Gestational constipation and the gut microbiota: mechanisms, interventions, and implications for maternal and offspring health.

Gestational constipation affects up to 40% of pregnant women, yet remains underappreciated as a clinical entity with implications beyond maternal discomfort. This review synthesizes current evidence on the intricate relationships between pregnancy-associated constipation, gut microbiota dynamics, and perinatal health outcomes. Pregnancy induces profound remodeling of the maternal gut ecosystem-characterized by reduced alpha diversity, expansion of Actinomycetota and Pseudomonadota, and increased Bifidobacterium-driven by hormonal, immunological, and dietary factors. When perturbed, these physiological shifts transition to dysbiosis, impairing colonic function through deficient short-chain fatty acid production, disrupted serotonergic signaling, and compromised intestinal barrier integrity. Dietary fiber intervention, critically dependent on physicochemical properties (solubility, fermentability), restores microbial equilibrium, alleviates constipation, and exerts systemic anti-inflammatory effects. Probiotic and synbiotic strategies offer strain-specific benefits extending to gestational diabetes mitigation and improved mental wellbeing. Translational evidence from swine models demonstrates that microbiota-targeted interventions during late gestation enhance reproductive performance, colostrum quality, and offspring health-effects mediated through vertical transmission and metabolic programming. Epidemiological studies link maternal constipation to increased risks of offspring atopic dermatitis (1.26-fold) and allergic rhinitis (1.20-fold), while low fiber intake associates with neurodevelopmental delays. Moving beyond one-size-fits-all approaches, future prenatal care must integrate personalized, microbiota-targeted strategies based on predictive microbial biomarkers, optimizing both maternal wellbeing and long-term child health across two generations.