Maternal gastrointestinal tract adaptation to pregnancy
- Angela Bianco, MD
Angela Bianco, MD
- Associate Professor
- Department of Obstetrics and Gynecology
- Division of Maternal Fetal Medicine
- Mount Sinai Medical Center
Pregnancy has little, if any, effect on gastrointestinal secretion or absorption, but it has a major effect on gastrointestinal motility. Pregnancy-related changes in motility are present throughout the gastrointestinal tract and are related to increased levels of female sex hormones. In addition, the enlarging uterus displaces bowel, which can affect the presentation of disorders such as appendicitis. Knowledge of the gastrointestinal adaptation to pregnancy is necessary for accurate interpretation of laboratory tests, as well as imaging studies in the gravid patient.
Maternal gastrointestinal tract changes during pregnancy and common gastrointestinal disorders related to pregnancy will be reviewed here.
The mucous membrane lining the oropharynx is responsive to the hormonal changes related to pregnancy. The gingiva is primarily affected, while the teeth, tongue, and salivary glands are spared, although excessive salivation during pregnancy has been described . The effect of pregnancy on the initiation or progression of caries is not clear; pregnancy-related changes in the oral environment (salivary pH, oral flora) or in maternal diet and oral hygiene may increase the risk of caries . (See "The skin, hair, nails, and mucous membranes during pregnancy", section on 'Mucous membranes'.)
Taste — Most studies suggest that taste perception changes during pregnancy [3-6]. The etiology is unknown and the direction of taste change varies among studies.
Gingivitis — Enlargement and blunting of the interdental papillae of the gingiva may result in gingival bleeding, ulceration, and pain. Gingival inflammatory symptoms are frequently aggravated during pregnancy; prevalence rates of 40 to 100 percent have been reported . The cause of pregnancy-induced gingivitis (picture 1) is likely multifactorial and includes pregnancy hormone-related vascular and inflammatory changes [8-12].
- BERNSTINE RL, FRIEDMAN MH. Salivation in pregnant and nonpregnant women. Obstet Gynecol 1957; 10:184.
- Laine MA. Effect of pregnancy on periodontal and dental health. Acta Odontol Scand 2002; 60:257.
- Ochsenbein-Kölble N, von Mering R, Zimmermann R, Hummel T. Changes in gustatory function during the course of pregnancy and postpartum. BJOG 2005; 112:1636.
- Duffy VB, Bartoshuk LM, Striegel-Moore R, Rodin J. Taste changes across pregnancy. Ann N Y Acad Sci 1998; 855:805.
- Kuga M, Ikeda M, Suzuki K, Takeuchi S. Changes in gustatory sense during pregnancy. Acta Otolaryngol Suppl 2002; :146.
- Kölble N, Hummel T, von Mering R, et al. Gustatory and olfactory function in the first trimester of pregnancy. Eur J Obstet Gynecol Reprod Biol 2001; 99:179.
- Lee, H, Silness, J. Periodental disease in pregnancy. Acta Odontol Scan 1963; 21:533.
- Raber-Durlacher JE, van Steenbergen TJ, Van der Velden U, et al. Experimental gingivitis during pregnancy and post-partum: clinical, endocrinological, and microbiological aspects. J Clin Periodontol 1994; 21:549.
- GUSTAFSSON GT, NILSSON IM. Fibrinolytic activity in fluid from gingival crevice. Proc Soc Exp Biol Med 1961; 106:277.
- Kinnby, B, Lecander, I, Martinsson, G, Astedt, B. Tissue plasminogen activator and placental plasminogen activator inhibitor in human gingival fluid. Fibrinolysis 1991; 5:239.
- Kinnby, B, Astedt, B, Casslen, B. Reduction of PAI-2 production in cultured human peripheral blood monocytes by estradiol and progesterone on effect on t-PA, a-PA, and PAI-1. Fibrinolysis 1995; 9:152.
- Kinnby B, Matsson L, Astedt B. Aggravation of gingival inflammatory symptoms during pregnancy associated with the concentration of plasminogen activator inhibitor type 2 (PAI-2) in gingival fluid. J Periodontal Res 1996; 31:271.
