Constipation Management in Pregnancy

Recommended Treatment Approach

The American Gastroenterological Association recommends dietary fiber, lactulose, and polyethylene glycol-based laxatives as safe treatment options for constipation in pregnancy 1
Increase dietary fiber to approximately 30 g/day through fruits, vegetables, whole grains, and legumes, as recommended by clinical guidelines 2
Ensure adequate fluid intake, particularly water, to soften stools, as advised by clinical guidelines 2
Psyllium husk or methylcellulose are safe during pregnancy due to minimal systemic absorption, according to clinical guidelines 2
Polyethylene glycol (PEG) can be safely administered during pregnancy and is the preferred osmotic laxative, as recommended by the American Gastroenterological Association 1
Lactulose is also safe and is the only osmotic agent specifically studied in pregnancy, though it may cause more bloating than PEG, according to clinical guidelines 3, 2

Constipation in pregnancy results from increased progesterone levels slowing GI motility, mechanical compression from the gravid uterus, and low dietary fiber intake, as explained by clinical guidelines 2
Screen for hemorrhoids, which occur in approximately 80% of pregnant women and may complicate constipation management, as recommended by clinical guidelines 2

Do not prescribe newer secretagogues (linaclotide, plecanatide, lubiprostone) during pregnancy due to insufficient safety data, as warned by clinical guidelines 4, 3
Do not withhold treatment for constipation, as it affects 20-40% of pregnant women and significantly impacts quality of life, according to clinical guidelines 2
Do not skip evaluation for secondary causes of constipation, such as hypothyroidism, hypercalcemia, and medication-related causes, as advised by clinical guidelines 5, 2