Sleep is essential for psychological and physical well-being. The mother's body undergoes ongoing physical and physiological changes as the fetus develops. Any time throughout pregnancy, sleep disturbances can appear, and some of them might have negative effects on the mother or the fetus.
The prevalence of insomnia is really high. According to a 2020 epidemiological study of 3073 adults, more women (18%) than males (10%) had insomnia at the 5-year follow-up, with the incidence being higher in women. Pre-gestational insomnia, obesity, and depressive symptoms have all been found to be risk factors for pregnancy-related insomnia in prospective studies.
When treating non-pregnant individuals with acute insomnia, benzodiazepines and non-benzodiazepines "Z" medicines (zopiclone and zolpidem) are frequently utilized. Due to probable teratogenicity and fetal withdrawal symptoms, its usage in pregnancy is restricted. This section will provide an overview of if using zolpidem during pregnancy is safe.
What is Ambien?
Zolpidem (Ambien) is a sedative-hypnotic medication used to treat insomnia. It improves sleep latency, reduces the number of sleep awakenings, and improves sleep quality.
Brand names are Ambien, Edluar, Intermezzo, and Zolpimist. Ambien works by binding to the alpha subunit of the benzodiazepine receptor and thereby induces sleep.
Indications of Ambien
Indicated for sleep maintenance and sleep initiation.
Off-label uses - neurological conditions, disorders of consciousness and movement, stress, anxiety, and migraine headache discomfort.
Dose And Dosage Forms Of Ambien
Due to higher clearance of zolpidem in women, women require lower initial doses. AMBIEN should not be given more than once during the same night. And the duration of treatment should be as brief as possible.
- Available doses are 5 mg and 10 mg tablets for oral administration.
- Ambien is available as immediate-release, extended-release, sublingual tablets, and oral sprays.
Dose in Adults:
- The initial dose is 5 mg for women and 5 or 10 mg for men.
- Take once daily immediately before bedtime, 7-8 hours before waking up.
Dose in elderly:
- Extended-release: 6.25 mg PO immediately before bedtime
- Immediate release, oral spray: 5mg PO/SL immediately before bedtime
Note: Not recommended in the pediatric population.
Ambien in Pregnancy- Is it safe?
According to estimates, up to 95% of pregnant women experience sleep disorders. The use of Ambien while pregnant may not be safe. The FDA has designated zolpidem as a category C pregnancy drug. The FDA's pregnancy categories help determine how likely a drug would harm the fetus if the mother consumes it.
As a category C medicine, Ambien still carries some risks. Category C drugs exhibited side effects on the fetus in animal studies. However, due to the apparent risk involved in conducting these trials, there is no adequate evidence of side effects in human studies when used on pregnant women.
Hypnotic benzodiazepine receptor agonists are nonbenzodiazepine drugs that act on the GABA-a receptor. Zolpidem is one of the commonly prescribed drugs for insomnia in pregnant women. It can cross the placenta causing adverse effects.
Studies related to Ambien use in Pregnancy
- There have been reports of respiratory depression and sedation in newborns whose mothers used zolpidem late in the third trimester.
- A study published in Clinical Pharmacology & Therapeutics shows that there is only limited information concerning zolpidem use (Ambien) in pregnant women.
- The study by Wang LH in Taiwan compared the risk of unfavourable pregnancy outcomes between pregnant women who received zolpidem treatment for insomnia and those who did not. Low birth weight infants, preterm births, small-for-gestational-age infants, congenitally abnormal infants, and caesarean deliveries were the unfavourable outcomes that were discovered and evaluated.
- The study included 45 pregnant psychiatric patients receiving zolpidem and discovered a higher probability of preterm birth (26.7% vs. 15.6%) and low birth weight (13.3% vs. 4.4%) in the zolpidem-exposed group compared to unexposed controls.
- The findings demonstrate that compared to the randomly chosen controls, unfavourable pregnancy outcomes for mothers who got zolpidem therapy during pregnancy were all higher.
