Behandlung der chronischen funktionellen Obstipation in der Schwangerschaft und Stillperiode

Zusammenfassung

Lösliche und unlösliche pflanzliche Fasern (Füll- und Quellmittel), Docusat-Natrium, Mineralöle (Schmier- und Gleitmittel), Makrogol (Polyethylenglykol, PEG), Zucker und Zuckeralkohole (osmotische Laxantien) und Antrachinone und diphenolische Laxantien (stimulierende Laxantien) gehören zu den herkömmlich in der Schwangerschaft und Stillperiode verwendeten Abführmittel. Sie scheinen kein Risiko für Teratogenität aufzuweisen und den Säugling nicht zu gefährden. Die Risikoklassifikation der US-amerikanischen Food and Drug Administration (FDA) für diese Substanzen ist eher durch das Fehlen von Daten als durch eine evidenzbasierte Studienlage beeinflusst und deshalb nicht hilfreich. Alternative Ansätze durch das American College of Gastroenterology’s Committee on FDA related matters (ACG-FDA) und das Motherisk Program sollen die Therapieentscheidung vereinfachen. Für neue Substanzen, wie Chlorid-Kanal-Aktivatoren und Prokinetika liegen keine Daten für Schwangerschaft und Stillzeit vor. Wir empfehlen als Mittel der ersten Wahl in der Schwangerschaft Makrogol und Laktulose, wobei Makrogol Vorteile, wie raschen Wirkeintritt und die wenig ausgeprägte Bildung von Flatulenzen aufweist. Erst bei Versagen dieser Therapie sollen ab dem zweiten Trimenon diphenolische Laxantien, wie Bisacodyl oder Natriumpicosulfat, verwendet werden. In der Schwangerschaft wird die Wahl des Laxans vor allem von seiner Gefahr, Tenesmen und damit Frühgeburtlichkeit auszulösen, bestimmt. Während des Stillens kann, je nach dem klischen Bild der Mutter, unter Makrogol (wegen fehlender Datenlage der Laktulose vorzuziehen), Laktulose, Bisacodyl und Natrium-picosulfat gewählt werden.

Abstract

Natural fibres (bulk-forming agents), docusate sodium (stool-softener), mineral oils (lubricant laxatives), macrogol (polyethylene glycol, PEG), sugars and sugar alcohols (osmotic laxatives) and anthraquinones and diphenolic laxatives (stimulant laxatives) seem to be safe medicaments regarding teratogenicity and lactation. The US Food and Drug Administration (FDA) risk categories for these substances taken during pragnancy and lactation are often the result of the lack of studies than of evidence-based information. So risk categories do not help in the decison-making for the right laxative. Alternative solutions such as proposals of the American College of Gastroenterology’s Committee on FDA related matters, (ACG-FDA) and the Motherisk Programme try to improve decision-making. For newer compounds such as chloride-channel-activators and procinetics no data regarding safe use in pregnancy and during breast-feeding are available as yet. We suggest the use of macrogol and lactulose as the first-line therapy in treating chronic constipation during pregnancy. Macrogol shows some advantages, such as faster onset of bowel action and fewer flatulences. If this treatment does not work or starts but then stops working, we recommend in the second and third trimenon a second-line treatment with diphenolic laxatives such as bisacodyl and and sodium picosulfate. During pregnancy the decision on the application of these laxatives is largely determined by the side-effects of tenesmus associated with preterm births. During lactation we recommend macrogol (preferable to lactulose due to the lack of data), lactulose, bisacodyl and sodium picosulfate, according to the nature of the conditions.

Schlüsselwörter

chronische funktionelle Obstipation - Schwangerschaft - Stillzeit - Behandlung

Key words

chronic functional constipation - pregnancy - lactation - treatment

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