Gut Health in Pregnancy: What's Safe

 Medically reviewed and written by Dr Zeeshan Afzal, MBBS — Medical Doctor and Clinical Content Lead at Welzo. Last updated: July 2026. This article is for general information and does not replace advice from your midwife, GP or obstetrician.

Pregnancy changes almost everything about how your digestive system behaves. Transit slows, hormones rise, the growing uterus physically presses on the bowel, and the composition of the gut microbiome shifts measurably from the first trimester to the third. For most women this shows up as constipation, bloating, heartburn or a general sense that digestion is simply not working the way it used to. It is one of the most common reasons women start looking into gut health for the first time — and one of the most common reasons they end up confused about what is actually safe to take. The question that dominates the search results is a narrow one: are probiotics in pregnancy safe? The honest answer is more nuanced than most articles admit. Large safety reviews have found no signal for miscarriage, malformation, preterm birth or low birth weight. But a 2021 Cochrane review found high-certainty evidence of an increased risk of pre-eclampsia in one specific research context, and no UK guideline currently recommends probiotics routinely in pregnancy. Both facts are true at once, and any article that gives you only the reassuring half is not serving you well. This guide walks through what changes in the pregnant gut, what the evidence genuinely supports, which supplements should be paused the moment a pregnancy test is positive, and how to manage constipation, reflux and bloating safely. If you want the broader background first, our gut health collection and our guides to microbiome diversity, gut barrier function and probiotics cover the fundamentals. Note early that three popular gut supplements — berberine, TUDCA and modified citrus pectin — are not appropriate for use in pregnancy without specialist supervision, and Akkermansia muciniphila has not been studied in pregnant populations at all. Those are covered in detail below.

Key takeaways

• Digestive symptoms in pregnancy are physiological, not a sign that something is wrong. Progesterone slows gut transit from the first trimester onwards.
• The gut microbiome changes substantially across pregnancy — reduced within-person diversity and increased Proteobacteria by the third trimester — and this appears to be an adaptive change rather than disease.
• Safety reviews of Lactobacillus, Bifidobacterium and Saccharomyces strains have not found increased rates of miscarriage, malformation, caesarean section or altered birth weight.
• A 2021 Cochrane review reported increased pre-eclampsia risk with probiotics used specifically to prevent gestational diabetes. This is the single most important caveat and is often omitted.
• No major UK, WHO or international obstetric guideline currently recommends routine probiotic supplementation in pregnancy.
• Food-first approaches — fibre, fermented foods that are pasteurised, hydration and movement — carry the strongest safety profile and should come first.
• Berberine is specifically contraindicated in pregnancy and breastfeeding because of a bilirubin displacement risk in newborns.
• Always discuss any supplement with your midwife, GP or obstetrician before starting it.

Table of contents

• Why gut health changes during pregnancy
• Common digestive symptoms and what causes them
• Are probiotics in pregnancy safe? What the evidence says
• What probiotics may and may not do in pregnancy
• How to choose a probiotic in pregnancy
• Prebiotics and fibre: the safest lever you have
• Fermented foods in pregnancy: safe and unsafe
• Supplements to pause or avoid in pregnancy
• Managing constipation, reflux and bloating safely
• After birth: breastfeeding and postnatal gut health
• Red flags: when to contact your midwife or GP
• Frequently asked questions
• References

Why gut health changes during pregnancy

Three separate mechanisms act on the digestive tract at the same time during pregnancy, which is why symptoms so often overlap.

Progesterone slows everything down

Rising progesterone relaxes smooth muscle throughout the body, including the muscular wall of the intestine. Slower peristalsis means food residue spends longer in the colon, more water is reabsorbed, and stools become harder and more difficult to pass. The same relaxation affects the lower oesophageal sphincter, which is why reflux becomes more likely as pregnancy progresses. Cochrane's review of constipation in pregnancy notes that circulating progesterone is thought to be the driver of slower gastrointestinal movement in mid and late pregnancy.

