Pregnancy & Baby Care Newsletter

Your Pregnancy and the Digestive System

Pregnancy is necessarily associated with adaptational changes to ensure the baby thrives and grows. These physiological changes are brought about by hormones that increase several thousand fold in some cases. The main hormones include Oestrogen and Progesterone produced by the placenta.

The impact of these hormones differ from person to person and depends on organ in question. The key purpose in all cases is for the hormone to facilitate the nourishment of the growing baby in the womb.

Oestrogen and Progesterone have important influences on the digestive system, including the liver and bowel. Without these changes pregnancy will most probably fail and the impact on the woman would be catastrophic.

Not all changes are welcome however.

In this month’s newsletter, Dr Menon and Sandra Prew provide our readers some insight into what changes take place and explain the problems commonly seen in pregnancy. Both writers are Research fellows in Gastroenterology at Sandwell & West Birmingham NHS Trust, a Teaching Hospital for the University of Birmingham.

Dr Menon and Sandra Prew are currently engaged in a study to establish what exactly causes reflux disease in pregnancy.

In these series of articles we will not only cover how pregnancy affects your pregnancy but will also review how your digestive system affects pregnancy. In the first of the series Dr Menon discusses the problem of heartburn.

Digestive and Bowel Problems in Pregnancy

Gastrointestinal symptoms are extremely common during pregnancy.  Increased levels of female sex hormones and the growing uterus/womb are thought to cause or contribute to symptoms such as heartburn, nausea, dyspepsia, vomiting, constipation and piles/haemorrhoids. All these are adaptational changes during pregnancy and generally completely settle after delivery.

Nausea and Vomiting

Nausea and vomiting in early pregnancy are due to hormonal changes.  Nausea occurs in 80% of all pregnancies during the first trimester; approximately a further 50% will also have vomiting. The severity of this varies from person to person and is usually worse in multiple pregnancies (i.e. twins, etc).  Most women report symptoms settling by 16-20 weeks.

General advice:

• Have small, frequent meals (5 or 6 a day).
• Eat something dry like toast or crackers before getting up in the morning.
• Get up gradually.
• Drink fluids before or after meals, not with your food.
• Avoid fried or fatty foods.
• Eat foods at room temperature (not hot), so they will have less food odour.
• Try ginger.
• Have a snack before bedtime.

Heartburn

Heartburn is described as a burning sensation or discomfort felt behind the sternum or throat or both.  It may be accompanied by acid regurgitation reaching the throat or mouth, causing a bitter or sour taste in the mouth.

It is estimated that it occurs in 30-50% of all pregnancies, one study suggests that frequency of heartburn increases with gestation, with 22% of women reporting heartburn in the first trimester, 39% in second and 72% in the third trimester.

Acid reflux is a common complication of being pregnant, causing acid indigestion with heartburn or acid regurgitation.

There are several potential reasons for women to develop acid reflux during pregnancy and these include relaxation of the gullet valve due to pregnancy hormones and pressure on the stomach due to the enlarging womb. Acid reflux therefore gets worse during pregnancy as the womb enlarges but generally tends to improve after delivery. What is not clearly understood is if the levels of pregnancy hormones that increase during pregnancy have an incremental effect in increasing the severity of acid reflux.

Here are some Lifestyle changes that may help with symptoms.  The following are commonly advised. There has been little research to prove how well these ‘lifestyle’ changes help to ease reflux and dyspepsia in pregnancy. However, they are certainly worth a try:

• Eat small meals and avoid greasy or spicy foods.

Some foods and drinks may make acid reflux worse in some people. Let common sense be your guide. If it seems that a type of food is causing symptoms; then try avoiding it for a while to see if symptoms improve. Foods and drinks that have been suspected of making symptoms worse in some people include: tomatoes, chocolate, fatty and spicy foods, fruit juices, coffee, and alcoholic drinks.

• Stop smoking if you are a smoker.

The chemicals from cigarettes relax the gullet valve and make acid reflux more likely. Symptoms may ease if you are a smoker and stop smoking. In any case, it is strongly advised that pregnant women should not smoke for other reasons as well.

• Have a good posture

Lying down or bending forward a lot during the day encourages acid reflux. Sitting hunched may put extra pressure on the stomach which may make any acid reflux worse. Avoid lying down for one to two hours after eating

• Bedtime

If symptoms recur most nights, it may help to go to bed with an empty stomach. Raise the head of the bed with books under the bed’s legs or use a pillow; this will help gravity to keep acid from coming back up into the esophagus/gullet.

Is there any medication for heartburn of pregnancy?

For many women (especially if they have mild symptoms), making some lifestyle changes as above is enough to ease dyspepsia. However, if lifestyle changes do not help, medication may be needed to treat heartburn in pregnancy.Consult your doctor before taking antacid tablets or other medications.

In a small percentage of women, heartburn/acid reflux may persist after delivery and may get worse during subsequent pregnancies. We do not clearly understand if pregnancy leads to a change in the function of the gullet valve or weakens it in this group of women and are organising a study to determine this (details at the end of this newsletter).