eMedicine Specialties > Gastroenterology > Systemic Disease

Gastrointestinal Disease and Pregnancy

Author: Praveen K Roy, MD, Comments and Criticisms Editor, Cochrane Colorectal Cancer Group
Coauthor(s): Abhishek Choudhary, MD, Resident, Department of Internal Medicine, University Hospital of Missouri; Mohamed Othman, MD, Staff Physician, Department of Internal Medicine, University of New Mexico School of Medicine; Homayoun Shojamanesh, MD, Former Fellow, Digestive Diseases Branch, National Institutes of Health; Jack Bragg, DO, FACOI, Assistant Professor, Department of Clinical Medicine, University of Missouri School of Medicine; Gautam Dehadrai, MD, Department Chair, Section Chief, Department of Interventional Radiology, Norman Regional Hospital; Showkat Bashir, MD, Assistant Professor, Department of Medicine, Division of Gastroenterology, George Washington University, Washington, DC
Contributor Information and Disclosures

Updated: Apr 2, 2009

Introduction

Gastrointestinal (GI) disorders are some of the most frequent complaints during pregnancy. Some women have certain GI disorders that are unique to pregnancy. Other pregnant patients present with chronic GI disorders that require special consideration during pregnancy. Understanding the presentation and prevalence of various GI disorders is necessary in order to optimize care for these patients.1,2 This article focuses on common GI symptoms during pregnancy and the common GI diseases that are challenging to manage during pregnancy.

For excellent patient education resources, visit eMedicine's Women's Health Center and Pregnancy and Reproduction Center. Also, see eMedicine's patient education articles Pregnancy and Pregnancy, Vomiting.

Nausea and Vomiting

Incidence

Nausea, with or without vomiting, is common in early pregnancy.3,4 Nausea occurs in 50-90% of pregnancies, whereas vomiting is an associated complaint in 25-55% of pregnancies.

Risk factors

Risk factors for nausea in pregnancy include youth, obesity, first pregnancy, and smoking. Nausea tends to recur in subsequent pregnancies, although it may be shorter in duration.

Clinical features

Nausea in pregnancy is usually self-limiting and occurs in 91% of women in the first trimester, generally in the first 6-8 weeks. In its mild form, nausea is known as morning sickness. The pathophysiology is debatable. It has been attributed to hormonal fluctuations, GI motility disorders, and psychosocial factors. Persistence of nausea and vomiting into the second or third semester should prompt a search for other causes.

Other causes include urinary tract infections, gastroenteritis, peptic ulcer disease (PUD), pancreatitis, biliary tract disease, hepatitis, appendicitis, adrenal insufficiency, and increased intracranial pressure. In later pregnancy, other considerations include hydramnios, preeclampsia, and onset of labor.

Treatment

The severity of symptoms dictates the therapy in a pregnant patient with nausea. Mild symptoms can be managed by reassurance, avoidance of precipitating factors, and changes in diet (eg, smaller, more frequent meals; increased carbohydrate intake; low fat intake).

For more severe and intractable symptoms, pharmacotherapy with antiemetics can be offered. Meclizine (class B) or promethazine (class C) can be used. Adverse effects to the human fetus have not been reported; however, meclizine and promethazine are not recommended for routine use in pregnancy.

Metoclopramide (class B) can be used in pregnancy. It has not been shown to induce teratogenic effects, but it crosses the placenta and produces substantial fetal blood alcohol effects.

Data on the harmful fetal effects of other antiemetics (eg, prochlorperazine [class C], diphenhydramine [class C], trimethobenzamide) preclude their use in pregnancy. Pyridoxine (vitamin B-6) is an alternative therapeutic agent in patients with severe nausea or vomiting.5

Prognosis

The prognosis for the mother and child is generally good. In fact, women with mild nausea and vomiting in pregnancy have better pregnancy outcomes compared with women without these symptoms.

Hyperemesis Gravidarum

Hyperemesis gravidarum is characterized by intractable nausea and vomiting that occurs in early pregnancy, leading to fluid and electrolyte imbalance.6,7,8  This condition may be considered the severe end of the spectrum of nausea and vomiting in pregnancy. 

Incidence

Hyperemesis gravidarum occurs in 3-10 cases per 1000 pregnancies.

Pathogenesis

The pathogenesis of hyperemesis gravidarum is poorly understood. Hormonal and psychological factors may play a role.

