Senna
MedicationSenokot
Stimulant laxative
Research strength: 3 / 5
MotherToBaby says the few studies of laxatives as a group do not suggest a higher chance of birth defects when used at recommended doses, but it asks people to discuss the specific laxative. A Hungarian case-control study found maternal senna use in 506 of 22,843 birth-defect cases and 937 of 38,151 controls (adjusted odds ratio 1.0, 95% CI 0.9-1.1), with no increase across 23 defect groups after exposure in pregnancy months two and/or three. MotherToBaby says studies have not been done to see whether laxatives increase miscarriage chance. EMA's senna-leaf monograph states, "The use during pregnancy is contraindicated because experimental data concerning a genotoxic risk of several anthranoids, e.g. emodin and aloe emodin." ACOG advises caution with stimulant laxatives generally, and the US Senokot label says, "If pregnant or breast-feeding, ask a health professional before use." Ask your provider about your situation.
Last reviewed: 2026-10-16
Sources
- MotherToBaby: Laxatives fact sheetTeratology service
- ACOG: Problems of the Digestive SystemProfessional society
- Acs et al., Reproductive Toxicology 2009: Senna treatment in pregnant women and congenital abnormalitiesUS government
- EMA: European Union herbal monograph on senna leafEU agencyEuropean guidance
- DailyMed: Senokot standardized senna tablet labelDrug company label
Research strength: 2 / 5
MotherToBaby's birth-defect statement applies to laxatives as a group and does not give a senna-specific second-trimester estimate. Acs et al. examined major birth defects after senna exposure in pregnancy months two and/or three, not the second trimester, and found no higher risk in those early exposures. EMA's senna-leaf monograph states, "The use during pregnancy is contraindicated because experimental data concerning a genotoxic risk of several anthranoids, e.g. emodin and aloe emodin." ACOG advises caution with stimulant laxatives generally, and the US Senokot label says, "If pregnant or breast-feeding, ask a health professional before use." Ask your provider about your situation.
Last reviewed: 2026-10-16
Sources
- MotherToBaby: Laxatives fact sheetTeratology service
- ACOG: Problems of the Digestive SystemProfessional society
- Acs et al., Reproductive Toxicology 2009: Senna treatment in pregnant women and congenital abnormalitiesUS government
- EMA: European Union herbal monograph on senna leafEU agencyEuropean guidance
- DailyMed: Senokot standardized senna tablet labelDrug company label
Research strength: 2 / 5
MotherToBaby says laxatives used as directed are not expected to affect a baby's later learning or behavior, but its statement covers laxatives as a group. The Hungarian study found no higher birth-defect odds after senna use overall, but its detailed timing analysis covered pregnancy months two and/or three rather than late pregnancy. EMA's senna-leaf monograph states, "The use during pregnancy is contraindicated because experimental data concerning a genotoxic risk of several anthranoids, e.g. emodin and aloe emodin." ACOG advises caution with stimulant laxatives generally, and the US Senokot label says, "If pregnant or breast-feeding, ask a health professional before use." MotherToBaby and the Hungarian study do not provide a senna-specific third-trimester estimate, so late-pregnancy evidence remains limited. Ask your provider about your situation.
Last reviewed: 2026-10-16
Sources
- MotherToBaby: Laxatives fact sheetTeratology service
- ACOG: Problems of the Digestive SystemProfessional society
- Acs et al., Reproductive Toxicology 2009: Senna treatment in pregnant women and congenital abnormalitiesUS government
- EMA: European Union herbal monograph on senna leafEU agencyEuropean guidance
- DailyMed: Senokot standardized senna tablet labelDrug company label
Senna — Breastfeeding
Research strength: 4 / 5
LactMed says usual doses are acceptable during breastfeeding, but it also notes an early diarrhea report with an older product. Faber et al. (1988) found small amounts of rhein, an active metabolite, in milk from 20 postpartum women and no abnormal stool consistency in their breastfed infants; Shelton's controlled 1980 trial found no evidence of an effect on breastfed babies. NHS Specialist Pharmacy Service says standardized senna preparations can be used, reports no infant side effects, and advises watching for diarrhea or irritability. EMA's senna-leaf monograph states, "The use during lactation is contraindicated because after administration of anthranoids, active metabolites, such as rhein, were excreted in breast milk in small amounts." LactMed reports no published information about infant drug levels or effects on milk production, and NHS SPS notes that the published evidence is limited. Ask your provider about your situation.
