Most sleeping tablets are not safe during pregnancy, but some are considered lower risk
The short answer is no for most over-the-counter and prescription sleeping tablets. Pregnancy changes how your body processes medication, and many sleep aids cross the placenta and reach your developing baby. The safest approach is to talk with your obstetrician or midwife before taking any sleep medication — even ones you took before pregnancy.
Some tablets carry higher risk than others. Benzodiazepines like diazepam and temazepam, commonly prescribed for sleep, have been linked to birth defects and withdrawal symptoms in newborns. Over-the-counter antihistamines like diphenhydramine (found in Benadryl and many sleep aids) lack enough safety data in pregnancy. A small number of medications — mainly certain antidepressants used off-label for sleep — have longer safety records in pregnancy, but even these require medical oversight.
The reason your doctor needs to be involved is that the risk changes by trimester. First trimester is when organ systems form, making it the highest-risk period. Second and third trimesters carry different concerns. Your doctor knows your medical history, the specific tablet you are considering, and how far along you are — all of which shape the decision.
Key Takeaways
- Most over-the-counter and prescription sleep tablets should be avoided during pregnancy because they cross the placenta and may harm fetal development.
- Benzodiazepines and antihistamines are among the most commonly used sleep aids but lack sufficient safety data or carry known risks in pregnancy.
- Some antidepressants used for sleep have longer safety records in pregnancy, but only your obstetrician can determine whether one is appropriate for you.
- Sleep problems in pregnancy are common and often respond to non-medication approaches like sleep hygiene, relaxation techniques, and positional changes.
- Always discuss any sleep medication — including over-the-counter options — with your obstetrician before taking it during pregnancy.
Why sleeping tablets carry risk in pregnancy
During pregnancy, your placenta does not block most medications. Substances you ingest reach your baby's bloodstream, and your baby's liver and kidneys are not fully developed to process them. This is especially true in the first trimester, when your baby's organs are forming.
Benzodiazepines — the class that includes diazepam, temazepam, and alprazolam — have the longest history of concern. Studies have suggested links to cleft palate when used in the first trimester, though the absolute risk is small. More consistently documented is the risk of withdrawal symptoms in newborns whose mothers took benzodiazepines regularly during pregnancy: babies can experience tremors, feeding difficulty, and irritability after birth.
Over-the-counter sleep aids containing diphenhydramine or doxylamine have not been thoroughly studied in pregnancy. Because the data is incomplete, most obstetricians recommend avoiding them. Melatonin supplements are sometimes discussed as lower-risk, but evidence in pregnancy is still limited, and your doctor needs to weigh the specific circumstances.
Medications with lower documented risk in pregnancy
A small number of medications have longer safety records in pregnancy because they have been used for other reasons — usually depression or anxiety — in pregnant people over many years. These are not sleep tablets in the traditional sense; they are antidepressants that happen to help with sleep.
Sertraline (Zoloft) and paroxetine (Paxil) are selective serotonin reuptake inhibitors (SSRIs) with the most pregnancy data. They have been used in thousands of pregnancies, and large studies have not found clear evidence of birth defects. Tricyclic antidepressants like amitriptyline also have longer safety records. None of these are risk-free — no medication in pregnancy is — but the data is more complete than for most sleep-specific tablets.
The catch is that these medications take two to four weeks to reach full effect, so they are not useful for acute insomnia. They are considered only when sleep problems are severe and persistent, and only under close medical supervision. Your obstetrician will weigh the risk of untreated sleep deprivation against the medication risk before recommending one.
Non-medication approaches that often work better
Sleep problems in pregnancy are extremely common — hormonal changes, physical discomfort, and anxiety all interfere with rest. The good news is that many pregnant people find relief without medication by adjusting their sleep environment and habits.
Sleep position matters. Lying on your left side improves blood flow to the placenta and reduces pressure on your vena cava (the large vein that returns blood to your heart). A body pillow or pregnancy pillow supports your belly and between your knees, reducing the tossing and turning that wakes you. Keeping your bedroom cool, dark, and quiet — standard sleep hygiene — works as well in pregnancy as it does otherwise.
Relaxation techniques reduce the anxiety that often keeps pregnant people awake. Slow, deep breathing, progressive muscle relaxation, and guided imagery are all evidence-based and carry no medication risk. Some pregnant people find prenatal yoga or gentle stretching helpful. If racing thoughts keep you awake, writing down worries before bed can help clear your mind.
