Is alpha‑lipoic acid safe to take during pregnancy?

Alpha-Lipoic Acid Safety in Pregnancy

Alpha-lipoic acid (ALA) appears safe for use during pregnancy based on observational data, with no evidence of maternal or fetal harm when administered at standard supplementation doses (600 mg daily orally). 1

Evidence for Safety

The strongest evidence comes from a large retrospective observational study of 610 pregnant women who received 600 mg oral ALA daily for at least 7 weeks during gestation. 1 This study demonstrated:

• No adverse maternal effects were observed during treatment, with normal physical examinations, laboratory parameters, and clinical assessments throughout pregnancy 1
• No adverse neonatal outcomes were detected, with birth weights, gestational ages, Apgar scores, and neonatal mortality rates comparable to or better than regional control data 1
• Outcomes were superimposable with controls from the Birth Registry, providing reassurance about ALA's safety profile during pregnancy 1

Mechanism and Potential Benefits

ALA functions as a natural antioxidant with anti-inflammatory and immunomodulatory properties that may actually benefit high-risk pregnancies. 2, 3

Specific pregnancy-related benefits include:

• Reduction of miscarriage risk through decreased pro-inflammatory cytokines (IL-1β, IL-6, IL-8, IL-17) and increased anti-inflammatory cytokines (IL-10), while inhibiting cyclooxygenase-2 and reducing prostaglandin E2 secretion 3, 4
• Acceleration of subchorionic hematoma resorption in patients with threatened miscarriage, with significant reduction in accompanying abdominal pain 3
• Prevention of preterm delivery by maintaining cervical length and reducing premature labor risk through its antioxidant effects on placental oxidative stress 2, 3
• Potential protection against preeclampsia by reducing oxidative stress in the placental bed, which plays a key role in abnormal placentation and excessive maternal inflammatory response 3

Dosing and Administration

Standard supplementation dose: 600 mg daily by oral route, typically started from early pregnancy (as early as 7th gestational week) and continued until delivery 1, 5

This dose has been consistently used across multiple studies without safety concerns. 1, 2

Clinical Context and Limitations

Important caveats:

• All available human safety data comes from observational studies rather than randomized controlled trials, which represents a limitation in the strength of evidence 1, 2
• ALA is classified as a dietary supplement rather than a pharmaceutical agent, meaning it lacks formal FDA pregnancy category classification 2
• The safety data specifically applies to oral administration at standard supplementation doses (600 mg daily), not higher therapeutic doses 1

When to consider ALA supplementation:

• Women with threatened miscarriage or history of recurrent pregnancy loss 3, 4
• High-risk pregnancies with oxidative stress concerns (e.g., risk of preeclampsia, intrauterine growth restriction) 3
• Patients with subchorionic hematoma requiring accelerated resorption 3
• Women with history of preterm labor requiring cervical length maintenance 3

Practical Recommendations

ALA can be safely used as dietary support during pregnancy at standard supplementation doses (600 mg daily orally), particularly in high-risk pregnancies where its antioxidant and anti-inflammatory properties may provide additional benefit. 2, 3

The reassuring safety profile from 610 treated pregnancies, combined with potential therapeutic benefits in preventing miscarriage and preterm delivery, supports its use when clinically indicated. 1, 3 However, patients should be counseled that evidence comes from observational rather than randomized controlled studies. 1