Constipation, heartburn, and haemorrhoids are common gastrointestinal complaints during pregnancy. Constipation occurs in 11-38% of pregnant women. Although the exact prevalence of haemorrhoids during pregnancy is unknown, the condition is common, and the prevalence of symptomatic haemorrhoids in pregnant women is higher than in non-pregnant women. The incidence of heartburn in pregnancy is reported to be 17-45%.
Methods and outcomes
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of interventions to prevent or treat constipation in pregnancy? What are the effects of interventions to prevent or treat haemorrhoids in pregnancy? What are the effects of interventions to prevent or treat heartburn in pregnancy? We searched: Medline, Embase, The Cochrane Library and other important databases up to July 2007 (BMJ Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
We found five systematic reviews, RCTs or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
In this systematic review we present information relating to the effectiveness and safety of the following interventions: Acid-suppressing drugs, anaesthetic agents (topical), antacids with or without alginates, bulk-forming laxatives, compound corticosteroid and anaesthetic agents (topical), corticosteroid agents (topical), increased fibre intake, increased fluid intake, osmotic laxatives, raising the head of the bed, reducing caffeine intake, intake of fatty foods, and the size and frequency of meals, rutosides, sitz baths, and stimulant laxatives.
Constipation, heartburn, and haemorrhoids are common gastrointestinal complaints during pregnancy.
Constipation occurs in 11-38% of pregnant women.
Stimulant laxatives may be more effective than bulk laxatives in improving constipation in pregnancy, although adverse effects, such as abdominal pain and diarrhoea, could limit their use.
Dietary fibre may improve constipation in pregnant women compared with placebo.We don't know whether increasing fluid intake improves constipation in pregnancy. However, because of other health benefits, increased fluid intake may be recommended as one of the first measures to relieve constipation.We don't have good evidence to show that bulk-forming or osmotic laxatives are of benefit for constipation in pregnancy.
Although the exact prevalence of haemorrhoids during pregnancy is unknown, the condition is common, and the prevalence of symptomatic haemorrhoids in pregnant women is higher than in non-pregnant women.
Rutosides improve the symptoms of haemorrhoids compared with placebo. However, further studies are needed to assess their potential adverse effects.
We don't know whether increased fibre and fluid intake are effective in relieving the symptoms of haemorrhoids in pregnancy, although it seems reasonable to encourage pregnant women to consume a fluid- and fibre-rich diet as a preventive measure.We don't know whether stimulant laxatives, bulk-forming laxatives, or osmotic laxatives are effective in relieving symptomatic haemorrhoids in pregnancy, although, if constipation is associated with haemorrhoids, treating constipation with stimulant laxatives may relieve straining, and thereby provide some symptomatic relief.We found no good evidence assessing the effects of topical anaesthetics, topical corticosteroids, or compound topical corticosteroids plus anaesthetics to treat symptomatic haemorrhoids in pregnancy. However, despite this, women who have painful complicated haemorrhoids may be offered topical anaesthetic agents unless contraindicated.
The incidence of heartburn in pregnancy is reported to be 17-45%.
Antacids may provide effective heartburn relief in pregnancy.
We don't know whether dietary and lifestyle modifications are of benefit to prevent or treat heartburn in pregnancy. However, there is consensus that lifestyle and dietary modifications, including avoiding fatty foods and caffeine, should remain first-line treatment for heartburn in pregnant women.We also don't know whether acid-suppressing drugs such as ranitidine are of benefit to treat heartburn in pregnancy.