Insomnia is very common among pregnant women and is often reported as one of the factors that, in addition to compromising the quality of sleep, also has a negative impact on the overall quality of life. The causes of insomnia in pregnancy are multifactorial, including hormonal changes, physical discomfort, psychological distress, and other associated conditions. There is growing evidence that insomnia and related sleep disturbances of gestation may have a variety of negative consequences on the health of the mother and the fetus, ranging from hypertension and gestational diabetes to preterm birth (PTB), which are still often overlooked. Therefore, a multidisciplinary approach is needed, as part of standard prenatal gynecological care, to effectively address insomnia and its influence on pregnancy outcomes. This should include an accurate and timely assessment of sleep changes during pregnancy, and the adoption of appropriate, mostly nonpharmacological, management strategies, emphasizing the importance of personalized treatments to improve sleep quality.