Managing Irritable Bowel Syndrome (IBS) During Early Pregnancy

General Management Principles

Mental health screening should be performed with appropriate referral to support services, given the increased burden of mental health issues during pregnancy, as recommended by the American College of Gastroenterology 1
Careful review of travel and contact history should be taken, with appropriate testing for infectious causes in patients with worsening symptoms, according to the American Gastroenterological Association 2

Regular exercise should be advised to all patients with IBS, as it helps manage symptoms, as suggested by the British Society of Gastroenterology 3
First-line dietary advice should include soluble fiber supplementation, such as ispaghula, starting at a low dose and gradually increasing to avoid bloating, as recommended by the National Institute for Health and Care Excellence 3
Avoiding insoluble fiber, such as wheat bran, is recommended as it may worsen symptoms, according to the American College of Gastroenterology 3

For IBS with diarrhea, loperamide may be used cautiously, but patients should be monitored for side effects, such as abdominal pain, bloating, nausea, and constipation, as advised by the European Society of Gastroenterology 3
For IBS with constipation, soluble fiber supplementation is particularly beneficial, as recommended by the American Gastroenterological Association 3
For abdominal pain, certain antispasmodics may be considered, though patients should be counseled about potential side effects, such as dry mouth, visual disturbance, and dizziness, according to the British Society of Gastroenterology 3

A low-FODMAP diet may be considered as a second-line dietary therapy for global symptoms and abdominal pain in IBS, as suggested by the National Institute for Health and Care Excellence 3
Implementation should be supervised by a trained dietitian, as recommended by the American College of Gastroenterology 3

Tricyclic antidepressants used as gut-brain neuromodulators may be considered for refractory symptoms, as advised by the European Society of Gastroenterology 3
Selective serotonin reuptake inhibitors may be considered as an alternative to tricyclic antidepressants for global symptom management, according to the American Gastroenterological Association 3

Pregnant women with severe dehydration should be hospitalized for intravenous fluid replacement and close monitoring, as recommended by the American College of Obstetricians and Gynecologists 1
Iron tablets should not be used in those with active disease as systemic inflammation inhibits absorption, according to the National Institute for Health and Care Excellence 1, 2
Avoid gadolinium as part of MR imaging during pregnancy, as advised by the American College of Radiology 1, 2
Do not delay urgent surgery to manage complications solely due to pregnancy, as recommended by the American College of Surgeons 1, 2

Stool cultures should be obtained for enteroinvasive bacterial infections and Clostridioides difficile testing in pregnant women with worsening gastrointestinal symptoms, as suggested by the Infectious Diseases Society of America 1
Outpatients with active symptoms should receive VTE prophylaxis during the third trimester, unless contraindicated, according to the American College of Chest Physicians 1, 2

Food elimination diets based on IgG antibodies are not recommended in patients with IBS, as advised by the American Gastroenterological Association 3
Gluten-free diets are not routinely recommended for IBS management unless celiac disease is confirmed, according to the National Institute for Health and Care Excellence 3
Probiotics as a group may help with global symptoms and abdominal pain, but no specific species or strain can be recommended; a 12-week trial is reasonable, as suggested by the European Society of Gastroenterology 3