Top 5 Gastrointestinal Problems in Pregnancy
Being pregnant is a special experience in a woman’s life. But the nine months are also a time of major hormonal upheaval and bodily changes.
are often reported by expecting mothers. Some of these gastrointestinal disorders are experienced only during the nine months of being pregnant. In this article, we will focus on the top 5 gastrointestinal complaints from expecting moms.
Top 5 Gastrointestinal problems in pregnancy
1. Nausea and vomiting :
- Sometimes nausea and vomiting are synonymous with pregnancy. The former occurs in 50-90% of pregnancies. Vomiting is prevalent in 25-55% of pregnancies. Nausea in pregnancy is mostly found in the first trimester (6-8 weeks) of pregnancy. Nausea and vomiting in the second and third semester is a matter of concern and should be thoroughly investigated.
- The hormonal changes in the body, congenital motility disorders of the gastrointestinal tract ( abnormal muscle contractions or nerve disorders affecting the passage of food through the digestive tract) and other psychological factors are thought to be responsible for the nausea and vomiting associated with pregnancy.
- Other more serious causes of nausea in pregnancy would include pancreatitis, gastric ulcers, hepatitis, enteritis, liver diseases, appendicitis, biliary tract disease, urinary tract infection. In the terminal stage of pregnancy, early onset of labor or preeclampsia (hypertension) can cause vomiting.
- Pregnancy makes it mandatory to treat the condition conservatively. Avoiding rich fatty meals,staying away from allergy causing foods, having 5 small meals in a day, going for a walk after meals, avoiding precipitating factors etc are tried first. For more severe symptoms, treatment with anti emetics like Meclizine (Class B) or Promethazine (Class C) are without any adverse effects. However, they cannot be used for a longer time period.
- Care needs to be taken to prevent dehydration, fluid and electrolyte imbalance due to vomiting. Water and electrolytes need to be taken consistently to prevent dehydration.
2. Gastroesophageal Reflux Disease (GERD):
- It is a gastric problem which does not spare most during pregnancy. It is experienced by 45-80% expecting moms. It could be present in all the three semesters and could be a serious nuisance during any particular semester. Heart burn and regurgitation are the prime symptoms.
- Increased abdominal pressure, abnormal esophageal motility problems, abnormal functioning of the lower esophageal sphincter (LES)muscle and increased gastric pressure are the main causes behind the expecting mom experiencing GERD.
- It is treated conservatively. Having small meals all through the day, avoiding gastric acid inducing foods, lying down with head in an elevated position, doing mild exercises, eating the last meal at least 3 hours prior bedtime etc are some common advice for relief from GERD.
- Antacids or sucralfate can be administered safely in pregnancy. However, gastric acid suppression can interfere with nutrient absorption like that of calcium, iron, vitamin B12 etc. Proton Pump Inhibitors may not be safe for pregnancy. Drugs like Cimetidine , ranitidine and famotidine (Class B drugs)can be used but they can be absorbed beyond the placenta too. Histamine 2 (H2) blockers are also thought to be safe to be used in pregnancy.
3. Constipation :
- 11-38% women suffer from constipation during pregnancy.
- Several causes could be attributed to it. Iron supplements, decreased motility in the small bowel muscles, increased water absorption, decreased level of the hormone motilin (hormone secreted by the endocrine cells of the small intestine which stimulates gastric activity) and decreased colonic motility have been associated with it.
- Abdominal cramps, intestinal gas, bloating, reduced appetite could be associated with constipation.
- Additional intake of a fiber like psyllium (bulking agent), including exercises suitable in pregnancy, stimulant laxatives (could be habit forming if regularly used) is conservatively recommended. Stool softeners like sodium ducosate are safe to be used in pregnancy.
- Other serious conditions like gastrointestinal obstruction, diabetes, hypercalcemia, hyperkalemia etc. should be ruled out by proper investigations. These diseases often cause constipation as a side effect.
4. Diarrhea :
- Diarrhea affects up to 34% of pregnant women.
- The most common causes of diarrhea could be an allergic reaction to a food, bacterial infection ( e.g Salmonella, Shigella, Campylobacter, E.coli, viruses and parasites), food poisoning, irritable bowel syndrome, side effects of medications etc.
- The symptoms could be dehydration, fatigue, decreased appetite, irregular heart beat etc.
- Non systemic (does not affect the whole body) drugs are conservatively used to treat diarrhea in pregnancy. In case of bacterial infection some antibiotics(like Amoxicillin, Ampicillin, Erythromycin, Penicillin and Clindamycilin) can be safely used during pregnancy. Apart from medications controlling the diarrhea, it is of utmost important to maintain the fluid and electrolyte balance in the body.
- Avoiding fiber and taking stool hardening agents like iron rich food may be suggested.
- 31% women develop gall bladder sludge (biliary residue in gallbladder) and 2% of women develop new gall stones during pregnancy. The risk of developing them is highest in the last two trimesters and in the period immediately after child birth. Gallstone removal is second only to appendectomy (surgery to remove appendix) in the count of most commonly performed surgeries in pregnancy.
- The common contributing factors to the development of gallstones are increased abdominal fat, increasing the lithogenicity in bile ( presence of cholesterol and fat droplets in bile), decrease bile production, decreased gall bladder emptying into the small intestine.
- The symptoms are generally mild to severe abdominal pain in the upper right quadrant of the abdomen, nausea, vomiting, fever, jaundice, pancreatitis etc.
- Cholecystectomy or the surgical removal of gall stones may become necessary if the condition is leading to recurrent symptoms, weight loss and nutritional malabsorption.
- Otherwise, gall stones are conservatively managed with excess water intake, diet changes and any associated infection is managed with antibiotics .
- In case the gall stones lodge into the common bile duct, it causes a blockage, accumulation and backflow of bile in the bile duct and gall bladder creating conditions like biliary obstruction, cholangitis and pancreatitis. A procedure known as Endoscopic retrograde cholangiopancreatography (ERCP) may need to be performed.
The above are the most common