Effects of Ambien use in pregnancy in mother and the fetus
- Zolpidem crosses the placenta and can cause drowsiness and respiratory depression in newborns. Observe neonates exposed to AMBIEN throughout pregnancy and childbirth for symptoms of excessive sedation, hypotonia, and respiratory depression and take appropriate action.
- Monitor for excessive sedation, hypotonia, and respiratory depression in babies exposed to AMBIEN through breast milk.
- To reduce drug exposure to a breastfed child, a lactating woman may think about stopping breastfeeding, pumping breast milk, and then discarding it throughout the treatment and for 23 hours (about five elimination half-lives) after AMBIEN administration.
- Using Ambien during pregnancy may cause withdrawal symptoms in the fetus. The baby may show weak muscles. Some reports link that taking Ambien during pregnancy causes maternal bonding and infant vision impairment.
Does Ambien Cause Mothers Or Babies To Experience Withdrawal Symptoms?
A sudden stop to the medicine could cause general withdrawal symptoms like:
-Spasms and anxiety
-stomach aches and cramps
-nausea and diarrhea
During birth, some babies may also experience breathing issues, low body temperatures, and limp and weak muscles
Alternatives for Ambien while pregnant
If the woman has sleep difficulty, a doctor may decide that Ambien's advantages during pregnancy exceed its hazards. Risks can still exist even with prescription drugs.
- Doctors often only suggest pregnant women take prescription and over-the-counter medications when it is deemed very necessary because of the unknown risks and side effects.
- Doctors might start by recommending tricyclic antidepressants or other benzodiazepines. For managing insomnia during pregnancy, these medications are safer than Ambien.
- Other OTC sleep aids for pregnant women include melatonin and antihistamines- like diphenhydramine and doxylamine. Diphenhydramine, an antihistamine, has been widely used throughout pregnancy and is not linked to birth abnormalities.
- There is limited data on the use of melatonin for insomnia. The prescription drugs most frequently used during and outside pregnancy include eszopiclone and zaleplon.
- Other prescription drugs, including benzodiazepines, anti-anxiety medications like lorazepam, and antidepressants like trazodone, can aid sleep during pregnancy or after delivery.
- Massage, yoga, meditation, and learning various relaxation techniques are among the natural remedies for sleeplessness when pregnant.
- The sleep patterns and environment of the pregnant patient may also need to modify. Avoid daytime naps and engage in physical activity. It can promote good sleep.
- If women cannot locate natural insomnia treatments, certain over-the-counter sleep aids may help.
- Consult your doctor before stopping taking Ambien if you were a regular user before getting pregnant.
Ambien is a sedative used to treat sleep disturbances, such as insomnia on a short-term basis. While there are limited studies on the adverse effects of zolpidem on pregnancy outcomes such as low birth weight, small for gestational age, and preterm labor, prescription zolpidem is commonly used during pregnancy.
Zolpidem may affect the fetus after crossing the placenta. Therefore, it is only advised to take Ambien while pregnant if the benefits outweigh the possible risks.If you have been taking zolpidem and learn that you are pregnant, don't stop using it without first consulting a healthcare professional.
Avoid stopping the medicine abruptly because doing so could cause withdrawal symptoms such as anxiety, muscle spasms, panic attacks, and tremors. Changing your daily routine and adopting good sleep hygiene could improve the quality of your sleep. Consult your doctor if you're experiencing problems sleeping while pregnant.
- Bouchette D, Akhondi H, Quick J. Zolpidem. [Updated 2022 Oct 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.Available from: https://www.ncbi.nlm.nih.gov/books/NBK442008/ Obtain on 14/09/2022
- Juric, S., Newport, D.J., Ritchie, J.C.et al.Zolpidem (Ambien) in pregnancy: placental passage and outcome.Arch Womens Ment Health12, 441446 (2009). From https://doi.org/10.1007/s00737-009-0100-7 Obtain on 14/09/2022
- Wang LH, Lin HC, Lin CC, Chen YH, Lin HC. Increased risk of adverse pregnancy outcomes in women receiving zolpidem during pregnancy. Clin Pharmacol Ther. 2010 Sep;88(3):369-74. From https://doi.org/10.1038/clpt.2010.97Obtain on 14/09/2022