Clinical features

The condition occurs early in the first trimester, usually in weeks 4-10. Symptoms usually resolve by weeks 18-20.

  • Intractable vomiting
  • Ptyalism
  • Weight loss – More than 5% of body weight
  • Malnutrition (possible)
  • Abdominal pain (not common)
  • Ketosis, hypokalemia, and metabolic alkalosis (possible)
  • Abnormal liver enzyme levels (possible)
  • Mild hyperthyroidism (possible)

Risk factors

  • Obesity
  • Nulliparity
  • Multiple gestations
  • Trophoblastic disease

Treatment

Replenish fluids, electrolytes, vitamins, and minerals.9 Thiamine supplementation is recommended for women who have had vomiting for longer than 3 weeks. Avoid environmental triggers.

Dietary management

Patients should eat frequent, small, high-carbohydrate, low-fat meals. Gut rest may be needed in some cases. Parenteral or enteral nutrition can be beneficial in some cases.

Medications

Antiemetics and pyridoxine can be used. Corticosteroids have been tried in severe and refractory cases.

Prognosis

The prognosis in hyperemesis gravidarum is good. No differences in birth weight or birth defects have been observed in pregnancies affected by this condition.

Gastroesophageal Reflux Disease

Incidence

Gastroesophageal reflux disease (GERD), generally known as heartburn, is common in pregnancy and is experienced by 45-80% of pregnant women.10,11,12,13,14,15,16,17,18 Fifty-two percent of pregnant women first experience GERD in the first trimester; 24-40% experience it in the second trimester, and 9% experience it in the third trimester.

Pathogenesis

Both mechanical and intrinsic factors are involved in GERD. Abnormal esophageal motility, decreased lower esophageal sphincter (LES) pressure,19,20,21,22,23,24,25 and increased gastric pressure contribute to GERD in pregnancy. Increased intra-abdominal pressure from the gravid uterus and displacement of the LES also play roles.

Clinical features

The clinical presentation of GERD in pregnant women is similar to that for the general population. Heartburn and regurgitation are the cardinal symptoms. The diagnostic evaluation consists of a thorough history and physical examination. Diagnostic studies are rarely needed. Endoscopy may be indicated in patients with complications of GERD. Twenty-four–hour ambulatory pH studies can be useful in patients with atypical presentations (eg, cough, wheezing, sore throat) and refractory symptoms.

Treatment

  • Lifestyle modifications: These are the first line of management in pregnant women with GERD. Advise patients to take the following measures:
    • Elevate the head of the bed.
    • Avoid bending or stooping positions.
    • Eat small, frequent meals.
    • Refrain from ingesting food (except liquids) within 3 hours of bedtime.
  • Nonsystemic medications: Antacids or sucralfate are safe in pregnancy because they are not systemically absorbed. Antacids may interfere with iron absorption.
  • Systemic gastric antisecretory medications: Histamine 2 (H2) blockers are preferred over proton pump inhibitors (PPI), because more data are available on the safety of H2 blocker use in pregnancy. Cimetidine, ranitidine, and famotidine can be used in pregnancy (class B drugs). They can cross the placental barrier. Lansoprazole is the preferred proton inhibitor in pregnancy (class B).

Prognosis

The outcome for pregnant patients with GERD is good. However, this condition tends to recur with subsequent pregnancies.

Gallstones

Pregnancy is associated with an increased risk of gallstone formation. Gallstones are an important cause of pancreatitis in pregnancy. Cholecystectomy is the second most common nonobstetric surgical procedure in pregnancy after appendectomy.26

Incidence

Thirty-one percent of women develop sludge during pregnancy, and 2% develop new gallstones. The risk is highest in the second or third trimester and postpartum.

Pathogenesis

The exact mechanism of gallstone formation in pregnancy is not known. Possible factors are increased lithogenicity of bile, increased stasis of bile, and decreased gall bladder emptying.

Clinical features

  • Right upper quadrant pain
  • Epigastric pain
  • Fever
  • Vomiting
  • Jaundice
  • Tenderness in right upper quadrant – May be difficult to elicit because of an enlarged uterus
  • Pancreatitis27

Treatment

Severe biliary colic can be managed conservatively with hydration, narcotics, antibiotics, and dietary modifications. Endoscopic retrograde cholangiopancreatography (ERCP) may be needed in cases of cholangitis, biliary obstruction, or pancreatitis.

