Movicol (Polyethylene Glycol) Safety in Pregnancy
Movicol (polyethylene glycol) is safe to use during pregnancy and is recommended as a first-line treatment option for constipation in pregnant women. 1
Primary Recommendation
The American Gastroenterological Association explicitly recommends polyethylene glycol-based laxatives as a safe treatment option for constipation during pregnancy. 1 This recommendation is based on the lack of systemic absorption and extensive clinical experience with osmotic laxatives in pregnant populations. 1
Clinical Context and Rationale
Constipation affects 20-40% of pregnant persons, resulting from hormonal changes (particularly increased progesterone slowing GI motility), medication-related effects, and physiological changes. 1
Polyethylene glycol (macrogol/Movicol) works as an osmotic laxative and can be administered safely throughout pregnancy. 1
Macrogol shows specific advantages over other laxatives, including faster onset of bowel action and fewer flatulence side effects compared to lactulose. 2
Treatment Algorithm
First-line approach:
- Increase dietary fiber to approximately 30 g/day (fruits, vegetables, whole grains, legumes) with adequate fluid intake. 1
- If dietary measures insufficient, initiate polyethylene glycol (Movicol) or lactulose as osmotic laxatives. 1, 2
Second-line approach (if first-line fails):
- In second and third trimesters only, diphenolic laxatives such as bisacodyl or sodium picosulfate may be considered. 2
- Stimulant laxatives should generally be avoided due to conflicting safety data and risk of tenesmus potentially associated with preterm birth. 1, 2
Important Caveats
Excessive use of osmotic laxatives like polyethylene glycol can cause maternal bloating, though this is a tolerability rather than safety concern. 1
Bulk-forming agents (psyllium, methylcellulose) are also safe due to lack of systemic absorption and may be used concurrently. 1
Avoid straining during bowel movements by ensuring adequate time, using relaxation techniques, and optimizing diet and hydration. 1
Lactation Safety
Polyethylene glycol is recommended during lactation as a first-line agent for chronic constipation, with preference over lactulose when data quality is considered. 2