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Pregnancy is one of the most sensitive physiological and emotional phases in women’s life (1) during which they may suffer from several complications including constipation (2). It is reported that approximately 11%38% of women experience constipation as a decrease in bowel movements and difficult evacuation. It is more common in women with a history of pre-pregnancy constipation and multiparous (3,4). Physiological and anatomical changes during pregnancy include elevated progesterone levels in the second and third trimesters, reduced motilin, decreased muscle tone, increased bowel movement period, and increased intake of intestinal water and drying of stools that lead to constipation (2,4,5). Constipation during pregnancy, which is evaluated via Rome IV criteria (3,6,7), is managed with the first line of treatments such as physical activity, increased fluid intake, dietary fiber volume, fruits and vegetables, and probiotic intake. Laxatives are considered as second-line treatment (6,8). The lack of peripheral absorption and no risk of fetal malformations make the short-term use of some laxatives safe with various side effects that may restrict their consumption (3,4,6). Due to the prevalence of constipation through pregnancy and the side effects of current treatments, it is necessary to investigate safe and healthy therapies. Over the past two decades, complementary and alternative medicines have been significantly employed worldwide (9). According to reports from the World Health Organization (WHO), almost 80% of the world’s population is using traditional herbal medicine to diagnose, prevent, and treat diseases (10). Common pregnancy issues such as constipation are one of the main reasons for using herbal remedies (11). From the perspective of traditional Persian medicine (TPM), as a complementary medicine, the use of safe laxatives has been emphasized for alleviating pregnancy constipation since it has an effective role in reducing the other complications of pregnancy. Rosa damascena Mill. (Rosaceae family) also known as Damask Rose (12,13), is one of the safest laxatives prescribed for constipation during pregnancy in TPM literature and has been introduced as an effective medicinal plant in strengthening and maintaining the fetus (3,14,15). Damask Rose has numerous pharmacological effects (12,16), and no report Abstract Objectives: Constipation is one of the most common issues at the time of pregnancy. Traditional Persian medicine (TPM) has always emphasized the use of safe laxatives to relieve constipation during pregnancy.The present study aimed to investigate the effect of Rosa damascena Mill. products on constipation and the quality of life during pregnancy. Materials and Methods: This is a single-arm clinical trial study on 35 pregnant women (14-34 weeks) with constipation diagnosed on the basis of Rome IV criteria in Tehran and Qom, Iran during 2018-2019. The consumption of R. damascena products was recommended daily for 4 weeks. Then, the severity of constipation and the quality of life were assessed via the Rome IV criteria and the World Health Organization (WHO) quality of life questionnaires (WHOQOL-BREF), respectively. Results: This study was performed on 35 pregnant women (14-34 weeks). The consumption of R. damascena products decreased the score of Rome IV criteria (Mean9.4 to 1.1) while increasing the frequency of bowel movements and improving the overall quality of life (P < 0.001). The predominant constipation signs, including straining, lumpy and hard stools, a sensation of incomplete evacuation, a sensation of anorectal obstruction, manual facilitation maneuvers, and less than 3 spontaneous bowel movements per week significantly improved after the consumption of R. damascena products (P < 0.001). Conclusions: Rosa damascena products can effectively treat constipation and enhance the quality of life.

Evaluation of the Effect of Rosa damascena Mill. Product on Constipation During Pregnancy: A Single-Arm Clinical Trial