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With all the changes your body is coping with as it expands to make way for your baby, it’s tempting to seek comfort and relaxation wherever you can find it, and that may include a nice long soak in a hot tub or jacuzzi bath.
However, studies in humans and animals suggest that using a hot tub early in your pregnancy can lead to hyperthermia and harm your baby’s development. Here’s what to know.
After the first trimester, a brief soak in a hot tub may be okay if your doctor approves but it’s best to avoid hot tubs in the first trimester and while you’re trying to conceive.
While there aren’t a lot of studies specifically on the use of hot tubs during pregnancy, the studies that exist suggest that hot tub use in the first four weeks of pregnancy can raise body temperature to a point that increases the risk of certain devastating birth defects.
The chief concern with using a hot tub while pregnant is hyperthermia — elevating your body temperature — which can happen very quickly in a hot tub. Immersion in a hot tub maintained at 104 degrees F for just 20 minutes can elevate core body temperature to 102 degrees F, which is the danger zone for pregnant women [*][*].
It’s particularly concerning in the first trimester because hyperthermia has been shown to harm the development of the fetal brain and spine. One study that compared hot tub use to hyperthermia caused by sauna exposure or fever in the first trimester found that hot tub exposure had the strongest adverse effect [*].
That said, there is not a lot of compelling research comparing the sources of hyperthermia (hot tub vs. sauna vs. steam room) to the effects of hyperthermia on pregnancy.
NTDs are severe birth defects affecting the development of the fetal brain, spine, or spinal cord in the first 4 weeks of pregnancy. It is generally acknowledged that hyperthermia in the first 4 weeks of pregnancy increases the risk of NTDs two-fold. A limited number of human studies indicate that hyperthermia specifically from hot tub use in the first trimester increases the risk of NTDs. A large volume of animal studies looking at elevated maternal core temperature from any source support this finding [*].
The neural tube is the baby’s developing brain and spine. It begins as a flat ribbon that evolves into a tube in the first 4 weeks of pregnancy. When the tube doesn't close completely somewhere along its length, it can lead to severe birth defects such as spina bifida and anencephaly, which causes the baby to be born without parts of their brain and skull [*].
Other neural tube defects that may result from elevated maternal core temperature include hydranencephaly, where parts of the baby’s brain are replaced by fluid-filled sacs, and iniencephaly, a lethal defect causing certain parts of the spine to fuse.
Neural tube defects are more often linked to the mother’s deficiency in folic acid before or during pregnancy, especially in developing countries, so research into hyperthermia during pregnancy typically considers only women who did not reveal a folate deficiency.
While some infants born with a neural tube defect may not experience symptoms, some will have severe physical or intellectual problems, be stillborn, or die shortly after birth [*].
Symptoms include:
Miscarriage may also be associated with hyperthermia from hot tub use but the results are mixed across the available studies. One study found a twofold increase in the risk of miscarriage which was compounded significantly by the frequency of use and timing — within 4 weeks after the woman’s last menstrual cycle [*].
However, some researchers invited to comment on that study thought it to be flawed. They thought the study’s low participation rate and the way maternal age was handled to be a source of potential bias, and noted that the researchers’ finding that fever did not increase the risk of NTDs to be contradictory, since both involve hyperthermia [*].
Another very large Danish study completed in 2017 found no association between maternal fever in the first trimester and an elevated risk of congenital defects [*].
Studies have indicated an association between cleft lip or cleft palate and maternal hyperthermia from fever [*][*].
These devastating congenital birth defects were twice as high in women who used hot tubs more than once and for more than 30 minutes in early pregnancy in one study [*].
In esophageal atresia, the infant is missing parts of its esophagus. Omphalocele is a rare abdominal wall defect where the abdominal organs end up outside the belly in a sac. Gastroschisis is a birth defect in which the baby’s intestines may extend from its body via a hole in the abdominal wall near the belly button [*].