Iron supplementation compounds this. Most UK women are offered or self-select an iron-containing prenatal, and iron is a well-recognised cause of harder stools — a problem we cover separately in our guide to iron supplements and constipation.

The microbiome shifts across trimesters

The landmark work here is Koren and colleagues' 2012 study in Cell, which followed 91 pregnant women through all three trimesters. First-trimester gut microbiota looked broadly similar to non-pregnant controls. By the third trimester, within-person richness had fallen while between-person diversity had expanded dramatically, with an average increase in Proteobacteria and Actinobacteria and a reduction in butyrate-producing organisms such as Faecalibacterium.

On paper that pattern resembles the dysbiosis seen in inflammatory conditions. In pregnancy, however, it is best understood as an adaptive shift that supports energy storage, insulin resistance and fetal growth rather than a state requiring correction. This distinction matters enormously: a third-trimester stool test that looks "abnormal" against a general reference range may be entirely normal for pregnancy. If you are curious about testing in general, read our overview of the gut microbiome test in the UK and our microbiome test comparison — but be aware that pregnancy-specific reference data is limited.

Because butyrate producers fall in late pregnancy, some readers ask about supplementing directly. Our guide to short-chain fatty acids and butyrate supplements explains the mechanism, but there is no pregnancy safety data for oral butyrate salts and they are not recommended in this context. Dietary fibre remains the evidence-backed route to supporting butyrate production.

Mechanical pressure in the third trimester

From roughly 24 weeks the growing uterus displaces the stomach and bowel upwards and backwards. This reduces gastric capacity, worsens reflux, and contributes to a feeling of fullness and trapped wind even after modest meals. It is also why symptoms that were manageable at 20 weeks can become considerably worse by 34.

Common digestive symptoms in pregnancy and what causes them

If you are not sure whether your bowel pattern has genuinely changed, the Bristol stool chart is a useful objective reference to track over a fortnight. Our guides to constipation relief, foods that cause bloating and IBS types cover the non-pregnancy context in more depth — but always apply the pregnancy-specific caveats in this article on top.

Are probiotics in pregnancy safe? What the evidence actually says

This is the section most readers come for, so it deserves to be handled carefully rather than reassuringly.

The reassuring safety data

Systematic reviews of randomised controlled trials using Lactobacillus, Bifidobacterium and Saccharomyces species in pregnancy have consistently failed to find an effect on the outcomes that worry people most. Pooled analyses have reported no meaningful difference in birth weight, gestational age at delivery or caesarean section rates, and no clustering of malformations or miscarriage attributable to supplementation.

A 2018 systematic review and meta-analysis in CMAJ specifically examined preterm birth — a concern raised by two earlier reviews — across randomised trials of probiotics, prebiotics and synbiotics in singleton pregnancies, and did not confirm the increased risk that had been speculated about. The International Scientific Association for Probiotics and Prebiotics has also published a considered analysis of the safety question in pregnancy, which is worth reading in full if you want the expert discussion rather than a headline.

Put plainly: a woman who has been taking a well-manufactured Lactobacillus or Bifidobacterium product and discovers she is pregnant has no reason to panic. There is no evidence base suggesting harm from ordinary exposure.

The pre-eclampsia signal you should know about

The 2021 Cochrane review by Davidson and colleagues examined probiotics for the prevention of gestational diabetes. It concluded that the effect on gestational diabetes itself was unclear on low-certainty evidence from six trials, but that probiotics increased the risk of pre-eclampsia compared with placebo — a risk ratio of 1.85 (95% CI 1.04 to 3.29) across four studies and 955 women, graded as high-certainty evidence.

