, L.A., et al. (2008). Creatine supplementation improves muscular performance in older women. *Eur J Appl Physiol, 102*(2), 223-31.
21. Gerber, I., et al. (2005). Stimulatory effects of creatine on metabolic activity, differentiation and mineralization of primary osteoblast-like cells in monolayer and micromass cell cultures. *Eur Cell Mater, 10*, 8-22.
22. Kreider, R.B., et al. (2017). International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine. *J Int Soc Sports Nutr, 14*, 18.