Pregnancy and GI Issues


Gastrointestinal (GI) issues are some of the most common complaints among pregnant women.

Unpleasant symptoms often result from problems with the gastrointestinal tract, primarily the esophagus, stomach, small intestine, large intestine, and rectum – and less frequently, the liver, gallbladder, and pancreas. Some expectant mothers may have chronic GI disorders prior to pregnancy that can worsen and require special consideration. 

Pregnant women with upset stomach, Pregnancy and GI issue

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CAUSE

Pregnancy hormones can have a significant impact on the digestive system. The hormone progesterone, responsible for smooth muscle relaxation, can cause digestion to slow as food moves through the stomach and small and large intestines. 

The gallbladder is also affected by this slowing, with delayed emptying increasing the potential for gallstone formation. Many of the digestive discomforts of pregnancy, such as morning sickness (nausea or vomiting), constipation, and heartburn, are all related to the slowed function of the digestive system. 

The growing uterus itself can also affect the digestive system, sometimes pressing on or even blocking parts of the GI tract. This can lead to slowed movement of food and constipation. Drinking plenty of fluids, exercising regularly, and increasing dietary fiber are some simple ways to prevent constipation. Always ask your healthcare provider before taking any medication to relieve constipation while pregnant.   

Many women have appetite changes during pregnancy, such as: 

  • Increased hunger
  • Decreased appetite
  • Cravings
  • Aversions
  • Nausea and vomiting

While rare, some women develop pica, a craving to eat things other than food – like dirt, clay, ice, raw rice, flour, starch, or coal. The craving indicates a nutritional deficiency, such as not getting enough iron.

FOODS TO AVOID DURING PREGNANCY

According to Health.gov, pregnant women should avoid eating the following foods: 

  • Fish
  • Alcohol
  • Raw shellfish
  • Certain meats
  • Raw or undercooked greens and sprouts
  • Raw or undercooked eggs
  • Soft cheese
  • Caffeine
  • Unpasteurized milk or fruit juices

FOODS TO EAT FOR GOOD GUT HEALTH DURING PREGNANCY

According to Health.gov, pregnant women can benefit from eating the following foods: 

  • Whole fruits (apples, berries, oranges, mango, bananas etc.)
  • Veggies (broccoli, sweet potatoes, beets, okra, spinach, peppers, jicama etc.)
  • Whole grains (brown rice, millet, oatmeal, bulgur, whole-wheat bread etc.)
  • Proteins (lean meats and chicken, eggs, seafood, beans and lentils, nuts, seeds, tofu etc.)
  • Low-fat or fat-free dairy (milk, yogurt, cheese, lactose-free dairy, fortified soy beverages like soy milk or soy yogurt etc.)
  • Oils (vegetable oil, olive oil, and oily foods like seafood, avocado, nuts etc.)

RISK FACTORS 

  • Advanced maternal age
    Mothers older than age 35 face a higher risk of pregnancy complications.
  • Lifestyle choices
    Smoking cigarettes, drinking alcohol, and using illegal drugs can put a pregnancy at risk.
  • Maternal health problems
    High blood pressure, obesity, diabetes, epilepsy, thyroid disease, heart or blood disorders, poorly controlled asthma, and infections can increase pregnancy risks.
  • Pregnancy complications
    Various complications that develop during pregnancy can pose risks. Examples include an unusual placenta position, fetal growth less than the 10th percentile for gestational age (fetal growth restriction) and rhesus (Rh) sensitization – a potentially serious condition that can occur when your blood group is Rh negative and your baby's blood group is Rh positive.
  • Multiple pregnancies
    Pregnancy risks are higher for women carrying more than one baby at a time.
  • Pregnancy history
    A history of pregnancy-related hypertension disorders, such as preeclampsia, increases the risk of having this diagnosis again during the next pregnancy. Mothers who have given birth prematurely face an increased risk of another early delivery.

SYMPTOMS

Bloating, the accumulation of gas in your stomach and intestines, often makes the belly feel tight and hard to the touch. It’s often accompanied by excessive gas, cramps, and constipation – with symptoms ranging from mild to extremely uncomfortable.

Extra progesterone released during pregnancy slows digestion to allow more nutrients to reach the developing baby, but can also make you feel bloated. Bloating typically occurs around week 11 and can last until delivery.

As the uterus expands to accommodate the growing fetus, it puts pressure on the rectum and lower intestine, causing constipation. While it can occur at any time during pregnancy, constipation is most common during the third trimester, when the baby presses hardest against the bowel. Because it relaxes your intestines, progesterone also slows down the passage of stool. Estrogen, another hormone, can have the same effect. Be aware that prenatal vitamins and iron supplements may cause constipation too.

