Insomnia In Late Pregnancy Sign Of Labor

Pharmacological treatment of insomnia in pregnancy

The use of sleep aids is acknowledged by 4.5 percent of pregnant women, and 1 9% of natural remedies. 10 This varies by trimester: 0. 9% in the first trimester, 0% during the second trimester, and 2 2% during the third trimester. 4 A review article on the sleep-promoting drugs used during pregnancy was just published. 47.

Alprazolam, clonazepam, diazepam, lorazepam, and temazepam are benzodiazepines that enhance the action of the neurotransmitter gamma-aminobutyric acid (GABA) at the GABAa receptor, producing a sedative effect. Zaleplon, zolpidem, and eszopiclone are nonbenzodiazepine drugs that act on the GABAa receptor and are hypnotic benzodiazepine receptor agonists. They are the most frequently prescribed sleep aids, even for expectant mothers. 49.

Each of these substances can cross the placenta and may have negative consequences. 48 In their recent review article, Okun et al. 47 summarized seven studies, one of which was a prospective cohort study in which the pregnancies of 411 pregnant women who reported using alprazolam in the first trimester were tracked through delivery. These studies revealed no discernible rise in the risk of congenital malformations. Diazepam use during pregnancy has been linked to reports of “floppy infant syndrome,” and benzodiazepines have also raised concerns about neonatal withdrawal symptoms. 51.

The use of hypnotic benzodiazepine receptor agonists in pregnancy has been the subject of numerous studies, the majority of which found no conclusive evidence of congenital malformations, preterm birth, or low birthweight. However, a retrospective cohort study from Taiwan found that zolpidem use during pregnancy was associated with an increased risk of low birthweight and/or small-for-gestational-age infants, preterm labor, and/or cesarean delivery when compared to 12,485 pregnant women who were not using zolpidem. 52 This study utilized the Taiwan National Health Insurance Dataset. Since medical records were not reviewed, it was unable to take into account the degree of insomnia, other contributing factors like alcohol and/or tobacco use, or adherence to zolpidem. An increased risk of preterm and low birthweight was also observed in a population-based retrospective cohort study of 390 Swedish pregnant women who were exposed to benzodiazepines and/or hypnotic benzodiazepine receptor agonists in the latter stages of pregnancy. 53 This was a registry study once more, which has its limitations; it did not take into account maternal use of drugs or alcohol. The Swedish Birth Registry later collected data on 1318 pregnant women who used the benzodiazepine receptor agonists zolpidem, zaleplon, and zopiclone, and found no increase in congenital malformations. This registry does not record the timing, dose, or duration of the medication used; rather, it records maternal self-reported medication use from the first visit with a midwife. Additionally, it does not take into account artificially induced pregnancies, which may understate the frequency of congenital defects.

Another group of medications that are occasionally used for their sedative effects are antidepressants. They function by influencing the monoamine neurotransmitters that control wakefulness and sleep architecture, such as norepinephrine, dopamine, and serotonin. 55 Trazadone increased sleep duration and efficiency compared to placebo in a randomized controlled trial of the antidepressant, an antihistamine, or a placebo for the treatment of insomnia in 54 age-matched pregnant patients at 26 to 30 weeks’ gestation. However, this study did not examine outcomes for delivery or infants. 56 It also contained diphenhydramine, an H1 receptor antagonist and antihistamine. This class of drug is available over-the-counter and is widely used in pregnancy for symptoms besides insomnia such as nausea, vomiting, and cold/ allergy symptoms57; 92% of women reported using an over-the-counter sleep aid occasionally during their pregnancy When compared to a placebo, diphenhydramine and the antidepressant trazadone were both equally effective at reducing depressive symptoms and improving sleep quality. 56 Overall, the National Birth Defects Prevention study’s data indicated that early pregnancy antihistamine exposure did not appear to be associated with an increased risk of cardiac effects, birth defects, or major malformations. 57.

In conclusion, benzodiazepines and hypnotic benzodiazepines receptor agonists may be linked to an increased risk of preterm labor, cesarean delivery, and small-for-gestational-age and/or low birthweight infants. However, the sleep aids described above do not appear to increase the risk of congenital malformations. However, it is still unknown what part insomnia itself plays in the emergence of these negative outcomes.

We want to ensure that every pregnant person looking for the most precise information on identifying the signs of labor can find it because we practically invented childbirth classes. Lets take a look.

(Ask your provider in advance for specific instructions and a phone number to call if you think you might be in labor.)

If you have four or more contractions in an hour or break your water and you are not at least 37 weeks pregnant, call your doctor as you may be in preterm labor.

Anyone in their third trimester probably searches for information on how to recognize labor the most on Google (I don’t have data to support this; let’s call it a strong hunch).

What Do True Labor Contractions Feel Like?

For me, the contractions didnt hurt all that bad. I could feel my uterus tightening from the muscles surrounding my uterus and on the outside of my stomach, where there wasn’t much “padding.” Though they squeezed, it still didnt hurt too bad. It was like having a severe stomachache that came and went. But roughly every 10 or 15 minutes, I would experience a contraction that would cause me to lose consciousness. I discovered that I had to breathe deeply during contractions even though there was no pain. I decided it was time to visit the doctor when the contractions began to space out by about 10 minutes, though they weren’t entirely regular. The doctor confirmed that I was in active labor.

“False labor” contractions are also known as Braxton Hicks contractions. Women claim that these sporadic (not daily) contractions resemble menstrual cramps. Over time, these cramps don’t get worse, happen more frequently, or last longer. It is perfectly normal to experience cramps like these during the third trimester or as early as the second trimester, and the contractions may come and go with a change in position. These contractions are not a sign of approaching labor.

4 Early Signs Of Labor

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