Cholecystectomy is indicated in the presence of persistent or recurrent symptoms, significant nutritional compromise, and weight loss. This procedure is required in fewer than 0.1% of cases. The second trimester is the best period for surgery in affected pregnant women.

Peptic Ulcer Disease

Incidence
PUD is uncommon during pregnancy. The reported incidence rate is 0.005%, although this is probably underestimated. PUD is believed to improve during pregnancy because of the decreased gastric acid secretion that occurs in pregnancy.

Risk factors
Risk factors for PUD in pregnancy include smoking, alcoholism, stress, socioeconomic status, and previous history of PUD or Helicobacter pylori gastritis. Nonsteroidal medications are not a common risk factor for PUD in pregnancy.

Clinical features
Clinical features are similar to those of the nonpregnant state. Symptoms include dyspepsia, epigastric pain, nausea, vomiting, and heartburn. GI bleeding and perforation are rare complications of PUD in pregnancy.

Treatment
H2-receptor antagonists (eg, cimetidine, ranitidine, famotidine) are the first choices of treatment. Treatment for H pylori gastritis should be initiated after the pregnancy and breastfeeding, because some of the recommended medications are relatively contraindicated in pregnancy. Lansoprazole has been reported to be safe in pregnancy.

Prognosis
PUD does not cause increased maternal or fetal morbidity and mortality.

Diarrhea

Incidence

Diarrhea occurs in up to 34% of pregnant women.

Etiology

Causes of diarrhea in pregnancy mirror those of the nonpregnant state, the most common being infectious agents (eg, Salmonella, Shigella, and Campylobacter species; Escherichia coli; protozoans; viruses). Food poisoning, medications, and irritable bowel syndrome are other common causes. Exacerbations of inflammatory bowel disease can also occur in pregnancy.

Evaluation

Conduct a routine laboratory evaluation with stool studies for bacterial culture, ova, parasites, fecal leukocytes, and stool assay for Clostridium difficile infection. For persistent diarrhea, flexible sigmoidoscopy can be performed. Flexible sigmoidoscopy is safe in pregnancy.

Treatment

Conservative management is the mainstay of treatment for diarrhea in pregnancy.

  • Administer fluid replacements.
  • Administer medications to control the diarrhea, if needed. Nonsystemic medications should be tried first.
  • Treat the underlying cause.
  • Treat patients with irritable bowel syndrome as follows:
    • Institute a high-fiber diet.
    • Administer stool-bulking agents.
    • Anticholinergics/antispasmodics are not recommended.
    • Avoid antidepressants.

Constipation

Incidence

The incidence rate of constipation in pregnancy is 11-38%.28,29

Etiology

The etiology of constipation in pregnancy is multifactorial. Possible factors include the following:

  • Decreased small bowel motility
  • Decreased motilin level
  • Decreased colonic motility
  • Increased absorption of water
  • Iron supplementation

Evaluation

Extensive clinical evaluation is seldom warranted; it should include a careful history, including the presence of preexisting constipation, dietary habits, current medications, and the use of laxatives. Perform a digital rectal examination to exclude fecal impaction.

The results of blood studies can be useful to exclude hypothyroidism, diabetes mellitus, hypercalcemia, and hypokalemia as possible causes.

If rectal bleeding is present, anoscopy or flexible sigmoidoscopy can be performed to exclude anorectal lesions.30,31,32

Treatment

Conservative treatment is the mainstay of therapy for diarrhea in pregnancy.

  • Dietary changes
  • Increase in physical activity
  • Kegel exercises (may be useful)
  • Bulking agents, eg, psyllium (safe in pregnancy)

Medications

Few data are available on the safety and efficacy of medications in pregnancy. Stool softeners such as sodium docusate are probably safe. Stimulant laxatives are probably safe for intermittent use, but these agents should not be used regularly. Castor oil and mineral oil should not used in pregnancy.