Several important qualifiers apply. The trials contributing pre-eclampsia data were largely in overweight or obese cohorts, pre-eclampsia was not the primary outcome any trial was designed to detect, event numbers were small, and the confidence interval sits close to 1. The ISAPP commentary makes the case that this is a signal warranting further study rather than proof of causation. Cochrane itself notes that the underlying physiology linking probiotics and pre-eclampsia risk needs to be considered.

Nonetheless, "high-certainty evidence of increased risk" is not a phrase to gloss over, and it is the reason this article does not tell you that probiotics in pregnancy are unambiguously safe. If you have any risk factor for hypertensive disease in pregnancy — previous pre-eclampsia, chronic hypertension, pre-existing diabetes, autoimmune disease, BMI over 35, a first pregnancy, multiple pregnancy or a family history — this is a conversation to have with your obstetric team before starting anything.

What UK and international guidance says

No major obstetric or public health body currently recommends routine probiotic supplementation in pregnancy. NHS pregnancy nutrition guidance focuses on folic acid and vitamin D supplementation, a varied diet and specific foods to avoid — probiotics do not feature as a recommendation. The World Health Organization, the International Federation of Gynecology and Obstetrics, and the Australian Pregnancy Care Guidelines have likewise not endorsed routine use, on the basis that the benefit of universal supplementation remains unclear.

The absence of a recommendation is not the same as a prohibition. It means the evidence has not reached the threshold at which a guideline body will advise everyone to do something — which is a high bar in pregnancy, and appropriately so.

Who should be more cautious than average

• Immunocompromised women — including those on immunosuppressants or with HIV. Live organisms carry a small but real theoretical risk of translocation.
• Women with a central venous catheter or recent abdominal surgery.
• Women at risk of, or with, pre-eclampsia or hypertensive disease of pregnancy, per the Cochrane finding above.
• Women with significant heart valve disease.
• Women with a history of preterm birth or preterm prelabour rupture of membranes — discuss with your consultant rather than self-managing.
• Women taking Saccharomyces boulardii — this is a yeast rather than a bacterium and has the largest body of case reports of fungaemia in vulnerable hospitalised patients. Our guide to Saccharomyces boulardii explains this in more detail.

What probiotics in pregnancy may and may not do

The eczema finding deserves emphasis because it is routinely overstated in marketing. The 2008 Wickens trial randomised women to HN001, B. animalis subsp. lactis HN019 or placebo from 35 weeks, with infants continuing the same allocation to age two. HN001 reduced eczema risk; HN019 did not. When a later trial gave HN001 to mothers only, without infant supplementation, the eczema benefit disappeared. The effect is therefore strain-specific and appears to depend on the infant receiving the organism directly — which is a very different claim from "probiotics in pregnancy prevent allergy". Our article on single vs multi-strain probiotics explains why strain identity matters this much.

How to choose a probiotic in pregnancy

If, after discussion with your midwife or GP, you decide to use one, the selection criteria are stricter than they would be otherwise.

Insist on full strain designation

A label reading "Lactobacillus rhamnosus" tells you almost nothing. The evidence attaches to Lactobacillus rhamnosus HN001 or GG — the alphanumeric suffix is the strain. Species-level labelling means the manufacturer either does not know or is not telling you which strain you are taking, and therefore no trial evidence can be applied to it. Our guides to how to choose a probiotic and Lactobacillus rhamnosus GG cover this in depth.

Prefer strains actually studied in pregnancy

The pregnancy trial literature is dominated by a small handful of organisms: L. rhamnosus HN001 and GG, Bifidobacterium animalis subsp. lactis BB-12 and HN019, and L. salivarius UCC118. Novel organisms with no pregnancy data — including next-generation candidates such as Akkermansia muciniphila, discussed in our Akkermansia vs probiotics comparison and our note on pasteurised Akkermansia — should be reserved for after pregnancy and breastfeeding. Similarly, spore-based probiotics have no meaningful pregnancy safety dataset.

