A review of sleep-promoting medications used in pregnancy

Am J Obstet Gynecol. 2015 Apr;212(4):428-41. doi: 10.1016/j.ajog.2014.10.1106. Epub 2014 Oct 31.


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.

Keywords: benzodiazepine; hypnotics; medication; pregnancy; sleep.

Publication types

  • Review

MeSH terms

  • Abnormalities, Drug-Induced / etiology
  • Female
  • Humans
  • Hypnotics and Sedatives / adverse effects*
  • Hypnotics and Sedatives / therapeutic use
  • Infant, Low Birth Weight
  • Infant, Newborn
  • Infant, Small for Gestational Age
  • Pregnancy
  • Pregnancy Complications / drug therapy*
  • Premature Birth / chemically induced
  • Sleep Initiation and Maintenance Disorders / drug therapy*


  • Hypnotics and Sedatives