Keywords

gastrointestinal disease and pregnancy, gastrointestinal disease, pregnancy, complicated pregnancy, pregnancy complications, complications of pregnancy, problem pregnancy, gastrointestinal disorders, GI disorders, morning sickness, hyperemesis gravidarum, gastroesophageal reflux disease, GERD, heartburn, gallstones, peptic ulcer disease, PUD, diarrhea, constipation, food poisoning, irritable bowel disease, IBD, irritable bowel syndrome, IBS, GI disease

 


More on Gastrointestinal Disease and Pregnancy

References
Further Reading
[ CLOSE WINDOW ]

References

  1. Atlay RD, Weekes AR. The treatment of gastrointestinal disease in pregnancy. Clin Obstet Gynaecol. Jun 1986;13(2):335-47. [Medline].

  2. Knudsen A, Lebech M, Hansen M. Upper gastrointestinal symptoms in the third trimester of the normal pregnancy. Eur J Obstet Gynecol Reprod Biol. May 1995;60(1):29-33. [Medline].

  3. Koch KL. Gastrointestinal factors in nausea and vomiting of pregnancy. Am J Obstet Gynecol. May 2002;186(5 suppl understanding):S198-203. [Medline].

  4. Koch KL, Frissora CL. Nausea and vomiting during pregnancy. Gastroenterol Clin North Am. Mar 2003;32(1):201-34, vi. [Medline].

  5. Flake ZA, Scalley RD, Bailey AG. Practical selection of antiemetics. Am Fam Physician. Mar 1 2004;69(5):1169-74. [Medline]. [Full Text].

  6. Abell TL, Riely CA. Hyperemesis gravidarum. Gastroenterol Clin North Am. Dec 1992;21(4):835-49. [Medline].

  7. Eliakim R, Abulafia O, Sherer DM. Hyperemesis gravidarum: a current review. Am J Perinatol. 2000;17(4):207-18. [Medline].

  8. Kuscu NK, Koyuncu F. Hyperemesis gravidarum: current concepts and management. Postgrad Med J. Feb 2002;78(916):76-9. [Medline]. [Full Text].

  9. Pearce CB, Collett J, Goggin PM, Duncan HD. Enteral nutrition by nasojejunal tube in hyperemesis gravidarum. Clin Nutr. Oct 2001;20(5):461-4. [Medline].

  10. Lind JF, Smith AM, McIver DK, Coopland AT, Crispin JS. Heartburn in pregnancy--a manometric study. Can Med Assoc J. Mar 23 1968;98(12):571-4. [Medline]. [Full Text].

  11. Briggs DW, Hart DM. Heartburn of pregnancy. A continuation study. Br J Clin Pract. Apr 1972;26(4):167-9. [Medline].

  12. Bassey OO. Pregnancy heartburn in Nigerians and Caucasians with theories about aetiology based on manometric recordings from the oesophagus and stomach. Br J Obstet Gynaecol. Jun 1977;84(6):439-43. [Medline].

  13. Marrero JM, Goggin PM, de Caestecker JS, Pearce JM, Maxwell JD. Determinants of pregnancy heartburn. Br J Obstet Gynaecol. Sep 1992;99(9):731-4. [Medline].

  14. Broussard CN, Richter JE. Treating gastro-oesophageal reflux disease during pregnancy and lactation: what are the safest therapy options?. Drug Saf. Oct 1998;19(4):325-37. [Medline].

  15. Ho KY, Kang JY, Viegas OA. Symptomatic gastro-oesophageal reflux in pregnancy: a prospective study among Singaporean women. J Gastroenterol Hepatol. Oct 1998;13(10):1020-6. [Medline].

  16. Richter JE. Gastroesophageal reflux disease during pregnancy. Gastroenterol Clin North Am. Mar 2003;32(1):235-61. [Medline].

  17. Baron TH, Richter JE. Gastroesophageal reflux disease in pregnancy. Gastroenterol Clin North Am. Dec 1992;21(4):777-91. [Medline].

  18. [Best Evidence] Dowswell T, Neilson JP. Interventions for heartburn in pregnancy. Cochrane Database Syst Rev. Oct 8 2008;CD007065. [Medline]. [Full Text].

  19. Fisher RS, Roberts GS, Grabowski CJ, Cohen S. Inhibition of lower esophageal sphincter circular muscle by female sex hormones. Am J Physiol. Mar 1978;234(3):E243-7. [Medline].

  20. Fisher RS, Roberts GS, Grabowski CJ, Cohen S. Altered lower esophageal sphincter function during early pregnancy. Gastroenterology. Jun 1978;74(6):1233-7. [Medline].

