Constipation up to three times more prevalent in pregnant women
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The prevalence of constipation among women was two- to threefold higher during pregnancy and for the first few days postpartum, researchers wrote in the British Journal of Obstetrics and Gynecology.
“Gastrointestinal function during pregnancy and in postpartum should receive attention because severe constipation may have a substantial impact on the pregnancy experience and may affect the mother’s physical and social heath status and impair the relationship between mother and newborn,” Moona Kuronen, a student at the University of Eastern Finland, and colleagues wrote.
Kuronen and colleagues reviewed responses to questionnaires that assessed bowel function and other gastrointestinal symptoms in five cohorts of women in Finland: women in their second trimester of pregnancy (n = 264); women in their third trimester of pregnancy (n = 210); women who had a vaginal delivery within the past month (n = 200); women who had undergone caesarean section in the past month (n = 203); and a control group who had not given birth in the past year (n = 200).
Among all women, those in the second trimester were the youngest (mean age, 29 years) and the women who gave birth by caesarean section were the oldest (mean age, 31 years). The researchers determined the prevalence of constipation based on the Rome IV criteria, which they wrote is the “gold standard” for assessing constipation but has not been validated for pregnancy.
Kuronen and colleagues reported that constipation occurred in 40% of pregnant women, 52% of postpartum women and 21% of women in the control group (P < 0.001 for all). A few days after delivery, the prevalence of constipation was lower after vaginal delivery than caesarean section (47% vs. 57%, P < .039). One month postpartum, the prevalence of constipation was 9% after vaginal delivery (P = .002 vs. the control group) and 15% after caesarean section.
“We were able to minimize selection bias as the subject characteristics were similar in the five study groups,” the researchers wrote. “Thus, we believe our data are sound.”
Perspective
Back to TopMichael Cackovic, MD
This article discusses one of the topics that probably sparks the most calls postpartum.
There are several factors contributing to constipation after delivery. The study mentions the effect of placental hormones on gastrointestinal motility, mechanical changes with advancing gestation, reduced activity, changes in water absorption and activity. But there are also other postpartum factors like pain and use of pain medications, adjusting to the lifestyle changes of a new baby and recovery from the physical demands of labor and delivery.
The most effective way for dealing with constipation is to prevent it. Hydration, healthy diet and activity — high-fiber foods, such as fruits, vegetables, beans and whole grains —are the keystones to prevent constipation and the healthiest ways to avoid medications.
Perspective
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Tamika C. Auguste, MD, FACOG
The findings of this study confirm what we have known for quite some time — constipation is a common, and often unwelcome, condition experienced by pregnant and postpartum women. During pregnancy, increased levels of hormones can cause the digestive system to work more slowly, which can lead to slower functioning of the gut. This is typically the cause of the constipation. The iron in prenatal vitamin supplements can also be a contributor.
To help ease this problem, I typically recommend that my patients drink plenty of liquids and increase their intake of fiber, which is found in fruits, vegetables and whole grains, aiming for about 25 g of fiber daily. However, an unfortunate side effect of increased fiber consumption is gas. So, to combat this problem, I suggest eating meals more slowly and avoiding anything that causes one to swallow air, such as gum chewing or carbonated drinks. A woman’s body will eventually adjust to the dietary changes.
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