Germs can flourish in hot tubs and that is a real concern for pregnant women whose immune systems are in a delicate state. Even when cleaned and treated with germ-killing chemicals, hot tubs can still have germs such as cryptosporidium, giardia, legionella, norovirus, and pseudomonas aeruginosa aka “hot tub folliculitis”.
If you have symptoms such as nausea, vomiting, diarrhea, or a skin rash after being in a hot tub, call your doctor immediately [*].
Perhaps it goes without saying, but infection during pregnancy can pose serious risks to you and your fetus.
Dehydration is a serious concern for pregnant women. It is linked with neural tube defects, low amniotic fluid, a failure to produce enough breast milk, and premature labor. Being in a hot tub may cause you to lose more water than you can replenish [*].
Hormonal shifts that may make it harder to regulate your body temperature and the way your body sends increased blood supply to your skin can hamper your ability to cool down like you did before pregnancy. Overheating will draw more blood away from the brain, making you feel lightheaded.
Chlorine and bromine, typically used to sanitize the water, may be a concern, especially if swallowed. The CDC recommends that free chlorine levels at 2 and 4 parts per million (ppm) and bromine levels at 4 and 6 ppm, with an overall pH level between 7.2 and 7.8.
If your eyes or skin feel irritated, get out right away, and be sure to shower immediately after getting out to wash any residual chemicals off your skin [*]. If you can find a saltwater hot tub near you, that would be a safer alternative [*].
Note that hot tubs and swimming pools do not use the same type of chlorine and sanitizing chemicals [*].
Surprisingly, Dad’s sperm may also be affected by heat exposure. One study examining two types of childhood brain tumors and parental heat exposure found that the father’s exposure to a heat source such as a sauna in the three months before the pregnancy increased the odds of the child having such a tumor. It also found that the mother’s sauna use close to conception or in the first trimester increased the odds [*].
First, keep your cool. Many people get out of a hot tub before their core temperature reaches 101 degrees F because it’s just plain uncomfortable, and you may have done the same [*].
Neural tube defects are rare even with exposure to hyperthermia — about 2 in 1,000 births globally — so even if your risk is doubled by hyperthermia from sauna or hot tub exposure it is still pretty low [*].
If you used a hot tub during early pregnancy or before you knew you were pregnant, talk to your doctor about your exposure and discuss tests to identify neural tube defects.
Neural tube defects can be very reliably detected on your prenatal ultrasound scans as early as 12 weeks gestation. Other tests that diagnose NTDs include MRI scans (for spina bifida) and maternal blood tests that measure alpha-fetoprotein, chorionic gonadotropin, and estriol. In some cases, an amniotic fluid test may be used to confirm a diagnosis [*].
After the first trimester, you can use hot tubs or saunas without endangering your baby if your doctor approves and you don’t have any other pregnancy complications that could be affected by elevating your core temperature.
But be aware of the potential for dehydration, dizziness, or feeling faint, as well as the potential for exposure to harmful bacteria. Here are some other ways to minimize your risk:
A warm (not hot) bath is a great way to relax during pregnancy. It doesn’t pose the same risks as a hot tub because you have the option not to be fully immersed and are therefore less likely to overheat if the water is warmer than you thought it would be. You can also set the water to a warm temperature that feels soothing but keeps you from sweating too much.
In most tubs, the water will start to cool immediately so you don’t have the sustained hot temperature of a hot tub. You also won’t have the same risks of infection as you would from hot tub bacteria.
If you’re well on your way, you may want to ensure you have some help getting in and out of the tub.
There are plenty of safer alternatives to relax and unwind that do not involve a hot tub.
Maternal hyperthermia in pregnancy can be a serious issue for a developing fetus. Although not every dip in a hot tub or visit to a sauna equates to hyperthermia, be aware that your pregnant body may not manage temperature fluctuations as it did before pregnancy.
It would be smart to avoid hot tubs and saunas while you’re trying to conceive in the event you may already be pregnant and unaware of it since the first four weeks are when it can harm your baby’s development.
A quick dip in a hot tub later in your pregnancy, after the first trimester, may be just fine, but talk to your care team first to understand the risks or contraindications specific to your pregnancy.
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