TREATMENT OF CONSTIPATION IN PREGNANCY
Date of issue: July 2022, Version: 3
Constipation is common in pregnancy and affects approximately 40% of women. It is thought to be caused by progesterone-induced intestinal smooth muscle relaxation.
There is very little published epidemiological information available on laxative exposure during pregnancy; however, most have minimal systemic absorption and are commonly used during pregnancy without concerns regarding teratogenic effects being raised.
Initial treatment of constipation in pregnancy should ideally be non-pharmacological, e.g. exercise, dietary measures and increased fluid intake. No adverse fetal effects have been reported following the use of bulk-forming laxatives during pregnancy, therefore ispaghula husk, sterculia or wheat bran may be used if non-pharmacological measures are not effective.
Limited data on the use of osmotic laxatives lactulose and macrogol in pregnancy do not raise concerns of adverse fetal effects and the manufacturers state that use may be considered if necessary.
The very limited available data regarding the use of docusate sodium and senna in pregnancy suggest no increased risk of congenital malformations but are insufficient to conclusively state that there is no increase in risk. There are no studies investigating other adverse pregnancy outcomes.
There are no published data regarding the use of bisacodyl, sodium picosulfate, linaclotide, lubiprostone, prucalopride, glycerine suppositories, or enemas in pregnancy.
Due to their osmotic nature and stimulant effects, laxatives may induce electrolyte imbalance and should therefore only be used for short periods of time during pregnancy.
Exposure to any of the agents described in this monograph at any stage in pregnancy would not usually be regarded as medical grounds for termination of pregnancy or any additional fetal monitoring. However, other risk factors may be present in individual cases which may independently increase the risk of adverse pregnancy outcome. Clinicians are reminded of the importance of consideration of such factors when performing case-specific risk assessments.
Please note that this document does not cover the potential effects of laxative abuse during pregnancy.
This is a summary of the full UKTIS monograph for health care professionals and should not be used in isolation. The full UKTIS monograph and access to any hyperlinked related documents is available to NHS health care professionals who are logged in.
If you have a patient with exposure to a drug or chemical and require assistance in making a patient-specific risk assessment, please telephone UKTIS on 0344 892 0909 to discuss the case with a teratology specialist.
If you would like to report a pregnancy to UKTIS please click here to download our pregnancy reporting form. Please encourage all women to complete an online reporting form.