Diarrhea is a condition defined by three or more loose/runny stools within 24 hours. It usually clears up on its own in several days. During pregnancy, diarrhea is more common during the third trimester – and may be a sign that labor is drawing nearer but not yet imminent. 

There are three types of diarrhea:

  • Acute: The most common type of diarrhea, it usually resolves after several days without any special treatment.
  • Persistent: Persistent diarrhea lasts two to four weeks.
  • Chronic: To be considered chronic, diarrhea must last more than four weeks or come and go over a long time period.

Diarrhea during pregnancy can have three causes:

  • Food sensitivity:  Some pregnant women develop sensitivities to foods they regularly eat. 
  • Sudden dietary changes: To ensure the baby is properly nourished, some women must alter their diet suddenly.
  • Hormonal changes: An increase in certain hormones during pregnancy can lead to diarrhea.

  • Gallstones

Gallstones are hardened pieces of bile that develop in the gallbladder when the bile contains too much cholesterol and too little bile salts. Gallstones can range in size, from grain of rice to a golf ball. Some patients develop just one, while others have many at once. In many cases, gallstones don’t have any symptoms or require treatment. However, a gallstone lodged in a bile duct can cause infection and extreme pain.

Elevated levels of estrogen during pregnancy increase cholesterol secretion, causing levels to rise in the bile. The simultaneous boost in progesterone causes the muscles to relax, which in turn, slows down the release of bile. Together, these hormonal changes can lead to the formation of gallstones.

  • Frequent Urination

Frequent urination is a common pregnancy symptom linked to the higher amount of blood in the uterus. Because the kidneys must produce more fluids to process this increased blood flow, fluids are retained in the bladder. The pressure of the uterus on the bladder means that pregnant women must use the bathroom more often. Frequent urination can start as early as the first few weeks of pregnancy and increase as the baby grows and puts more pressure on the bladder. There's no specific number of bathroom trips needed to qualify as “frequent,” only the need to urinate more than you typically do.

  • Heartburn

During the third trimester, more than half of pregnant women experience heartburn, also called gastroesophageal reflux disease (GERD). It mainly affects women who have experienced heartburn before pregnancy as well as women who have been pregnant before. Despite what its name suggests, heartburn doesn’t affect your heart at all. 

Rising hormone levels can cause this condition by causing food to move more slowly through the GI tract. A growing baby may also squeeze the stomach, causing acid to flow back into the esophagus.

Shifts in progesterone levels can also cause your esophageal sphincter to relax, allowing food and stomach acid to flow back into the esophagus and cause discomfort.

Hemorrhoids are painful, itchy, swollen veins inside and around your anus. Constipation may cause pregnant women to strain in order to pass a bowel movement, resulting in bulging veins. In fact, about 50% of pregnant women have hemorrhoids. 

Pressure from the growing baby, changing hormone levels, and increased blood volume in the pelvic region can also contribute to hemorrhoids. Pushing during labor can aggravate hemorrhoids too. One way to relieve hemorrhoids while pregnant is to relieve constipation by consuming a fiber-rich diet and drinking plenty of fluids. Hemorrhoids are particularly common during the third trimester but most often disappear after the baby is delivered.

  • Hyperemesis gravidarum

Hyperemesis gravidarum (HG) is intense, uncontrollable nausea and vomiting that can lead to loss of up to 5% of weight, electrolyte imbalance, severe dehydration, and other serious symptoms. Unlike morning sickness, a milder condition, nausea caused by HG is always accompanied by severe vomiting. It never subsides, can cause severe dehydration, and prevents you from keeping food down. If you suspect you have HG, contact your doctor as soon as possible to ensure you and your baby receive the nutrients you need.

  • Nausea and vomiting

Better known in pregnant women as morning sickness, nausea and vomiting can happen at any time of day or night. It’s the earliest symptom most women experience, usually occurring during the first six to eight weeks. Nausea isn’t always accompanied by vomiting.

Hormonal changes are considered to be responsible for morning sickness. An increase in human chorionic gonadotropin, or hCG (which helps form the placenta), is the leading cause of morning sickness. Elevated levels of estrogen and progesterone may also play a role. Morning sickness can be triggered by certain scents (since the sense of smell is heightened during pregnancy), bright lights, television, riding in a car, toothpaste, or certain foods – even ones you used to like. Sometimes there are no triggers at all!

WHEN TO SEE A DOCTOR

Even if your GI symptoms are mild, it is important to let your doctor know. Your GI specialist can recommend some tips for managing symptoms and monitor you more closely throughout your pregnancy.

