Gastrointestinal symptoms and disorders of gut-brain interaction in pregnancy

Gastrointestinal (GI) symptoms occur frequently in pregnant women, resulting in poor quality of life. These patients frequently require co-management with the obstetrician and a physician/GI specialist. The causation is complex and multifactorial. It is a result of a combination of maternal changes in pregnancy and feto-placental hormonal effects on the GI tract (the feto-placental-gut axis). Additional factors such as the gut-brain interaction, genetics, immune response and effects of maternal supplements during pregnancy also contribute to the causation of symptoms. The most common of these symptoms include nausea and vomiting followed by heartburn. The common lower GI symptoms include constipation and hemorrhoids. Irritable bowel syndrome (IBS) is also common in a pregnant patient. But there is a paucity of literature and high-quality studies concerning the management of IBS. This review addresses the pathophysiology and clinical and laboratory evaluation of the common upper GI and lower GI symptoms and their management. A majority of symptoms are mild and lifestyle modifications with non-pharmacological measures should be the first-line management, whereas drugs should be used judiciously in case of non-response or severe symptoms. The nutritional status of the mother and the fetus needs close monitoring. Drugs that are routinely used in pregnancy are discussed with regard to the safety of the mother and the fetus. GI endoscopy may be needed in select patients and the indications for endoscopy and colonoscopy in pregnancy along with special pregnancy-related precautions are discussed. Most symptoms improve to pre-pregnancy state after delivery.