Is Ambien safe during pregnancy?

What does the evidence say about Ambien during pregnancy?

1. Several studies have reported no increased chance of birth defects with zolpidem use during pregnancy, and several found no meaningful rise in preterm delivery or low birth weight. 1
2. Whether zolpidem raises the chance of miscarriage is not known, and newborns exposed near delivery should be watched for heavy sleepiness, poor weight gain, low muscle tone, or slow breathing. 1
3. Adjusted odds ran higher for low birth weight at 1.39, preterm delivery at 1.49, small-for-gestational-age birth at 1.34, and cesarean delivery at 1.74 among 2,497 pregnancies with zolpidem prescriptions compared with 12,485 without. 2
4. Zolpidem crosses the human placenta and clears the fetal circulation quickly, and across 45 exposed pregnancies the higher rates of preterm delivery and low birth weight were not statistically significant. 3
5. Zolpidem carries a boxed warning for complex sleep behaviors such as sleepwalking and sleep driving, and FDA advises stopping the medicine and contacting a clinician right away if any of these happen. 4

Is Ambien safe in each trimester?

• First trimester. Several studies have reported no rise in birth defects with first-trimester zolpidem. Early insomnia often travels with nausea, frequent bathroom trips, and a shifting sleep schedule, which is why most clinicians start with sleep timing, light, and positioning before reaching for a prescription.
• Second trimester. The pregnancy-outcome signal comes mainly from a Taiwanese national study of 2,497 exposed pregnancies, which found modestly higher adjusted odds of low birth weight, preterm delivery, small-for-gestational-age birth, and cesarean delivery. Whether zolpidem or the underlying insomnia drove that is not settled.
• Third trimester. Zolpidem crosses the placenta and clears the fetal circulation quickly. Watch a newborn exposed close to delivery for heavy sleepiness, poor weight gain, floppiness, or slow breathing, and call the baby's provider if you see them. Late-pregnancy sleep problems usually deserve a non-medication plan first.