If your symptoms are severe, become severe, and are persistent, contact your doctor right away. Be sure to seek immediate medical attention if you experience any of the following:

  • Vomiting blood
  • Bloody or black stools
  • Dramatic weight loss
  • Severe discomfort that interferes with daily life
  • Choking episodes
  • Pain or difficulty when swallowing
  • Extreme fatigue

DIAGNOSTIC TEST 

  • Blood test
  • Stool test
  • Physical exam 

TREATMENT

  • Maintain a healthy diet.
    Changing what, how frequently, and how much you eat may help manage or relieve GI symptoms. Depending on the issue you’re experiencing, you may need to increase the amount of fiber in your diet, avoid sugary, processed foods, or limit caffeine and dairy intake. Speak with a registered dietitian for a customized nutrition plan to meet your needs.
  • Stay hydrated.
    Increase the amount of fluids you consume each day, including water, fruit juice, and clear soups. Getting plenty of fluids aids in digestion and helps keep your GI tract moving. And because certain GI issues can cause dehydration, taking in adequate fluids is key.
  • Exercise regularly.
    Exercise promotes blood circulation and brings more oxygen to the organs, including the bowels. Aim for at least two and a half hours of moderate physical activity a week, or about 30 minutes a day, 5 days a week. Speak with your doctor to determine the best workout plan for you.
  • Medication
    If your GI symptoms are severe, persistent, or unmanageable even after lifestyle modifications, your doctor may prescribe medication to alleviate symptoms. Medication may include antacids, digestive enzymes, antidiarrheals, GI stimulants, and antiemetics.. 

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FREQUENTLY ASKED QUESTIONS

What gastrointestinal issues are normal during pregnancy?

While many GI issues are widely experienced by pregnant women, you may not have experienced any of them before. Some common causes or risk factors of gastrointestinal conditions during pregnancy can include:

  • Hormone fluctuations
  • GI motility disorders
  • Obesity
  • Certain medications
  • Poor diet
  • Thyroid disorders
  • Physical internal changes due to a growing uterus 
  • Lack of exercise 
  • Stress
  • History of laxative overuse
  • Antacid (containing calcium or aluminum) use
  • Viral or bacterial infection
  • Food intolerance or allergy

What are GI symptoms during pregnancy?

It’s important to know which symptoms are normal and which require medical treatment. These symptoms are commonly experienced in pregnant women:

  • Nausea and vomiting 
  • Heartburn
  • Diarrhea 
  • Constipation

What contributes to the need to urinate more often when you’re pregnant?

  • Bladder refills more often, making frequent trips to the bathroom necessary.  
  • Blood volume in the body doubles, so there will be more liquid for the kidneys to filter.
  • Hormonal changes loosen and soften the urethra’s ligaments, making it harder to hold your urine.
  • There is less room for urine as the growing baby pressure on the bladder – with the most pressure coming at the end of pregnancy when the baby drops lower into the pelvis. 
  • The body absorbs more fluid from the legs during sleep, increasing the urge to urinate, especially if the feet or legs are swollen. 

What is pregnancy gas? 

Your body makes gas as the natural bacteria in your stomach and intestines break down food. When you eat, drink, laugh, breathe, and talk, air is swallowed as well. 

Developing babies do not feel the gas pain or pressure experienced by their mothers. The movement and sounds that gas makes as it moves through your intestines might even be soothing for babies in the womb.  

How can I treat gas and bloating problems during pregnancy?

There are a few things you can do to minimize gas and bloating, such as: 

  • Drink plenty of water. 
  • Drink from a cup or a glass to encourage slower swallowing.
  • Cut back on gas-producing foods.
  • Try peppermint or ginger tea.
  • Maintain a healthy diet and change your eating habits if needed.
  • Exercise often.
  • Add fiber to your diet gradually.
  • Don’t chew gum. 
  • Never smoke.
  • Dress comfortably. 

Is being lactose intolerant during pregnancy normal?

If you didn’t consume much dairy prior to pregnancy, you may find that your body doesn’t tolerate it as well as it used to. If you are lactose intolerant or have a milk allergy, gas, bloating, pain, and diarrhea are common.

What does IBS in pregnancy feel like?

Many expectant mothers experience a variety of digestive issues during pregnancy, including diarrhea, constipation, heartburn, vomiting, nausea, and bloating.

Does pregnancy cause IBS symptoms?

Increased levels of estrogen and progesterone during pregnancy may contribute to IBS symptoms.

What foods trigger IBS?