  21. Dodds WJ, Dent J, Hogan WJ. Pregnancy and the lower esophageal sphincter. Gastroenterology. Jun 1978;74(6):1334-6. [Medline].

  22. Brock-Utne JG, Dow TG, Welman S, Dimopoulos GE, Moshal MG. The effect of metoclopramide on the lower oesophageal sphincter in late pregnancy. Anaesth Intensive Care. Feb 1978;6(1):26-9. [Medline].

  23. Brock-Utne JG, Dow TG, Dimopoulos GE, et al. Gastric and lower oesophageal sphincter (LOS) pressures in early pregnancy. Br J Anaesth. Apr 1981;53(4):381-4. [Medline].

  24. Dow TG, Brock-Utne JG, Rubin J, et al. The effect of atropine on the lower esophageal sphincter in late pregnancy. Obstet Gynecol. Apr 1978;51(4):426-30. [Medline].

  25. Brock-Utne JG, Downing JW, Dimopoulos GE, Rubin J, Moshal MG. Effect of domperidone on lower esophageal sphincter tone in late pregnancy. Anesthesiology. Apr 1980;52(4):321-3. [Medline].

  26. Date RS, Kaushal M, Ramesh A. A review of the management of gallstone disease and its complications in pregnancy. Am J Surg. Oct 2008;196(4):599-608. [Medline].

  27. [Best Evidence] Eddy JJ, Gideonsen MD, Song JY, Grobman WA, O'Halloran P. Pancreatitis in pregnancy. Obstet Gynecol. Nov 2008;112(5):1075-81. [Medline].

  28. Tytgat GN, Heading RC, Muller-Lissner S, et al. Contemporary understanding and management of reflux and constipation in the general population and pregnancy: a consensus meeting. Aliment Pharmacol Ther. Aug 1 2003;18(3):291-301. [Medline]. [Full Text].

  29. Jewell DJ, Young G. Interventions for treating constipation in pregnancy. Cochrane Database Syst Rev. 2001;CD001142. [Medline]. [Full Text].

  30. Chaliha C, Sultan AH, Bland JM, Monga AK, Stanton SL. Anal function: effect of pregnancy and delivery. Am J Obstet Gynecol. Aug 2001;185(2):427-32. [Medline].

  31. Martinez Hernandez Magro P, Villanueva Saenz E, Jaime Zavala M, Sandoval Munro RD, Rocha Ramírez JL. Endoanal sonography in assessment of fecal incontinence following obstetric trauma. Ultrasound Obstet Gynecol. Dec 2003;22(6):616-21. [Medline].

  32. O'Boyle AL, O'Boyle JD, Magann EF, et al. Anorectal symptoms in pregnancy and the postpartum period. J Reprod Med. Mar 2008;53(3):151-4. [Medline].

  33. Bani D, Baccari MC, Quattrone S, et al. Relaxin depresses small bowel motility through a nitric oxide-mediated mechanism. Studies in mice. Biol Reprod. Mar 2002;66(3):778-84. [Medline]. [Full Text].

  34. Belmonte-Montes C, Hagerman G, Vega-Yepez PA, Hernandez-de-Anda E, Fonseca-Morales V. Anal sphincter injury after vaginal delivery in primiparous females. Dis Colon Rectum. Sep 2001;44(9):1244-8. [Medline].

  35. Boyer F, Fontanges E, Miossec P. Rheumatoid arthritis associated with ulcerative colitis: a case with severe flare of both diseases after delivery. Ann Rheum Dis. Sep 2001;60(9):901. [Medline]. [Full Text].

  36. Cappell MS. Gastric and duodenal ulcers during pregnancy. Gastroenterol Clin North Am. Mar 2003;32(1):263-308. [Medline].

  37. Chiloiro M, Darconza G, Piccioli E, et al. Gastric emptying and orocecal transit time in pregnancy. J Gastroenterol. Aug 2001;36(8):538-43. [Medline].

  38. De Leeuw JW, Vierhout ME, Struijk PC, Hop WC, Wallenburg HC. Anal sphincter damage after vaginal delivery: functional outcome and risk factors for fecal incontinence. Acta Obstet Gynecol Scand. Sep 2001;80(9):830-4. [Medline].

  39. Debby A, Golan A, Sadan O, Glezerman M, Shirin H. Clinical utility of esophagogastroduodenoscopy in the management of recurrent and intractable vomiting in pregnancy. J Reprod Med. May 2008;53(5):347-51. [Medline].

