When a pregnant woman is troubled by poor sleep, preference should be given to non-drug measures: avoid consumption of stimulants and heavy meals and follow the usual advice such as physical activity in the run-up to bedtime, going to bed only when sleepy, getting up at the same time every day.

At present, given what is known about the harm-benefit balance of sedative drugs, even their occasional use must remain an exception. In that case, doxylamine, an antihistamine, is the first-choice drug in any trimester of pregnancy.

Exceptionally, a low-dose benzodiazepine may sometimes be considered, for the shortest possible period, in which case oxazepam is recommended, but this may cause adverse effects in the new-born which should be anticipated.

A plant such as valerian is a one-off option, only in the second and third trimesters, provided that it is in the form of low-concentration aqueous or hydroalcoholic extract. In general, it is preferable to avoid taking concentrated plant extracts repeatedly for medicinal purposes during pregnancy, due to uncertainties about their effects.

Some drugs with an adverse harm-benefit balance for pregnant women or the unborn child should be ruled out. These include alimemazine and promethazine; fast-acting benzodiazepines such as flunitrazepam and triazolam; melatonin; plants such as Cimicifuga, horehound, Anemone pulsatilla and high-concentration alcohol extracts of valerian.

©Prescrire 1 October 2018

"Insomnia during pregnancy" Prescrire Int 2018; 27 (197): 240-244. (Pdf, subscribers only).

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