Expert reviews
Obstetrics
A review of sleep-promoting medications used in pregnancy

https://doi.org/10.1016/j.ajog.2014.10.1106Get rights and content

Approximately 4% of adults who have symptoms of insomnia resort to various hypnotic or sedating medications for acute symptom relief. Although typically a common practice for nonpregnant adults, this is not the case for the thousands of pregnant women who also report substantial sleep issues. Unfortunately, a paucity of randomized controlled trials in this population, scant empiric evidence regarding the appropriateness of prescribing options, and the concern of subsequent teratogenicity restricts the ability of clinicians to make informed decisions. We synthesized the current research regarding hypnotics and sedating medications used (both on- and off-label) during pregnancy and their association with adverse outcomes. Medications that we investigated included benzodiazepines, hypnotic benzodiazepine receptor agonists, antidepressants, and antihistamines. Overall, the examined studies showed no correlation of increased risk of congenital malformations. However, benzodiazepines and hypnotic benzodiazepine receptor agonists may increase rates of preterm birth, low birthweight, and/or small-for-gestational-age infants. The small number of studies and the small number of subjects prohibit any definitive interpretation regarding the consequences of the use of hypnotic or sedating medications in pregnancy. Additional case reports, randomized clinical trials, and epidemiologic studies are needed urgently.

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Search strategy

We exhaustively searched PubMed and found articles based on key search terms: pregnancy and sleep with various medications or drug classes (hypnotics, sedatives, benzodiazepine, nonbenzodiazepine, melatonin, antidepressants, antihistamines, ramelteon, zolpidem, zopiclone, zaleplon, alprazolam, clonazepam lorazepam, medazepam, nitrazepam, temazepam, tofisopam., mirtazapine, trazodone, diphenhydramine, doxylamine, hydroxyzine, pheniramines). These search terms, which allowed for 30 different

Results

All studies included here reported on pregnant women. Most of the studies were retrospective cohort studies. Most of the data emanated from Sweden, the United States, and the United Kingdom, with a few studies from Taiwan, Hungary, and Canada. Prospective comparative and prospective cohort (matched pairs) studies were the second most common study design.

Because most data came from registries, in some cases it is not clear whether a drug was used off-label for sleep and/or insomnia, particularly

Comment

This review has summarized research studies that examined various medications that often are used to promote sleep in pregnant women and resultant maternal and/or fetal adverse outcomes. The literature we looked at covered a comprehensive time frame, and to the best of our knowledge, is the only review to collate information on outcomes that resulted from exposure to sedating drugs or drugs used for sleep concerns as per indication or for on- and off-label purposes in pregnant women. Our review

Acknowledgment

The authors thank Ms Linda Willrich for her assistance.

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    The authors report no conflict of interest.

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