Last reviewed: 2026-10-16
Sources
- LactMed: SennaUS government
- Faber and Strenge-Hesse, Pharmacology 1988: Relevance of rhein excretion into breast milkUS government
- Shelton, South African Medical Journal 1980: Standardized senna in the management of constipation in the puerperiumUS government
- NHS Specialist Pharmacy Service: Using laxatives during breastfeedingUK government
- EMA: European Union herbal monograph on senna leafEU agencyEuropean guidance
- DailyMed: Senokot standardized senna tablet labelDrug company label
Pregnancy
MotherToBaby's April 2026 fact sheet says only a few studies have examined laxative use in pregnancy, says recommended OTC laxatives are not expected to increase first-trimester birth-defect risk, and notes that studies have not tested whether laxatives increase miscarriage risk. Acs et al. (2009) used Hungary's population-based congenital-abnormality case-control system: 506 of 22,843 cases and 937 of 38,151 controls had maternal senna exposure (adjusted OR 1.0, 95% CI 0.9-1.1). In the detailed timing analysis, no higher risk was found across 23 defect groups after exposure during the second and/or third gestational month among 260 mothers compared with 500 matched controls. This is one observational human study; it does not establish miscarriage risk or resolve all trimester-specific outcomes. EMA's 2018 senna-leaf monograph formally contraindicates pregnancy based on experimental data concerning a genotoxic risk from several anthranoids, including emodin and aloe emodin. ACOG's FAQ, last reviewed in November 2025, advises caution with stimulant laxatives generally but gives no senna-specific pregnancy outcome estimate.
Breastfeeding
LactMed reports that usual doses are acceptable, but it also describes an early uncontrolled report with an older product and a nonblinded study with infant diarrhea. It contrasts these with controlled studies of modern preparations, including the 1980 standardized Senokot trial, whose PubMed abstract reports no evidence of an effect on breastfed infants. Faber and Strenge-Hesse (1988) examined 100 milk samples from 20 postpartum women after three days of a standardized senna and psyllium product containing 15 mg of sennosides daily; rhein levels ranged from 0 to 27 ng/mL, 94% were below 10 ng/mL, and the abstract says none of the infants had abnormal stool consistency. LactMed says relevant published information was not found on infant drug levels or effects on milk production. NHS SPS (updated 2023) says standardized senna can be used during breastfeeding but advises monitoring for infant diarrhea or irritability. EMA's 2018 senna-leaf monograph contraindicates use during lactation because small amounts of active metabolites such as rhein were found in milk.
The DailyMed label for Senokot standardized senna tablets lists 8.6 mg of sennosides per tablet and identifies the product as a laxative. Other senna products can have different strengths or formulations.
What was tested
Pregnancy evidence includes a population-based case-control study of recorded senna use and congenital abnormalities. Breastfeeding evidence includes postpartum studies measuring milk levels of sennosides or rhein and studies reporting infant stool outcomes. The available primary reports are old and include different products, doses, and study designs.
Pregnancy: EMA contraindication and observational human findings
- Source A says
- EMA's 2018 monograph for senna-leaf preparations states that use during pregnancy is contraindicated because experimental data concern a genotoxic risk from several anthranoids, including emodin and aloe emodin. (EMA: European Union herbal monograph on senna leaf)
- Source B says
- A Hungarian case-control study found no higher odds of congenital abnormalities with maternal senna exposure; MotherToBaby says recommended OTC laxatives are not expected to raise first-trimester birth-defect risk, while noting that its evidence is limited and class-wide; ACOG advises caution with stimulant laxatives generally. (Acs et al., Reproductive Toxicology 2009: Senna treatment in pregnant women and congenital abnormalities, MotherToBaby: Laxatives fact sheet, ACOG: Problems of the Digestive System)
- Why they differ
- The EMA monograph takes a precautionary position based on experimental findings for several anthranoids. Acs et al. report human observational outcomes for senna, but the study does not answer every pregnancy outcome or provide trimester-specific estimates for all periods.
- What the evidence shows overall
- The human study did not find an increase in congenital abnormalities, but miscarriage and detailed later-pregnancy outcomes remain unresolved. The formal EMA contraindication stays visible; limited and conflicting guidance supports retaining guidance rather than presenting an unqualified compatible rating.
