Table 9. Recommendation for insomnia treatment during pregnancy and breastfeeding.
| Category | Intervention | Recommendation | Consensus rate |
|---|---|---|---|
| BZD agonists | Zolpidem - Oral | NOT Recommended | 93.75% |
| Zolpidem - Sublingual | NOT Recommended | 93.75% | |
| Zolpidem - CR | NOT Recommended | 93.75% | |
| Zolpidem – orodispersible | NOT Recommended | 93.75% | |
| Zopiclone | NOT Recommended | 93.75% | |
| Eszopiclone | NOT Recommended | 93.75% | |
| BZD a | NOT Recommended | 87.50% | |
| DORAs | Suvorexant | NOT Recommended | 87.50% |
| Lemborexant | NOT Recommended | 86.67% | |
| Daridorexant | NOT Recommended | 81.25% | |
| Antidepressants | Trazodone | NOT Recommended | 81.25% |
| Doxepin | NOT Recommended | 81.25% | |
| Mirtazapine | NOT Recommended | 81.25% | |
| Amitriptyline | NOT Recommended | 75.00% | |
| Agomelatine | NOT Recommended | 93.75% | |
| Melatonin | Melatonin | NOT Recommended | 87.50% |
| Melatoninergic agonists | Ramelteon | NOT Recommended | 93.75% |
| Antipsychotics | Quetiapine | NOT Recommended | 81.25% |
| Olanzapine | NOT Recommended | 87.50% | |
| Clozapine | NOT Recommended | 93.75% | |
| Periciazine | NOT Recommended | 93.75% | |
| Levomepromazine | NOT Recommended | 81.25% | |
| Chlorpromazine | NOT Recommended | 87.50% | |
| Anticonvulsants | Gabapentin | NOT Recommended | 87.50% |
| Pregabalin | NOT Recommended | 87.50% | |
| Others | Difenhydramine | NOT Recommended | 87.50% |
| Promethazine | NOT Recommended | 93.75% | |
| Hydroxyzine | NOT Recommended | 93.75% | |
| Dimenhydrinate | NOT Recommended | 87.50% | |
| GABA | NOT Recommended | 93.75% | |
| Tryptophane | NOT Recommended | 93.75% | |
| Phytotherapeutics | Valeriana officinalis | NOT Recommended | 93.75% |
| Passiflora incarnata | NOT Recommended | 87.50% | |
| Matricaria recutita1 | NOT Recommended | 93.75% | |
| Withania somnifera1 | NOT Recommended | 93.75% | |
| Erythrina Mulungu | NOT Recommended | 93.75% | |
| Cannabinoids | Cannabis sativa | NOT Recommended | 100.00% |
| Cannabidiol | NOT Recommended | 100.00% | |
| Delta-9-THC | NOT Recommended | 100.00% | |
| CBT-I | In-person CBT-I | Recommended | 100.00% |
| Online CBT-I | Recommended | 100.00% | |
| Group CBT-I | Recommended | 100.00% | |
| Digital CBT-I | Recommended | 100.00% | |
| Self-help CBT-I | No consensus | ||
| ACT-I | Recommended | 83.87% | |
| MBCT-I | Recommended | 77.42% | |
| Alternative | Acupuncture a | NOT Recommended | 87.10% |
| treatments | Aromatherapy a | No consensus | |
| Biofeedback a | No consensus | ||
| Massage a | NOT Recommended | 77.42% | |
| Meditative practices a b | No consensus | ||
| Mind-body practices a c | No consensus | ||
| Physical exercises a | No consensus |
Abbreviations: ACT-I, Acceptance and commitment therapy applied to insomnia; BZD, Benzodiazepines; CBT-I, Cognitive-behavioral therapy applied to insomnia; DORA, Dual orexin receptor antagonists; GABA, Gamma-aminobutyric acid; MBCT-I, Mindfulness-based cognitive therapy applied to insomnia; THC, Tetrahydrocannabinol.
a
Intervention not included in the systematic reviews.
b
Recommendations voted in group for the whole class, instead of individually for each intervention.
c
Includes meditation and vipassana.
d
Includes qigong, tai-chi, and yoga.