Check the practical details

• CFU at end of shelf life, not at manufacture. See CFU vs AFU for why this distinction matters.
• Third-party testing and a UK or EU manufacturing base with GMP certification.
• No added botanicals. Many "gut health" blends include herbs, digestive bitters or aloe that have no pregnancy safety data. Read digestive bitters and aloe vera for gut health before assuming a blend is inert.
• Storage requirements — see do probiotics need refrigeration and shelf-stable probiotics.
• Timing — our guide on when to take probiotics covers this, though timing is a minor variable compared with strain choice.

Red flags on a pregnancy probiotic label

• "Proprietary blend" with no per-strain quantities.
• Species listed without strain codes.
• Added laxative herbs such as senna, cascara or aloe latex.
• Claims to "detox", "cleanse" or "reset" — see our discussion of the gut reset protocol for why these claims are usually meaningless.
• Marketing that implies treatment of a pregnancy complication. That is a regulated medicinal claim and should not appear on a food supplement.

Prebiotics and fibre: the safest lever you have

Where probiotic evidence in pregnancy is equivocal, fibre evidence is not. Cochrane's review of interventions for constipation in pregnancy found that fibre supplementation increased stool frequency and produced softer stools, with no adverse effects identified — and that fibre is a reasonable first step before any pharmacological option.

How much fibre, and from where

UK guidance for adults is 30g of fibre daily, and most adults achieve well under 20g. Pregnancy does not change the target but does make achieving it more important. Practical high-yield sources include:

• Oats — around 9g per 100g dry, plus beta-glucan.
• Pulses — a 150g portion of cooked lentils or chickpeas contributes 6–8g.
• Wholegrain bread and pasta in place of white.
• Berries, pears and apples with skin on.
• Ground flaxseed or chia — one to two tablespoons daily, taken with plenty of fluid.
• Psyllium husk — ispaghula husk is the bulk-forming laxative most often used first in UK pregnancy practice, and UKTIS notes no adverse fetal effects have been reported with bulk-forming laxatives.

Our guides to high fibre foods in the UK, how to increase fibre, prebiotic foods and psyllium vs inulin go into more detail. Our overview of 30 plants a week and increasing gut bacteria diversity is a useful framing device, though in pregnancy the goal is comfortable consistency rather than maximal variety.

Increase slowly to avoid making bloating worse

Adding 15g of fibre overnight in a gut that is already transiting slowly is a reliable way to produce more bloating, not less. Increase by roughly 3–5g every three to four days, increase fluid intake alongside it, and expect two to three weeks before the pattern settles. Highly fermentable prebiotics such as inulin and FOS are the most likely to cause wind — our comparison of prebiotic vs probiotic and our guide to the best prebiotic supplements explains the differences, but in late pregnancy a gentler soluble fibre such as psyllium is usually better tolerated.

A note on restrictive approaches: the low FODMAP diet should not be undertaken unsupervised in pregnancy. It restricts multiple food groups at a time when nutrient adequacy matters most. If your IBS is genuinely unmanageable, ask for a referral to a registered dietitian who can supervise a modified approach and a structured FODMAP reintroduction.

Fermented foods in pregnancy: what's safe and what isn't

Fermented foods are often recommended as a food-first alternative to supplements. In pregnancy the picture is more complicated, because the same conditions that support beneficial fermentation can also support Listeria monocytogenes. NHS guidance is clear that unpasteurised or soft ripened dairy foods may contain listeria, and listeriosis in pregnancy can cause miscarriage or stillbirth, or make a newborn seriously unwell.

Kombucha is the one most people are surprised by. Beyond the pasteurisation question, fermentation produces residual ethanol, and the UK position on alcohol in pregnancy is that the safest approach is not to drink at all. Combined with unpredictable caffeine content, it is straightforwardly easier to choose something else. Our guides to fermented foods in the UK, kefir benefits and fermented food vs probiotics give more background, and the full NHS list of foods to avoid is linked in the references.

