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Pregnancy causes or exacerbates conditions that pregnant women commonly experience including
constipation gastroesophageal reflux hemorrhoids and nausea and vomiting Women with pregnancy
influenced gastrointestinal GI issues can be treated safely with lifestyle modification or medications many
of them nonprescription Gestational diabetes gestational hypertension and venous thromboembolism
VTE have the potential to cause adverse pregnancy consequences Gestational thyrotoxicosis GTT is
usually self limiting

Constipation during pregnancy is prevalent a ecting up to of women and may contribute to the
development or exacerbation of hemorrhoids hemorrhoids are more prevalent in pregnant women
compared with the general population Moderate physical exercise and increased intake of dietary fiber
and fluid should be instituted first for constipation If additional treatment is needed supplemental fiber
and or a stool so ener is appropriate Bulk forming agents eg psyllium methylcellulose and polycarbophil
are safe for long term use because they are not absorbed Osmotic laxatives eg polyethylene glycol
lactulose and sorbitol and stimulant laxatives eg senna and bisacodyl can also be used Use of
magnesium and sodium salts may cause electrolyte imbalance Castor oil and mineral oil should be avoided
because they cause stimulation of uterine contractions and impairment of maternal fat soluble vitamin
absorption respectively Data supporting other management options for hemorrhoids during
pregnancy are limited Conservative treatment ie high dietary fiber intake adequate oral fluid intake and
use of sitz baths should be tried first Laxatives and stool so eners can be used if conservative management
is inadequate for preventing or treating constipation Topical anesthetics skin protectants and astringents
eg witch hazel can be used for anal irritation and pain Hydrocortisone may reduce inflammation and
pruritis

Between and of pregnant women experience gastroesophageal reflux disease An algorithm

starting with lifestyle and dietary modifications eg small frequent meals alcohol and tobacco avoidance
food avoidance before bedtime elevation of the head of the bed should be used If symptoms are not
relieved antacids eg aluminum calcium or magnesium preparations or sucralfate are acceptable
however sodium bicarbonate and magnesium trisilicate should be avoided Histamine H receptor
blockers can be used for patients unresponsive to lifestyle changes and antacids evidence supports the use
of ranitidine and cimetidine Literature evaluating the use of famotidine and nizatidine is limited but they
are likely safe The use of proton pump inhibitors PPIs during pregnancy does not appear to increase the
risk of major birth defects most data comes from use of omeprazole Since more data and clinical
experience are available for H antagonists use of PPIs should be reserved for women with inadequate
response to H antagonists

Nausea and vomiting of pregnancy NVP is estimated to a ect up to of pregnant women NVP usually
begins between weeks and of gestation and usually resolves by weeks to peak symptoms occur

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between weeks and Hyperemesis gravidarum HG ie unrelenting vomiting causing weight loss of
more than prepregnancy weight dehydration electrolyte imbalance and ketonuria occurs in to
of women Dietary modifications such as eating frequent small bland meals and avoiding fatty or
spicy foods may be helpful Applying pressure at acupressure point P on the volar aspect of the wrist may
be beneficial Ginger has shown e icacy for hyperemesis in randomized controlled trials and is probably
safe Pharmacotherapeutic approaches for NVP that have shown e icacy include pyridoxine vitamin B
and antihistamines including doxylamine The American College of Obstetricians and Gynecologists ACOG
considers pyridoxine alone or in combination with doxylamine first line the combination was approved by
FDA in Metoclopramide and phenothiazines are generally considered safe but may cause sedation
and extrapyramidal e ects including dystonia Conflicting data exist regarding ondansetron use While
recent studies showed no increase in risk of congenital anomalies a large case control study found an
increased risk of oral cle s Some suggest using metoclopramide before ondansetron Corticosteroids
may be e ective for HG use should be reserved until a er the first trimester because of a small increase in
the risk of oral cle s

Gestational diabetes mellitus GDM is diabetes diagnosed in the second or third trimester that is not
overt diabetes It develops in about to of pregnant women in the United States Risks of GDM are
many and include fetal loss increased risk of major malformations and fetal macrosomia The American
Diabetes Association and a consensus panel of the International Association of Diabetes and Pregnancy
Study Groups IADPSG recommends universal screening of pregnant women not previously diagnosed with
diabetes At the first prenatal visit all women considered high risk for diabetes eg obesity glycosuria
and strong family history of diabetes should be screened for overt diabetes which would indicate
pregestational origin Overt diabetes occurs if the A C is greater than or equal to mmol mol
Hgb fasting plasma glucose FPG is greater than or equal to mg dL mmol L or hour plasma
glucose mg dL mmol L or greater during an oral glucose tolerance test OGTT or if random
plasma glucose RPG is greater than or equal to mg dL mmol L in a patient with hyperglycemic
crisis or classic hyperglycemic symptoms If overt diabetes is not diagnosed or for women not at high risk for
diabetes screening for GDM should occur at weeks to using either the one step g OGTT or two step
g hour glucose challenge test followed by a g hour OGTT method summarizes
screening and diagnosis of GDM

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