Lin Chang, MD, on IBS and Pregnancy - HMP Global Learning Network

Lin Chang, MD, on IBS and Pregnancy  HMP Global Learning Network

• Hormonal impact on GI motility and reflux: Elevated estrogen and progesterone during pregnancy relax GI smooth muscle, slowing intestinal transit and relaxing the lower esophageal sphincter. This leads to early-onset constipation and GERD symptoms—often beginning by the end of the first trimester, independent of uterine size.

• IBS and pregnancy outcomes: Limited data show women with irritable bowel syndrome (IBS) may have a ~20% higher miscarriage risk versus non-IBS controls, but most experience stable or improved symptoms during pregnancy. Further research is needed to clarify IBS course and outcomes in pregnancy.

• Constipation management in pregnancy: First-line therapies include fiber (psyllium), magnesium-based osmotic laxatives, and polyethylene glycol (Miralax). Lactulose may be used but can cause bloating. Prescription options such as lubiprostone or linaclotide are generally reserved when benefits outweigh risks; prucalopride is not recommended. For IBS with diarrhea, short-term loperamide is acceptable. SSRIs (sertraline, citalopram) and SNRIs (duloxetine) may be used for comorbid mood or pain symptoms under OBGYN guidance, prioritizing maternal health

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