Supplements to pause or avoid in pregnancy

This is the section to read most carefully. Popularity in the general gut health market says nothing about pregnancy safety.

Berberine deserves a specific note because it has become extremely popular for blood sugar and PCOS management, and many women conceive while taking it. If that describes you: stop, and tell your midwife or GP at your booking appointment. There is no evidence that incidental early exposure causes harm, but continuation through pregnancy is not appropriate. Our articles on berberine interactions and berberine vs metformin cover the wider picture, and metformin — unlike berberine — is used in pregnancy under medical supervision where indicated.

Managing constipation, reflux and bloating safely

Constipation

Work through the steps in order, and involve your midwife, pharmacist or GP before moving to medication.

1. Fluid — aim for roughly 8–10 cups daily. Fibre without fluid makes constipation worse.
2. Fibre — increase gradually, as above.
3. Movement — regular light to moderate activity is specifically advised in NHS constipation guidance and is safe in uncomplicated pregnancy.
4. Toileting position and routine — a footstool to raise the knees above the hips, and responding to the urge rather than deferring it.
5. Review your iron — a different formulation or an alternate-day schedule may help. Do not stop iron without advice.
6. Bulk-forming laxative — ispaghula husk, sterculia or methylcellulose are typically tried first, and UKTIS notes no adverse fetal effects have been reported.
7. Osmotic laxative — lactulose or a macrogol such as Movicol or Laxido are usually next, and are poorly absorbed.
8. Stimulant laxative — short-term use only, on advice, and senna is generally avoided near term.

Magnesium for constipation is a common self-treatment. Magnesium in prenatal-appropriate doses is not a concern, but high-dose magnesium oxide or citrate used as an osmotic laxative should be discussed with your midwife first rather than self-prescribed.

Heartburn and reflux

Smaller and more frequent meals, avoiding eating within three hours of lying down, raising the head of the bed, and identifying personal triggers will resolve mild cases. Where medication is needed, alginate-based products and certain antacids are used routinely in pregnancy, and acid-suppressing medication can be prescribed where symptoms are severe — all on the advice of your midwife, pharmacist or GP. Our guides to acid reflux supplements and omeprazole long-term effects provide context, but pregnancy prescribing decisions belong with your clinician.

Bloating and wind

Slower eating, smaller portions, reduced carbonated drinks, a short walk after meals, and gradual rather than sudden fibre changes address most cases. Persistent, severe or asymmetric abdominal distension is not something to manage at home — see the red flags section. Our guides to supplements for bloating and enzymes vs probiotics describe options outside pregnancy; most have no pregnancy safety data.

After birth: breastfeeding and postnatal gut health

Many restrictions ease after delivery, but not all of them. Berberine remains contraindicated during breastfeeding for the same bilirubin-related reason, and newborns are, if anything, more vulnerable in the first weeks of life. Most other supplements you paused can be reconsidered once breastfeeding is established, ideally with input from your GP or health visitor.

The postnatal period is also when antibiotic exposure is common — for caesarean prophylaxis, group B streptococcus prophylaxis, or treatment of infection. If you have received antibiotics, our guides to probiotics after antibiotics and gut dysbiosis are relevant, though the same principle applies: discuss with a clinician while breastfeeding rather than assuming a product is inert.

Pelvic floor and bowel function often need attention postnatally too. Constipation and straining after a vaginal delivery or caesarean is common and worth treating early rather than tolerating. For longer-term planning, our overviews of probiotics for women, gut health and hormones and probiotics in pregnancy are useful next reads.

Red flags: when to contact your midwife, GP or maternity unit

Digestive symptoms in pregnancy are usually benign, but some overlap with serious conditions. Contact your maternity unit or GP promptly — do not wait for a routine appointment — if you experience any of the following.