Timing also matters. Eating a light snack with protein and carbohydrates an hour or two before bed can stabilize blood sugar and prevent waking from hunger. Avoiding caffeine after noon and limiting fluids in the evening reduce sleep disruption. If you cannot fall asleep after 20 minutes, getting up and doing a quiet activity until you feel sleepy is more effective than lying in bed frustrated.
When to contact your obstetrician about sleep problems
Occasional poor sleep is normal in pregnancy and does not harm your baby. Contact your obstetrician if you are sleeping fewer than five or six hours most nights over several weeks, or if sleep deprivation is affecting your mood, safety, or ability to function at work or home.
Tell your doctor if you have a history of sleep disorders like sleep apnea or restless leg syndrome. These conditions can worsen in pregnancy and may need specific treatment. Also mention if you were taking a sleep medication before pregnancy — your doctor needs to know what you were using and why, and whether stopping it suddenly caused rebound insomnia.
Bring a list of any over-the-counter sleep aids, supplements, or herbal products you are considering. Your obstetrician can tell you which ones have data in pregnancy and which ones to avoid. This conversation works best when you have it before you start taking something, not after.
Sleep problems linked to pregnancy complications
Untreated sleep apnea in pregnancy carries real risks: it can raise blood pressure and increase the chance of preeclampsia and gestational diabetes. If you snore loudly, gasp for breath during sleep, or wake unrefreshed despite long sleep, mention this to your obstetrician. Sleep apnea is treatable with devices like a CPAP machine, which is safe in pregnancy.
Severe insomnia that persists despite non-medication approaches can contribute to depression and anxiety in pregnancy. These conditions themselves carry risks if untreated. This is one reason your doctor may consider a medication with a longer safety record — not because the insomnia alone is dangerous, but because the depression or anxiety it triggers might be.
Restless leg syndrome — an irresistible urge to move your legs, especially at night — affects some pregnant people and worsens as pregnancy progresses. Iron deficiency can trigger or worsen it. Your obstetrician can check your iron level and may recommend supplementation. If that does not help, certain medications are considered safer than others in pregnancy.
What to do if you were already taking a sleeping tablet when you became pregnant
Do not stop a medication abruptly without talking to your doctor, even if you are worried about pregnancy. Stopping benzodiazepines suddenly can cause rebound insomnia, anxiety, and in severe cases, seizures. Stopping other medications can trigger withdrawal or a return of the condition they were treating.
Contact your obstetrician as soon as you know you are pregnant or planning to become pregnant. Bring the name of the medication, the dose, and how long you have been taking it. Your doctor can tell you whether continuing it, tapering it, or switching to something else is safest for your specific situation. This conversation is most useful early in pregnancy, when your doctor has the most options.
If you have already taken a sleep tablet during early pregnancy before realizing you were pregnant, this does not automatically mean harm has occurred. Many medications carry some risk but do not cause problems in most pregnancies. Your obstetrician can discuss what is known about the specific tablet and what monitoring or follow-up might be helpful.
Frequently Asked Questions
Is melatonin safe to take while pregnant?
Melatonin has not been thoroughly studied in pregnancy, so most obstetricians recommend avoiding it unless your doctor specifically suggests it. Some research suggests it may be lower-risk than other sleep aids, but the evidence is not complete enough to call it safe. Talk to your obstetrician before taking it.
Can I use herbal sleep aids like valerian or chamomile during pregnancy?
Most herbal sleep products lack safety data in pregnancy. Valerian, passionflower, and other herbal remedies are not regulated the way medications are, so their strength and purity vary. Your obstetrician can tell you which ones, if any, might be reasonable to try, but most recommend sticking with non-medication approaches first.
What if I have severe insomnia and non-medication approaches are not working?
Talk to your obstetrician about the severity and how long it has been happening. If sleep deprivation is affecting your health or mood, your doctor may consider a medication with a longer safety record, usually an antidepressant used off-label for sleep. The decision depends on your trimester, medical history, and the specific medication.
Is it safe to take sleeping tablets in the third trimester?
The risk profile changes in the third trimester, but most sleep tablets are still not recommended. Benzodiazepines taken close to delivery can affect the newborn's breathing and muscle tone. Your obstetrician can discuss what is safest at your stage of pregnancy, but non-medication approaches are usually tried first.
Will poor sleep during pregnancy harm my baby?
Occasional poor sleep does not harm your baby. Chronic severe sleep deprivation over weeks may increase stress hormones and affect your own health, which indirectly matters for pregnancy. This is why your doctor takes persistent insomnia seriously — not because a few bad nights are dangerous, but because ongoing sleep loss can affect your wellbeing.