  40. Dietrich CS 3rd, Hill CC, Hueman M. Surgical diseases presenting in pregnancy. Surg Clin North Am. Apr 2008;88(2):403-19, vii-viii. [Medline].

  41. Einarson A, Mastroiacovo P, Arnon J, et al. Prospective, controlled, multicentre study of loperamide in pregnancy. Can J Gastroenterol. Mar 2000;14(3):185-7. [Medline].

  42. Fenner DE, Genberg B, Brahma P, Marek L, DeLancey JO. Fecal and urinary incontinence after vaginal delivery with anal sphincter disruption in an obstetrics unit in the United States. Am J Obstet Gynecol. Dec 2003;189(6):1543-9; discussion 1549-50. [Medline].

  43. Francombe J, Carter PS, Hershman MJ. The aetiology and epidemiology of faecal incontinence. Hosp Med. Sep 2001;62(9):529-32. [Medline].

  44. Gilat T, Konikoff F. Pregnancy and the biliary tract. Can J Gastroenterol. Nov 2000;14 suppl D:55D-59D. [Medline].

  45. Giordano P, Wexner SD. The assessment of fecal incontinence in women. J Am Coll Surg. Oct 2001;193(4):397-406. [Medline].

  46. Katz JA, Pore G. Inflammatory bowel disease and pregnancy. Inflamm Bowel Dis. May 2001;7(2):146-57. [Medline].

  47. Larson JD, Patatanian E, Miner PB Jr, Rayburn WF, Robinson MG. Double-blind, placebo-controlled study of ranitidine for gastroesophageal reflux symptoms during pregnancy. Obstet Gynecol. Jul 1997;90(1):83-7. [Medline].

  48. Lindow SW, Regnéll P, Sykes J, Little S. An open-label, multicentre study to assess the safety and efficacy of a novel reflux suppressant (Gaviscon Advance) in the treatment of heartburn during pregnancy. Int J Clin Pract. Apr 2003;57(3):175-9. [Medline].

  49. Ludvigsson JF. Effect of gastroenteritis during pregnancy on neonatal outcome. Eur J Clin Microbiol Infect Dis. Dec 2001;20(12):843-9. [Medline].

  50. Lyass S, Pikarsky A, Eisenberg VH, et al. Is laparoscopic appendectomy safe in pregnant women?. Surg Endosc. Apr 2001;15(4):377-9. [Medline].

  51. MacArthur C, Glazener CM, Wilson PD, et al. Obstetric practice and faecal incontinence three months after delivery. BJOG. Jul 2001;108(7):678-83. [Medline].

  52. Magee LA, Inocencion G, Kamboj L, Rosetti F, Koren G. Safety of first trimester exposure to histamine H2 blockers. A prospective cohort study. Dig Dis Sci. Jun 1996;41(6):1145-9. [Medline].

  53. Mayberry JF, Atkinson M. Achalasia and pregnancy. Br J Obstet Gynaecol. Sep 1987;94(9):855-9. [Medline].

  54. Meyer LC, Peacock JL, Bland JM, Anderson HR. Symptoms and health problems in pregnancy: their association with social factors, smoking, alcohol, caffeine and attitude to pregnancy. Paediatr Perinat Epidemiol. Apr 1994;8(2):145-55. [Medline].

  55. Nikfar S, Abdollahi M, Moretti ME, Magee LA, Koren G. Use of proton pump inhibitors during pregnancy and rates of major malformations: a meta-analysis. Dig Dis Sci. Jul 2002;47(7):1526-9. [Medline].

  56. Norgard B, Czeizel AE, Rockenbauer M, Olsen J, Sorensen HT. Population-based case control study of the safety of sulfasalazine use during pregnancy. Aliment Pharmacol Ther. Apr 2001;15(4):483-6. [Medline]. [Full Text].

  57. Oludiran OO, Okonofua FE. Morbidity and mortality from bowel injury secondary to induced abortion. Afr J Reprod Health. Dec 2003;7(3):65-8. [Medline].

  58. Reymunde A, Santiago N, Perez L. Helicobacter pylori and severe morning sickness. Am J Gastroenterol. Jul 2001;96(7):2279-80. [Medline].