• Severe itching, particularly of the palms and soles, especially at night. This can indicate intrahepatic cholestasis of pregnancy, which requires bile acid and liver function testing.
• Persistent right upper abdominal pain, particularly with headache, visual disturbance or swelling — possible pre-eclampsia or HELLP syndrome.
• Blood in stool, or black tarry stool.
• Persistent vomiting preventing you keeping fluids down.
• Fever with diarrhoea, or diarrhoea lasting more than 48 hours.
• Any symptoms after eating unpasteurised dairy, pâté or undercooked meat — listeriosis symptoms can mimic flu and may appear days or weeks later.
• Unexplained weight loss or failure to gain weight as expected.
• Reduced fetal movements at any time, regardless of digestive symptoms.

Our guide to when to see your GP about stomach symptoms covers the general population; in pregnancy the threshold for seeking advice should be lower, not higher.

Frequently asked questions

Are probiotics safe in pregnancy?

Safety reviews of Lactobacillus, Bifidobacterium and Saccharomyces strains have not found increased rates of miscarriage, malformation, altered birth weight or caesarean section. However, a 2021 Cochrane review found high-certainty evidence of increased pre-eclampsia risk when probiotics were used specifically to prevent gestational diabetes, and no UK or international obstetric guideline recommends routine use. Discuss with your midwife or GP before starting.

Which probiotic strains have been studied in pregnancy?

The best-studied are Lactobacillus rhamnosus HN001 and GG, Bifidobacterium animalis subsp. lactis BB-12 and HN019, and Lactobacillus salivarius UCC118. Strain identity matters: HN001 reduced infant eczema in one trial while HN019 in the same trial did not. Products labelled only to species level cannot claim this evidence.

Can I keep taking my probiotic now that I'm pregnant?

If it is a well-manufactured single- or multi-strain Lactobacillus or Bifidobacterium product with no added botanicals, there is no evidence of harm from continuing, but mention it at your booking appointment. If it contains herbs, enzymes, laxative ingredients, spore-forming organisms or novel species with no pregnancy data, pause it until you have had that conversation.

Do probiotics help constipation in pregnancy?

There is very little pregnancy-specific trial evidence for probiotics and constipation. Fibre supplementation, by contrast, has direct evidence from Cochrane's review of constipation in pregnancy, increasing stool frequency and producing softer stools without identified adverse effects. Fibre, fluid and movement are the appropriate first steps, followed by a bulk-forming laxative such as ispaghula husk if needed.

Is kombucha safe during pregnancy?

It is best avoided. Kombucha is frequently unpasteurised, contains small residual amounts of alcohol from fermentation, and has variable caffeine content. Since UK advice is to avoid alcohol entirely in pregnancy and to avoid unpasteurised products because of listeria risk, kombucha sits on the wrong side of three separate cautions.

Can I take berberine while pregnant?

No. The US National Center for Complementary and Integrative Health states that people who are pregnant or breastfeeding should not use berberine, because it can cause or worsen jaundice in newborn infants and could lead to kernicterus, a serious form of bilirubin-related brain injury. If you conceived while taking it, stop and tell your midwife or GP.

Is it safe to eat live yoghurt and kefir in pregnancy?

Yes, provided they are made from pasteurised milk — which almost all UK supermarket products are. Check the label. Avoid raw-milk kefir, home cultures of unknown origin, and any unpasteurised dairy. NHS guidance confirms pasteurised soft cheeses such as cottage cheese, cream cheese, mozzarella, feta, paneer, ricotta and halloumi are safe.

Do probiotics in pregnancy prevent eczema in my baby?

The evidence is narrower than the marketing suggests. In the 2008 Wickens trial, L. rhamnosus HN001 given to mothers from 35 weeks and continued in infants to age two reduced eczema risk. When a later trial supplemented mothers only, without giving the organism to the infant, the eczema benefit was not seen. Any decision about infant supplementation should involve your health visitor or GP.

Can probiotics cause bloating or wind in pregnancy?

