Metamucil

THE SAFETY OF PSYLLIUM DURING PREGNANCY OR BREASTFEEDING

The information provided below is for readers based in the United States of America. Readers outside of the United States of America should seek the information from local sources.

THIS MEDICATION IS UNLIKELY TO CAUSE HARM TO YOUR BABY:

Although there are not many studies evaluating the safety of psyllium during pregnancy, it is not absorbed into the body. The short-term use of psyllium is expected to pose a low risk of harm to an infant. Caution is advised when using this medication while nursing an infant.

What is psyllium?

Psyllium is a naturally-occurring, soluble fiber supplement or laxative. Psyllium is currently available as a generic or brand name medication (Metamucil™). Psyllium is most often available as a powder or capsules. Psyllium powder is mixed with 8 ounces of water to drink according to the package instructions. Psyllium is administered in multiple doses throughout the day for constipation. It is available over-the-counter. 

What is psyllium used to treat?

Psyllium is used as a daily fiber supplement, to treat constipation lasting more than 1 week, or to decrease the risk of heart disease with daily use in children over 1-2 years old, adolescents, and adults. Constipation is common in pregnant women. Constipation is defined as having less than three bowel movements per week in addition to hard stool and abdominal bloating. Constipation during pregnancy is treated first by increasing fiber in the diet, moderate exercise, and increasing fluid intake. Bulk forming laxatives and probiotics may also be recommended by your doctor depending on the severity of the constipation and lack of response to first-line treatments. 

How does psyllium work?

Psyllium is known as a bulk-forming laxative that works by absorbing water in the colon, softening and enlarging the stool, and producing a bowel movement. 

If I am using psyllium can it harm my baby?

Psyllium used for occasional constipation during pregnancy is not expected to pose a risk of harm to a baby. There are very few studies evaluating the safety of psyllium use during pregnancy. However, psyllium is not absorbed in the small intestine or into the body. 

Evidence from animal studies with psyllium:

When given to pregnant rats and rabbits in amounts 5% to 10% of the daily diet, psyllium caused no adverse effects.

Evidence for the risks of psyllium in human babies:

Bulk-forming laxatives are not absorbed into the body and have not been associated with a risk of harm to the baby. A randomized clinical trial in first-time pregnant women in their third trimester who were taking psyllium powder twice daily to prevent constipation found that psyllium supplementation decreased constipation, hemorrhoids, and anal fissure. The Boston Collaborative Drug Surveillance Program from 1981 in 100-199 women in their first trimester of pregnancy and taking psyllium found no increase the risk of birth defects in the babies. 

The American College of Obstetricians and Gynecologists notes laxatives may be recommended to treat constipation during pregnancy. Bulk-forming laxatives are the preferred laxative to use in pregnant women. Bulk-forming laxatives may be associated with maternal bloating, gas, or cramping. Bulk-forming laxatives may take a few days to start working so they are not recommended for acute symptoms of constipation or fecal impaction. First-line options your doctor may recommend to treat constipation during pregnancy can include increasing fluid intake, exercising, and eating more foods with fiber. 

Bottom line: There are limited studies evaluating the safety of psyllium in pregnant women. Because psyllium is not absorbed into the body, it can be used for occasional cases of constipation during pregnancy without posing a risk of harm to a baby.

If I am taking psyllium and become pregnant, what should I do?

If you are taking psyllium and become pregnant, you should contact your doctor immediately. Your doctor will determine if your medication is medically necessary, or if it should be discontinued until after the birth of your baby.

If I am taking psyllium, can I safely breastfeed my baby?

There is limited information available on the effects of psyllium supplementation on the breastfed baby. Twenty women receiving a postpartum laxative containing psyllium and a stimulant laxative reported no loose stools in their breastfed babies. Psyllium is not absorbed from the gastrointestinal tract into the body, so it is expected to pose a low risk of harm to nursing infants. It is recommended to weigh the risks versus benefits of psyllium use while breastfeeding. 

Bottom line: Psyllium is not expected to pose a risk of harm to the nursing infant. Due to the lack of safety information, caution is recommended in women taking psyllium while breastfeeding.

If I am taking psyllium, will it be more difficult to get pregnant?

Studies in rats given psyllium in 5% of their diet found no evidence of negative effects on male or female fertility. 

If I am taking psyllium, what should I know?

The short-term use of psyllium is expected to pose a low risk of harm to an infant. There have been limited studies evaluating the safety of psyllium supplementation in pregnant and breastfeeding women. Caution is recommended in women using this medication while breastfeeding babies.

If I am taking any medication, what should I know?

This report provides a summary of the available information about the use of psyllium during pregnancy and breastfeeding. Content is from the product label unless otherwise indicated.

You may find Pregistry's expert report about constipation here, and reports about various other digestive health conditions as well as the individual medications used to treat digestive disorders here.   Additional information can also be found in the resources below. 

For more information about psyllium during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or check the following links:

ACOG: Problems of the Digestive System

U.S. National Library of Medicine: PSYLLIUM

Read the whole report
General information

It is very common for women to worry about having a miscarriage or giving birth to a child with a birth defect while they are pregnant. Many decisions that women make about their health during pregnancy are made with these concerns in mind.

For many women these concerns are very real. As many as 1 in 5 pregnancies end in a miscarriage, and 1 in 33 babies are born with a birth defect. These rates are considered the background population risk, which means they do not take into consideration anything about the health of the mom, the medications she is taking, or the family history of the mom or the baby’s dad. A number of different things can increase these risks, including taking certain medications during pregnancy.

It is known that most medications, including over-the-counter medications, taken during pregnancy do get passed on to the baby. Fortunately, most medicines are not harmful to the baby and can be safely taken during pregnancy. But there are some that are known to be harmful to a baby’s normal development and growth, especially when they are taken during certain times of the pregnancy. Because of this, it is important to talk with your doctor or midwife about any medications you are taking, ideally before you even try to get pregnant.

If a doctor other than the one caring for your pregnancy recommends that you start a new medicine while you are pregnant, it is important that you let them know you are pregnant.

If you do need to take a new medication while pregnant, it is important to discuss the possible risks the medicine may pose on your pregnancy with your doctor or midwife. They can help you understand the benefits and the risks of taking the medicine.

Ultimately, the decision to start, stop, or change medications during pregnancy is up to you to make, along with input from your doctor or midwife. If you do take medications during pregnancy, be sure to keep track of all the medications you are taking.