Pregnancy and Contraception in Central Hypersomnolence Disorders

Purpose of Review Many women will experience central hypersomnolence disorders, such as narcolepsy and idiopathic hypersomnia (IH). However, there have been few investigations on the impacts of these sleep disorders on women’s health issues including pregnancy, contraception, and lactation. We summarize the literature on central hypersomnolence disorders in relation to women’s health and assess areas where additional research is needed. Recent Findings Women with central hypersomnolence disorders face unique challenges associated with pregnancy and related to contraception and lactation decision making. Hormonal contraceptives (HCPs) may worsen insomnia and sleepiness. Modafinil and pitolisant may decrease effectiveness of HCPs; most women are not counseled on these interactions, with some reporting unintended pregnancy. Women with narcolepsy have fewer pregnancies, increased prevalence of gestational diabetes, and more miscarriages; live births generally result in normal development. Stimulant use during pregnancy is associated with minimal risk of congenital malformations, while modafinil exposure has increased risk based on small samples. Most FDA-approved medications for hypersomnia transfer into breast milk, but at low levels and without harmful effects on the infant. Summary We recommend discussing concomitant HCP and hypersomnolence medication use with patients, careful consideration of medication use in pregnancy, increasing adjuvant wake-promotion strategies, adapting medication use for breastfeeding, and periodically consulting pregnancy registries for updates. More longitudinal data is needed for more robust recommendations.