Yes, particularly in the first one to two weeks, and particularly with products containing prebiotic fibres such as inulin or FOS. In a gut that is already transiting slowly, this can be uncomfortable. Starting at a lower dose and increasing gradually usually helps. Our guide to probiotic side effects covers what is typical and what is not.

Should I have a gut microbiome test during pregnancy?

There is no clinical indication for it, and interpretation is genuinely problematic. Koren's work showed the third-trimester microbiome naturally shifts towards a pattern that resembles dysbiosis when measured against non-pregnant reference ranges — reduced within-person diversity, more Proteobacteria, fewer butyrate producers. A commercial test could therefore flag a normal pregnancy adaptation as a problem and prompt unnecessary intervention.

References

1. Davidson SJ, Barrett HL, Price SA, Callaway LK, Dekker Nitert M. Probiotics for preventing gestational diabetes. Cochrane Database of Systematic Reviews, 2021, Issue 4. Art. No.: CD009951.
2. Cochrane. Probiotics to prevent gestational diabetes mellitus — plain language summary.
3. Koren O, Goodrich JK, Cullender TC, et al. Host remodeling of the gut microbiome and metabolic changes during pregnancy. Cell. 2012;150(3):470–480.
4. NHS. Foods to avoid in pregnancy.
5. UK Teratology Information Service (UKTIS). Treatment of constipation in pregnancy.
6. UKTIS / Medicines in Pregnancy. Treating constipation during pregnancy — patient leaflet.
7. Cochrane. Interventions for treating constipation in pregnancy.
8. National Center for Complementary and Integrative Health (NIH). In the News: Berberine.
9. Wickens K, Black PN, Stanley TV, et al. A differential effect of 2 probiotics in the prevention of eczema and atopy: a double-blind, randomized, placebo-controlled trial. J Allergy Clin Immunol. 2008.
10. Wickens K, Barthow C, Mitchell EA, et al. Maternal supplementation alone with Lactobacillus rhamnosus HN001 during pregnancy and breastfeeding does not reduce infant eczema. Pediatr Allergy Immunol. 2018.
11. Wickens KL, Barthow CA, Murphy R, et al. Early pregnancy probiotic supplementation with Lactobacillus rhamnosus HN001 may reduce the prevalence of gestational diabetes mellitus. Br J Nutr. 2017.
12. Slykerman RF, Hood F, Wickens K, et al. Effect of Lactobacillus rhamnosus HN001 in pregnancy on postpartum symptoms of depression and anxiety. EBioMedicine. 2017.
13. Jarde A, Lewis-Mikhael AM, Moayyedi P, et al. Pregnancy outcomes in women taking probiotics or prebiotics: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2018.
14. International Scientific Association for Probiotics and Prebiotics (ISAPP). Can probiotics cause harm? The example of pregnancy.
15. Girling J, Knight CL, Chappell L, on behalf of the RCOG. Intrahepatic cholestasis of pregnancy: Green-top Guideline No. 43. BJOG. 2022.
16. Chappell LC, Bell JL, Smith A, et al. Ursodeoxycholic acid versus placebo in women with intrahepatic cholestasis of pregnancy (PITCHES): a randomised controlled trial. Lancet. 2019;394:849–860.
17. NHS inform (Scotland). Eating well in pregnancy.
18. Tommy's. Foods to avoid in pregnancy.

About the author

Dr Zeeshan Afzal, MBBS is a practising medical doctor and Welzo's Clinical Content Lead. He reviews Welzo's digestive health content against current NHS, NICE, RCOG and peer-reviewed evidence, and updates articles as guidance changes.

Medical disclaimer

This article provides general information and is not a substitute for individualised medical advice. Pregnancy care is personal to you. Always discuss supplements, dietary changes and symptoms with your midwife, GP, obstetrician or pharmacist before acting on anything you read here. If you have any red flag symptom listed above, or reduced fetal movements, contact your maternity unit immediately.