A 30-year-old woman in her second trimester of pregnancy presents with ongoing constipation. She has been eating more fibre and drinking more fluids, but this has not improved her symptoms. Which one of the following is the most appropriate recommendation?

• A. Lactulose oral solution
• B. Senna extract
• C. Glycerol suppositories
• D. Docusate sodium

Answer: (A)

Constipation in pregnancy often arises from slowed gut motility due to hormonal changes and iron supplementation. When lifestyle measures (more fiber and fluids) don’t help, the safest and most effective next step is an osmotic laxative that isn’t absorbed systemically. Lactulose works in the colon by drawing water into the stool, softening it and increasing bowel movements, and it has a long history of safe use in pregnancy with minimal systemic absorption.

Stimulant laxatives like senna are generally avoided in pregnancy because they can stimulate uterine activity and cramping. Glycerol suppositories provide rapid, short-term relief and aren’t ideal for ongoing management. Docusate sodium helps soften stool but may not be sufficient for constipation with harder stools. So lactulose is the best option in this scenario.