Ashwin Lewis
Sleep disturbances are common during pregnancy, and many pregnant people experience trouble sleeping, particularly in the later stages. While sleeping pills and sleep aids can be effective in treating insomnia, their safety during pregnancy is a concern. There is limited data on the safety of prescription sleeping pills for pregnant women, and certain medications may have adverse effects on the fetus or newborn. Melatonin, a natural sleep aid, is likely safe for short-term use during pregnancy, but there is a lack of definitive research on its effects. Other non-drug therapies, such as cognitive behavioral therapy (CBT), may be preferable for improving sleep during pregnancy.
| Characteristics | Values |
|---|---|
| Prevalence of insomnia in the third trimester | 66% to 97% of women |
| Safety of sleeping pills during pregnancy | Limited research available |
| Safety of melatonin during pregnancy | Limited research available, crosses the placenta |
| Safety of Unisom during pregnancy | Generally considered safe |
| Safety of Benadryl during pregnancy | Generally considered safe |
| Safety of prescription sleeping pills during pregnancy | Cautioned against by most providers |
| Safety of Zolpidem during pregnancy | Limited data on reproductive safety, potential withdrawal symptoms in newborns |
| Safety of Lunesta during pregnancy | Limited data on reproductive safety |
| Safety of Sonata during pregnancy | Limited data on reproductive safety |
| Safety of Restoril during pregnancy | Not recommended without a prescription |
| Safety of Ativan during pregnancy | May be useful, controversy regarding risk of cleft lip and palate |
| Safety of Klonopin during pregnancy | May be useful, controversy regarding risk of cleft lip and palate |
| Safety of Valium during pregnancy | Cautioned against by most providers |
| Safety of Trazodone during pregnancy | Under study, no definitive conclusions |
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What You'll Learn
Zolpidem and other sedative-hypnotic agents
Zolpidem is a sedative-hypnotic medication used to treat insomnia. Zolpidem and other sedative-hypnotic agents, including Lunesta (eszopiclone) and Sonata (zalepion), are commonly prescribed to women with sleep disturbances. However, limited data is available regarding their reproductive safety, and they are generally avoided during pregnancy.
Zolpidem belongs to a group of medications called hypnotic benzodiazepine receptor agonists or HBRAs (sometimes called z-drugs or z-hypnotics). While HBRAs are not benzodiazepines, they work in a similar way. Some brand names for zolpidem include Ambien®, Edluar®, Intermezzo®, and Zolpimist®.
It is important to consult with a healthcare provider before making any changes to medication, as stopping zolpidem suddenly may cause withdrawal symptoms such as fatigue, nausea, vomiting, flushing, lightheadedness, crying, and nervousness. Additionally, taking a sleep aid may impact an individual's ability to care for their newborn during the day or at night.
Studies have shown conflicting results regarding the safety of zolpidem during pregnancy. Some studies have reported an increased risk of adverse pregnancy outcomes, including low birth weight, small for gestational age, preterm birth, caesarean section, and NICU admission. However, other studies have not found an increased risk of major malformations in infants exposed to z-drugs during pregnancy. It is important to note that the frequency of medication use and the stage of pregnancy during which the medication is taken may impact these outcomes.
In summary, while zolpidem and other sedative-hypnotic agents are commonly prescribed for insomnia during pregnancy, there is limited data on their reproductive safety. It is recommended to consult with a healthcare provider to weigh the risks and benefits and consider alternative treatments for sleep disturbances during pregnancy.
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Benzodiazepines
There is controversy regarding the use of benzodiazepines during pregnancy. Most benzodiazepines have a category D rating within the U.S. Food and Drug Administration (FDA) Pregnancy Categories. This means that there is some evidence of potential harm to the foetus, but the benefits may sometimes warrant their use. However, some benzodiazepines are given a category X rating, indicating that the risks clearly outweigh the benefits and they should be avoided during pregnancy.
Some studies have found that maternal use of benzodiazepines is associated with an increased risk of adverse outcomes, including a higher likelihood of C-section deliveries and the need for ventilatory support for the newborn. There is also a potential risk of neonatal withdrawal symptoms, such as irritability, sleep disruption, restlessness, depression, tremors, and seizures. Additionally, prolonged use during pregnancy may lead to concerns about altered transmitter synthesis and function, potentially causing neurobehavioural problems in children.
On the other hand, some reports suggest that there is no association between exposure to benzodiazepines and certain risks, such as cleft lip or palate. One study of over 6,000 women found no increased risk of preterm birth, low birth weight, or other adverse pregnancy outcomes associated with sedative drug use, including benzodiazepines.
It is important to note that data on the safety of benzodiazepines during pregnancy is limited, and healthcare providers generally try to avoid their use during this time. Pregnant women who are currently using or considering using benzodiazepines should understand the potential risks involved and consult with their healthcare providers for guidance.
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Melatonin
While melatonin is likely safe for short-term use, especially after the first trimester, there is insufficient scientific evidence to confirm that melatonin supplements are safe for pregnant women. The safety and efficacy of supplements are not closely monitored by the U.S. Food and Drug Administration (FDA), and the dose used in most melatonin preparations is higher than what the body normally produces. As a result, there are concerns about the impact of high levels of hormones on the developing fetus.
