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The spectrum and treatment of gastrointestinal disorders during pregnancy

Nature Clinical Practice Gastroenterology & Hepatology volume 5, pages 430–443 (2008)Cite this article

Abstract

Gastrointestinal symptoms are extremely common during pregnancy. Increased levels of female sex hormones cause or contribute to symptoms such as heartburn, nausea, vomiting and constipation. If these symptoms do not respond adequately to lifestyle and dietary changes, drug therapy is often warranted to improve quality of life and to prevent complications. Physicians, therefore, need to be familiar with the low-risk treatment options available. Treatment of chronic conditions such as IBD or chronic liver disease during pregnancy can be demanding. In women with IBD, maintenance of adequate disease control during pregnancy is crucial. Most IBD drugs can be used during pregnancy, but the benefits and risks of specific drugs should be discussed with the patient. Liver diseases can be coincidental or pregnancy-specific. Pregnancy-specific liver diseases include not only benign disorders such as intrahepatic cholestasis of pregnancy, but also pre-eclampsia, eclampsia and HELLP syndrome (hemolytic anemia, elevated liver enzymes and low platelet count). Accordingly, the spectrum of therapeutic measures ranges from expectant management to urgent induction of delivery. During pregnancy, lamuvidine therapy for chronic hepatitis B can be continued; however, interferon and ribavirin therapy for chronic hepatitis C is contraindicated. This Review provides an overview of the spectrum and therapy of motility disturbances that occur during pregnancy, and discusses pregnancy-specific aspects of IBD and liver diseases.

Key Points

  • Gastrointestinal symptoms such as heartburn, nausea and vomiting, and constipation are very common during pregnancy and are mainly attributable to motility disturbances caused by increased female sex hormone levels

  • Therapy for these symptoms usually follows a stepwise approach that starts with reassurance, avoidance of precipitating factors, and dietary changes; drug therapy is reserved for women whose symptoms do not respond adequately

  • For pregnant women with IBD, maintenance of adequate disease control is crucial for the health of both mother and fetus and often requires continuation of drug treatment

  • According to the available evidence, most drugs used to treat IBD—except the teratogenic drugs methotrexate and thalidomide—are low-risk options during pregnancy

  • The spectrum of liver diseases during pregnancy is very heterogeneous, and encompasses diseases unique to pregnancy, coincidental conditions, and pre-existing chronic liver diseases

  • Although pregnancy is rare in women with severe chronic liver diseases, clinicians need to be aware that nearly 10% of pregnant women may develop a liver disease that is unique to pregnancy, in particular pre-eclampsia, and that adequate monitoring and therapy are needed

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Figure 1: Therapeutic options for the treatment of reflux symptoms during pregnancy.
Figure 2: Therapeutic options for the treatment of nausea and vomiting during pregnancy.

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Acknowledgements

Désirée Lie, University of California, Orange, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape-accredited continuing medical education activity associated with this article.

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  1. D Frederking is Senior House Officer and P Layer is Director of the Department of Internal Medicine, J Keller is Head of the Gastrointestinal Laboratory and Senior Physician, Israelitic Hospital, University of Hamburg, Hamburg, Germany.,

    Jutta Keller, Dorothea Frederking & Peter Layer

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Correspondence to Jutta Keller.

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Keller, J., Frederking, D. & Layer, P. The spectrum and treatment of gastrointestinal disorders during pregnancy. Nat Rev Gastroenterol Hepatol 5, 430–443 (2008). https://doi.org/10.1038/ncpgasthep1197

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