Breastfeeding: EMA contraindication versus clinical lactation sources
- Source A says
- EMA's senna-leaf monograph states that use during lactation is contraindicated because small amounts of active metabolites such as rhein were excreted in breast milk. (EMA: European Union herbal monograph on senna leaf)
- Source B says
- LactMed says usual doses are acceptable; NHS SPS says standardized senna preparations can be used during breastfeeding; Faber et al. found no abnormal infant stool consistency, and Shelton's trial found no evidence of an effect on breastfed babies. (LactMed: Senna, NHS Specialist Pharmacy Service: Using laxatives during breastfeeding, Faber and Strenge-Hesse, Pharmacology 1988: Relevance of rhein excretion into breast milk, Shelton, South African Medical Journal 1980: Standardized senna in the management of constipation in the puerperium)
- Why they differ
- The EMA monograph emphasizes transfer of small amounts of metabolites in European senna-leaf preparations. LactMed and NHS SPS weigh reported infant outcomes for standardized products. The preparations and the evidence questions are not identical, and the clinical studies are old and limited.
- What the evidence shows overall
- The EMA's formal contraindication is stated directly, but the retrieved human studies do not establish infant injury with standardized products. Under R1, compatible remains the rating while the agency disagreement and monitoring language stay in the summary.
Historical infant-diarrhea reports versus standardized-product studies
- Source A says
- LactMed summarizes an early uncontrolled report of increased infant diarrhea with an older senna product and a separate nonblinded study with diarrhea reports. (LactMed: Senna)
- Source B says
- NHS SPS says no side effects have been reported in breastfed infants and advises monitoring; the controlled Senokot trial reported no evidence of an effect on breastfed babies. (NHS Specialist Pharmacy Service: Using laxatives during breastfeeding, Shelton, South African Medical Journal 1980: Standardized senna in the management of constipation in the puerperium)
- Why they differ
- The reports concern different formulations and study designs. The earlier findings are uncontrolled or nonblinded, while the Senokot study used a standardized product and a controlled design.
- What the evidence shows overall
- Keep the older signal distinct from controlled standardized-product findings. The evidence does not support treating all senna preparations as identical, and NHS SPS advises watching for infant diarrhea or irritability.
- MotherToBaby describes increasing fluids, eating high-fiber foods, and regular exercise as lifestyle measures that may help constipation during pregnancy. It also says to discuss the specific laxative with a health professional. (MotherToBaby)
- ACOG says laxatives, especially stimulant laxatives, should be used with caution and that overuse can cause the bowel to depend on them. (ACOG: Problems of the Digestive System)
- The DailyMed Senokot label says, "If pregnant or breast-feeding, ask a health professional before use." (DailyMed: Senokot label)
- NHS SPS says standardized senna preparations can be used during breastfeeding and advises monitoring for infant diarrhea or irritability. (NHS Specialist Pharmacy Service)
General research, not specific to pregnancy.
The Senokot label gives use-duration and symptom warnings for everyone. FDA also posted a lot-specific senna syrup recall for possible microbial contamination; the recall was completed.
- DailyMed says not to use laxative products for longer than one week unless directed by a doctor, and to ask a doctor before use if stomach pain, nausea, vomiting, or a persistent change in bowel habits is present. (DailyMed: Senokot standardized senna tablet label)
- FDA posted a recall on January 12, 2022, for one lot of AVpak Senna Syrup 8.8 mg/5 mL because of potential microbial contamination. The FDA page says the recall was completed and terminated. (FDA: AVpak Senna Syrup lot recall for microbial contamination)
- MotherToBaby: Laxatives fact sheetTeratology serviceSecondaryPage dated 2026-04-01
- ACOG: Problems of the Digestive SystemProfessional societySecondaryIndependent check
- LactMed: SennaUS governmentSecondaryPage dated 2024-11-15
- DailyMed: Senokot standardized senna tablet labelDrug company labelTertiaryPage dated 2026-09-09
- EMA: European Union herbal monograph on senna leafEU agencySecondaryPage dated 2018-09-25Independent checkEuropean guidance
- NHS Specialist Pharmacy Service: Using laxatives during breastfeedingUK governmentSecondaryPage dated 2023-11-10Independent check
- Acs et al., Reproductive Toxicology 2009: Senna treatment in pregnant women and congenital abnormalitiesUS governmentPrimaryIndependent check
- Faber and Strenge-Hesse, Pharmacology 1988: Relevance of rhein excretion into breast milkUS governmentPrimaryIndependent check
- Shelton, South African Medical Journal 1980: Standardized senna in the management of constipation in the puerperiumUS governmentPrimaryIndependent check
- FDA: AVpak Senna Syrup lot recall for microbial contaminationUS governmentSecondaryPage dated 2022-01-12
Last reviewed 2026-10-16
Independent check 2026-10-16
Not yet clinician-reviewed
Ask your provider about your situation.
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