TREATMENT OF CONSTIPATION IN PREGNANCY

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(Date of issue: March 2018, Version: 2)

This is a UKTIS monograph for use by health care professionals. For case-specific advice please contact UKTIS on 0344 892 0909. To report an exposure please download and complete a pregnancy reporting form. Please encourage all women to complete an online reporting form.

A corresponding patient information leaflet on treatment of constipation in pregnancy is available at www.medicinesinpregnancy.org.

Summary

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 the potential risks associated with the use of laxatives 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 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.

Although there are no data available regarding the use of the osmotic laxatives lactulose and macrogol in pregnancy, 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 document is regularly reviewed and updated. Only use full UKTIS monographs downloaded directly from TOXBASE.org to be sure you are using the most up-to-date version. The summaries of these monographs are openly available on UKTIS.org.

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 health care professionals at www.toxbase.org.

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.

Disclaimer: Every effort has been made to ensure that this monograph was accurate and up-to-date at the time of writing, however it cannot cover every eventuality and the information providers cannot be held responsible for any adverse outcomes of the measures recommended. The final decision regarding which treatment is used for an individual patient remains the clinical responsibility of the prescriber. This material may be freely reproduced for education and not for profit purposes within the UK National Health Service, however no linking to this website or reproduction by or for commercial organisations is permitted without the express written permission of this service. This document is regularly reviewed and updated. Only use UKTIS monographs downloaded directly from TOXBASE.org or UKTIS.org to ensure you are using the most up-to-date version.