Common Gastrointestinal Issues During Pregnancy

Gastrointestinal issues such as nausea and vomiting, heartburn, and constipation are quite common during pregnancy. 
For many, mild nausea with or without vomiting (also known as “morning sickness”) in early pregnancy is considered to be normal. Mild symptoms can typically be managed with dietary changes such as eating several small, frequent, high calorie, bland meals throughout the day. Drinking ginger tea or sucking on ginger candies may also help with the nausea.However, some patients develop severe nausea and vomiting before 9 weeks of pregnancy that can result in dehydration, weight loss, and nutritional deficiency and may even require hospitalization. While patients with these severe symptoms are known to have what is called “hyperemesis gravidarum,” the symptoms typically resolve anywhere from 16 to 20 weeks into pregnancy. Patients with severe nausea and vomiting should talk to their obstetrician or gastroenterologist to determine what medications can be specifically used to manage their symptoms as not all medications are safe in pregnancy. 
Heartburn is also a common problem during pregnancy. Pregnant women should try and avoid foods that make symptoms worse such as coffee, cola, tea, citrus foods, and chocolate. Elevating the head of the bed to 45 degrees, eating small meals throughout the day, and avoiding eating or drinking anything within three hours of bedtime can also be helpful. Medications such as famotidine are preferred over proton pump inhibitors (PPIs) for symptoms; especially in the first trimester. 
Constipation and bloating during pregnancy typically occur due to hormonal changes. However, pregnant women may also be taking prenatal vitamins or supplemental iron that can result in constipation. Certain anti-nausea medications can also result in constipation.  Conservative management of constipation includes dietary changes, increasing physical activity, and the addition of supplemental fiber. Stimulant laxatives should be avoided during pregnancy as they may trigger uterine contractions. 
Overall, women experiencing gastrointestinal issues during pregnancy should contact their obstetrician or gastroenterologist for further evaluation and management. 
About the Author: Amulya Reddy, DO is a Gastroenterology Fellow at Mountain Vista Medical Center in Mesa, AZ. Prior to her current fellowship, she completed a Women’s Gastrointestinal Health Fellowship at Women & Infants Hospital and Brown University in Providence, RI as well as a Hepatology Fellowship at Virginia Mason Medical Center in Seattle, WA.