Animal studies have shown that melatonin supplementation can negatively impact litter size and the growth and mortality rates of pups. However, it is unclear if these results can be generalized to humans. Melatonin may also cross the placenta and influence a baby's brain development, circadian rhythm, and sleep cycles.
If you are experiencing insomnia during pregnancy, it is recommended to first find the source of your sleep issues and address that. Other methods to improve sleep include maintaining a consistent sleep schedule, creating a good sleep environment, and using pillows and blankets for support while side sleeping, which is generally recommended during pregnancy.
If you are considering taking melatonin supplements, consult your doctor to discuss the risks and benefits and to ensure you select a reputable brand.
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Iron supplementation
The World Health Organization (WHO) recommends daily iron and folic acid supplementation as part of antenatal care to reduce the risk of low birth weight, maternal anemia, and iron deficiency. The suggested dose is 30-60 mg of iron, with a higher dose of 120 mg recommended in areas with severe anemia among pregnant women. Folic acid supplementation, with or without iron, is also recommended before conception and during the first trimester to decrease the risk of neural tube defects.
Studies have shown that higher ferritin concentrations early in pregnancy are associated with positive pregnancy outcomes, while higher concentrations in the third trimester are linked to poorer outcomes, including premature delivery and low birth weight. Iron supplementation in pregnant women with high hemoglobin concentrations during the second trimester can lead to fetal growth restriction, possibly due to maternal hypertension. Additionally, iron supplementation has been linked to an increased risk of gestational diabetes mellitus.
However, iron sufficiency during pregnancy results in better outcomes for both mother and child. The benefits of iron supplementation outweigh the risks for women who are about to become pregnant or those with evidence of iron deficiency. Improving iron intake in women of reproductive age can enhance pregnancy outcomes and overall maternal and infant health.
Oral iron administration is typically the first line of treatment, with IV administration reserved for cases where oral supplementation is not effective or tolerated. The use of IV iron before 13 weeks of gestation is not recommended by the European Medicine Agency, but the FDA does not restrict it to the second and third trimesters.
It is important to consult with a healthcare provider before starting any iron supplementation during pregnancy, as individual needs may vary.
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Natural remedies
There is a lack of data to determine whether many prescription sleeping pills are safe during pregnancy. Benzodiazepines, for example, have not been proven safe for pregnant women, and one study found an increased risk of miscarriage associated with their use. Therefore, it is best to avoid them.
Instead, many pregnant people opt for natural remedies to aid their sleep. Here are some natural remedies that may help improve your sleep during the third trimester:
Exercise
Regular exercise can benefit those experiencing insomnia during pregnancy. A review found that pregnant people who engaged in regular physical activity experienced significant improvements in their sleep quality and a reduction in anxiety symptoms. Exercise was especially helpful in treating insomnia in the third trimester.
Massage Therapy
Massage therapy has been shown to positively impact stress, mood, and sleep in pregnant women. A review found that pregnant individuals who took part in a massage and relaxation program reported fewer sleep disruptions.
Stress Reduction
Stress reduction is an important way to improve sleep. Cognitive behavioural therapy (CBT) teaches individuals to recognize and change negative thought patterns and behaviours. A clinical trial found that CBT led to significant improvements in sleep quality and insomnia symptoms in pregnant individuals.
Acupuncture
Acupuncture can significantly improve sleep quality in pregnant women. Research shows that acupuncture can increase the serum concentration of melatonin, a hormone that helps us relax and fall asleep. Increased melatonin levels may also benefit the baby as it plays an important role in fetal brain development.
Yoga
If you have been experiencing disturbed sleep during pregnancy, consider trying a prenatal yoga class. A review found that starting a regular yoga practice during the second trimester decreased the number of nighttime awakenings and time spent awake in bed for participants. Individuals who began yoga in their second trimesters experienced more benefits in sleep quality than those who started in their third trimesters.
Sleep Hygiene
Sleep hygiene involves training your body to go to bed and wake up at consistent times. Follow a strict sleep schedule, even on weekends. Keep your bedroom cool, dark, and quiet. Invest in a comfortable mattress or a pregnancy pillow. Try sleeping on your left side with one pillow between your legs and one supporting your belly. This position helps promote blood flow while keeping your body aligned.
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Frequently asked questions
There is limited data on the safety of sleeping pills during pregnancy. It is recommended to try natural sleep aids first, such as yoga, meditation, or improving your sleep hygiene. If you are having trouble sleeping, consult your healthcare provider for advice.
There are many natural sleep aids that you can try to improve your sleep during the third trimester. These include drinking tea, taking a warm shower, meditating, and light reading before bed. You should also try to avoid excessive screen time before bed.
Certain over-the-counter sleep aids, such as Unisom, Benadryl, and Doxylamine are generally considered safe for pregnancy. However, it is always recommended to consult your healthcare provider before taking any medication during pregnancy.
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