Some common food to avoid if you have IBS while pregnant include: 

  • Dairy products (milk, cheese, ice cream etc.)
  • High sugar foods
  • Carbonated drinks
  • Caffeine
  • Sugar-free gum

What lifestyle changes help manage IBS during pregnancy?

These lifestyle changes can ease IBS symptoms:

  • Eat a well-balanced diet high in essential nutrients. 
  • Eat smaller portions.
  • Skip spicy foods.
  • Drink more water.
  • Never drink alcohol or smoke.
  • Exercise daily.
  • Keep stress levels low through yoga and meditation

What helps relieve constipation during pregnancy?

  • Drink plenty of water.
  • Add prune juice to your diet.
  • Eat more whole-grain foods, fresh fruits, and vegetables.
  • Ask your GI specialist about stool softeners.

What helps relieve heartburn during pregnancy?

  • Eat five or six small meals a day, instead of three bigger ones.
  • Avoid caffeine.
  • Limit spicy, fried, or rich foods.
  • After you eat, wait 30 minutes before lying down.
  • Try an over-the-counter antacid, like Tums.

How can I avoid food poisoning during pregnancy?

Food poisoning can cause serious problems for a woman and her fetus since vomiting and diarrhea can cause significant water loss and chemical imbalance. To avoid food poisoning, follow the following guidelines:

  • Avoid all raw and undercooked seafood, eggs, and meat. Make sure meat is cooked to a safe internal temperature. 
  • Wash all raw produce thoroughly under running tap water before eating, cutting, or cooking. 
  • Keep your kitchen clean by washing your hands, knives, countertops, and cutting boards thoroughly after handling uncooked foods. 

Can GI problems cause miscarriage?

IBS, causing diarrhea or dehydration, could potentially cause preterm labor. Constipation due to IBS during pregnancy may result in rectal bleeding or even piles problems. It can raise the chances of miscarriage or even ectopic pregnancy.

Can I take probiotics while pregnant?

Probiotics are live microorganisms that boast many health benefits. Taking probiotics is generally safe and well tolerated by pregnant women. We recommend speaking with your doctor before taking any prebiotics, supplements, or medications.

What yogurt is best for pregnant women?

Greek yogurt typically has twice the protein of regular yogurt, making it a great choice for pregnant women. It's also a great source of probiotics, B vitamins, phosphorus, and calcium. 

What foods are best for your GI heath during pregnancy? 

Some common foods the support strong gut health during pregnancy include: 

  • Beans
  • Sweet potatoes
  • Whole grains
  • Walnuts
  • Greek yogurt
  • Broccoli and dark leafy greens
  • Lean meats and poultry
  • Colorful fruits and veggies
  • Avocados
  • Dried fruit

Can I drink kombucha while pregnant?

No, kombucha isn't considered safe during pregnancy because it contains alcohol and caffeine. It is also acidic and poses the risk of contamination. 

Can I have honey while pregnant?

Yes, it's safe to eat honey during pregnancy. But do not give honey to babies under a year old because of the bacteria’s potential to cause a rare illness called botulism.

Are blueberries good for pregnancy?

Yes. Blueberries are an excellent source of nutrients during pregnancy. They contain Vitamin C, fiber, potassium, and folate – all great for healthy fetal development.

Is green tea good during pregnancy?

Green teas, including matcha, are considered safe during pregnancy. While they're also much lower in caffeine than coffee, limit yourself to less than three cups of green tea a day.

What teas should I avoid during pregnancy?

Studies show that if you drink chamomile tea regularly, you may have a higher risk of miscarriage, preterm labor, or low birth weight. Other herbal teas to avoid include:

  • Alfalfa
  • Black cohosh
  • Blue cohosh
  • Comfrey
  • Dong quai
  • Ephedra (called ma huang in traditional Chinese medicine and banned in the United States since 2004)
  • European mistletoe
  • Goldenseal
  • Hibiscus
  • Horehound
  • Kava
  • Labrador
  • Lemongrass
  • Licorice root
  • Mugwort
  • Nettle leaf (also called stinging nettle leaf)
  • Passion flower
  • Pennyroyal
  • Rosemary
  • Sage
  • Sassafras
  • Saw palmetto
  • Vetiver
  • Yarrow
  • Yerba mate

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To learn more about treatment for GI tract and digestive issues in Charleston, SC, get in touch today! Our team is committed to providing a higher standard of caring, with our experienced gastroenterologists equipped to treat a wide range of GI issues.

If you are experiencing painful or unpleasant GI tract symptoms, schedule your appointment today! No referral needed!

Sources: National Library of Medicine, Lifespan Health System, University of Rochester Medical Center, & Office of Disease Prevention & Health Promotion.

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