Medical/Surgical/Diseases/Complications
Poster Session 1
.jpg "Daniel Martingano, DO MBA PhD photo")
Daniel Martingano, DO MBA PhD
OB/GYN Clerkship Director, Assistant Residency Program Director, Academic Chair of OB/GYN
St. John's Episcopal Hospital-South Shore
Far Rockaway, NY, United States
Andrea Ouyang, BS,MS
Medical Student
William Carey University College of Osteopathic Medicine
Baton Rouge, LA, United States
Marwah Al-Dulaimi, MD
Resident Physician, OB/GYN
St. John's Episcopal Hospital-South Shore
Far Rockaway, NY, United States
Jessica Marshall, DO
Resident
St. John's Episcopal Hospital-South Shore
Far Rockaway, NY, United States
Rachel Amuzu, DO, MSc (she/her/hers)
Resident Physician, OB/GYN
Rutgers Health, Jersey City Medical Center
Bayonne, NJ, United States
Shavana Singh, BSc
Student Doctor, OMSIII
Lake Erie College of Osteopathic Medicine
Far Rockaway, PA, United States
Alexander Ulfers, DO
Resident Physician
Walter Reed National Military Medical Center
Bethesda, MD, United States
Benjamin Dribus, PhD
Chair, Department of Mathematics
William Carey University
Hattiesburg, MS, United States
Kristin Cohen, CNM, DNP
RWJBarnabas Health, Trinitas Regional Medical Center
Elizabeth, NJ, United States
Shailini Singh, MD
Attending Maternal-Fetal Medicine Specialist
Hackensack Meridian Health, JFK University Medical Center
Edison, NJ, United States
Jacqueline Marecheau, MD
St. John's Episcopal Hospital-South Shore
Far Rockaway, NY, United States
Antonia F. Oladipo, MD, MSCI (she/her/hers)
Assistant Professor
Hackensack University Medical Center
Hackensack, NJ, United States
Donald Morrish, MD
Chief Medical Officer
St. John's Episcopal Hospital-South Shore
Far Rockaway, NY, United States
Pregnant patients experiencing insomnia in the 3rd trimester is a common occurrence, yet management approaches are highly varied and medication efficacy remains unclear. This study sought to determine which medication proved most effective for patients with insomnia in the 3rd trimester.
Study Design:
We conducted a multi-center, prospective observational study from 7/2021 to 7/2023 comparing all pregnant patients who received treatment of insomnia at a gestational age range of 28 0/7 to 40 0/7 weeks. Monotherapy medications dimenhydrinate, diphenhydramine, melatonin, gabapentin, benzodiazepines, and magnesium oxide were included as covariates. Patients taking overlapping medications or with allergies to any included medications were excluded. Primary outcomes included the need to switch medication, patient-reported resolution confirmed by provider assessment, patient-reported increased energy level due to adequate sleep, and patient-reported ability to fall asleep reliably with medication as discrete events.
Results:
The study included 686 patients who required pharmacologic treatment for insomnia in the 3rd trimester. Baseline demographics were not significantly different. Patients who received magnesium oxide at doses of 800mg or greater were less likely to switch to an alternative medication (61.2% v. 33.1%, p = 0.03) with a 68% decreased risk in adjusted models (RR 0.32, 95% CI 0.21-0.73, p = 0.004). Patients taking gabapentin at doses exceeding 1200mg (59.1% v. 17.9%, p = 0.003) or melatonin at doses of 40mg or greater (49.2% v. 11.5%, p = 0.01) had higher rates of increased energy levels due to adequate sleep. Adjusted models demonstrated an additional 44% and 21% increased likelihood when taking gabapentin (RR 1.44, 95% CI 1.23 – 1.77, p = 0.002) or melatonin (RR 1.21, 95% CI 1.11 – 1.53, p = 0.007), respectively.
Conclusion:
Magnesium oxide, melatonin, and gabapentin are reasonable medical therapies in the treatment of insomnia for 3rd-trimester pregnant patients.