Gastrointestinal Diseases in Pregnancy: Nausea, Vomiting, Hyperemesis Gravidarum, Gastroesophageal Reflux Disease, Constipation, and Diarrhea

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Key points

  • Pregnant women are susceptible to nausea, vomiting, gastroesophageal reflux, constipation, and diarrhea at rates similar to or higher than the general population.

  • Many of the pregnancy-induced gastrointestinal (GI) disorders result from the normal hormonal and structural changes associated with pregnancy.

  • Although a vast majority of GI complaints are caused by normal pregnancy-related changes, other pathologic conditions and causes should be considered.

  • When symptomatic remission cannot be

Nausea, vomiting, and hyperemesis gravidarum

A majority of pregnant women experience nausea and vomiting during pregnancy.1 The prevalence of nausea in this group is between 50% and 80% and for vomiting 50%.2 These are the most common medical conditions during gestation, usually beginning between weeks 4 and 6, peaking at approximately weeks 8 to 12, and often ceasing by week 20.3

Hyperemesis gravidarum (HG) is a severe and persistent form of nausea and vomiting.2 Fortunately, it only affects approximately 1.2% of pregnant women.3

Gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) typically manifests as heartburn and is reported by 40% to 85% of pregnant women.18 Pregnancy may be the first time a woman experiences GERD or it may exacerbate preexisting reflux disease.19 Box 2 lists the common symptoms of GERD, which typically begin in the later portion of the first trimester or early portion of the second trimester. When present, GERD usually lasts throughout gestation and may get progressively worse in the later months but typically

Constipation

Constipation is the second most common GI complaint in pregnancy.21 After modifying the duration of symptoms (1 month instead of 3 months), Bradley and colleagues22 used many elements of the Rome III Diagnositic Criteria for Functional Constipation to define constipation as the presence of at least 2 of the following 6 symptoms during at least 25% of defecations: having fewer than 3 bowel movements per week, straining, hard or lumpy stools, sensation of anorectal blockade/obstruction, sensation

Diarrhea

Compared with other GI disorders in pregnancy, there is significantly less literature on diarrhea in pregnancy. There are no recent studies documenting the prevalence of diarrhea in pregnancy, and GI motility has not been evaluated in pregnant women who report diarrhea.24, 25 Previous studies from the 1970s reported an increased frequency of bowel movements in 34% of pregnant women.27 Diarrhea that develops at or near term may be a precursor to labor.21

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  • Cited by (81)

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    Disclosure: Research support, Takeda Pharmaceuticals; Advisory Board, Synergy Pharmaceuticals.

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