  59. Shah S, Hobbs A, Singh R, et al. Gastrointestinal motility during pregnancy: role of nitrergic component of NANC nerves. Am J Physiol Regul Integr Comp Physiol. Oct 2000;279(4):R1478-85. [Medline]. [Full Text].

  60. Srinivasan R. Infliximab treatment and pregnancy outcome in active Crohn's disease. Am J Gastroenterol. Jul 2001;96(7):2274-5. [Medline].

  61. Staroselsky A, Nava-Ocampo AA, Vohra S, Koren G. Hemorrhoids in pregnancy. Can Fam Physician. Feb 2008;54(2):189-90. [Medline]. [Full Text].

  62. Ulmsten U, Sundstrm G. Esophageal manometry in pregnant and nonpregnant women. Am J Obstet Gynecol. Oct 1 1978;132(3):260-4. [Medline].

  63. Van Thiel DH, Wald A. Evidence refuting a role for increased abdominal pressure in the pathogenesis of the heartburn associated with pregnancy. Am J Obstet Gynecol. Jun 15 1981;140(4):420-2. [Medline].

  64. Viktrup L, Hee P. Appendicitis during pregnancy. Am J Obstet Gynecol. Jul 2001;185(1):259-60. [Medline].

  65. Winbery SL, Blaho KE. Dyspepsia in pregnancy. Obstet Gynecol Clin North Am. Jun 2001;28(2):333-50. [Medline].

[ CLOSE WINDOW ]

Further Reading

Best Evidence

Clinical Trials

National Guidelines Clearinghouse

[ CLOSE WINDOW ]

Keywords

gastrointestinal disease and pregnancy, gastrointestinal disease, pregnancy, complicated pregnancy, pregnancy complications, complications of pregnancy, problem pregnancy, gastrointestinal disorders, GI disorders, morning sickness, hyperemesis gravidarum, gastroesophageal reflux disease, GERD, heartburn, gallstones, peptic ulcer disease, PUD, diarrhea, constipation, food poisoning, irritable bowel disease, IBD, irritable bowel syndrome, IBS, GI disease

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Praveen K Roy, MD, Comments and Criticisms Editor, Cochrane Colorectal Cancer Group
Praveen K Roy, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, and Canadian Association of Gastroenterology
Disclosure: Nothing to disclose.

Coauthor(s)

Abhishek Choudhary, MD, Resident, Department of Internal Medicine, University Hospital of Missouri
Abhishek Choudhary, MD is a member of the following medical societies: American College of Physicians
Disclosure: Nothing to disclose.

Mohamed Othman, MD, Staff Physician, Department of Internal Medicine, University of New Mexico School of Medicine
Disclosure: Nothing to disclose.

Homayoun Shojamanesh, MD, Former Fellow, Digestive Diseases Branch, National Institutes of Health
Homayoun Shojamanesh, MD is a member of the following medical societies: American Gastroenterological Association, American Medical Association, and American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.

Jack Bragg, DO, FACOI, Assistant Professor, Department of Clinical Medicine, University of Missouri School of Medicine
Jack Bragg, DO, FACOI is a member of the following medical societies: American College of Osteopathic Internists and American Osteopathic Association
Disclosure: Nothing to disclose.

Gautam Dehadrai, MD, Department Chair, Section Chief, Department of Interventional Radiology, Norman Regional Hospital
Gautam Dehadrai, MD is a member of the following medical societies: American College of Radiology, Medical Council of India, and Radiological Society of North America
Disclosure: Nothing to disclose.

Showkat Bashir, MD, Assistant Professor, Department of Medicine, Division of Gastroenterology, George Washington University, Washington, DC
Showkat Bashir, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Ann Ouyang, MBBS, Professor, Department of Internal Medicine, Pennsylvania State University College of Medicine; Attending Physician, Division of Gastroenterology and Hepatology, Milton S Hershey Medical Center
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

David Chelmow, MD, Professor of Obstetrics and Gynecology, Tufts University School of Medicine; Program Director, Tufts University Affiliated Hospitals OB/GYN Residency Program; Chair, Tufts University Health Sciences Campus Institutional Review Board; Vice Chair for Research and Education, Dept of OB/GYN, Tufts Medical Center
David Chelmow, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Association of Professors of Gynecology and Obstetrics, Massachusetts Medical Society, Phi Beta Kappa, Sigma Xi, Society for Gynecologic Investigation, and Society for Medical Decision Making
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.