- Jafarzadeh H, Sanatkhani M, Mohtasham N. Oral pyogenic granuloma: a review. J Oral Sci 2006; 48:167.
- Van Dinter MC. Ptyalism in pregnant women. J Obstet Gynecol Neonatal Nurs 1991; 20:206.
- Thaxter Nesbeth KA, Samuels LA, Nicholson Daley C, et al. Ptyalism in pregnancy - a review of epidemiology and practices. Eur J Obstet Gynecol Reprod Biol 2016; 198:47.
- Freeman JJ, Altieri RH, Baptiste HJ, et al. Evaluation and management of sialorrhea of pregnancy with concomitant hyperemesis. J Natl Med Assoc 1994; 86:704.
- Nazik E, Eryilmaz G. Incidence of pregnancy-related discomforts and management approaches to relieve them among pregnant women. J Clin Nurs 2014; 23:1736.
- Mandel L, Tamari K. Sialorrhea and gastroesophageal reflux. J Am Dent Assoc 1995; 126:1537.
- Chiloiro M, Darconza G, Piccioli E, et al. Gastric emptying and orocecal transit time in pregnancy. J Gastroenterol 2001; 36:538.
- Whitehead EM, Smith M, Dean Y, O'Sullivan G. An evaluation of gastric emptying times in pregnancy and the puerperium. Anaesthesia 1993; 48:53.
- Wong CA, Loffredi M, Ganchiff JN, et al. Gastric emptying of water in term pregnancy. Anesthesiology 2002; 96:1395.
- Rey E, Rodriguez-Artalejo F, Herraiz MA, et al. Gastroesophageal reflux symptoms during and after pregnancy: a longitudinal study. Am J Gastroenterol 2007; 102:2395.
- Castro Lde P. Reflux esophagitis as the cause of heartburn in pregnancy. Am J Obstet Gynecol 1967; 98:1.
- Bainbridge ET, Temple JG, Nicholas SP, et al. Symptomatic gastro-oesophageal reflux in pregnancy. A comparative study of white Europeans and Asians in Birmingham. Br J Clin Pract 1983; 37:53.
- Van Thiel DH, Gavaler JS, Joshi SN, et al. Heartburn of pregnancy. Gastroenterology 1977; 72:666.
- Fisher RS, Roberts GS, Grabowski CJ, Cohen S. Altered lower esophageal sphincter function during early pregnancy. Gastroenterology 1978; 74:1233.
- Schulze K, Christensen J. Lower sphincter of the opossum esophagus in pseudopregnancy. Gastroenterology 1977; 73:1082.
- Van Thiel DH, Gavaler JS, Stremple J. Lower esophageal sphincter pressure in women using sequential oral contraceptives. Gastroenterology 1976; 71:232.
- Wiznitzer A, Mayer A, Novack V, et al. Association of lipid levels during gestation with preeclampsia and gestational diabetes mellitus: a population-based study. Am J Obstet Gynecol 2009; 201:482.e1.
- Brizzi P, Tonolo G, Esposito F, et al. Lipoprotein metabolism during normal pregnancy. Am J Obstet Gynecol 1999; 181:430.
- Piechota W, Staszewski A. Reference ranges of lipids and apolipoproteins in pregnancy. Eur J Obstet Gynecol Reprod Biol 1992; 45:27.
- Larsson A, Palm M, Hansson LO, Axelsson O. Reference values for clinical chemistry tests during normal pregnancy. BJOG 2008; 115:874.
- Mintz MC, Grumbach K, Arger PH, Coleman BG. Sonographic evaluation of bile duct size during pregnancy. AJR Am J Roentgenol 1985; 145:575.
- Kaiser R, Berk JE, Fridhandler L. Serum amylase changes during pregnancy. Am J Obstet Gynecol 1975; 122:283.
- Strickland DM, Hauth JC, Widish J, et al. Amylase and isoamylase activities in serum of pregnant women. Obstet Gynecol 1984; 63:389.
- Karsenti D, Bacq Y, Bréchot JF, et al. Serum amylase and lipase activities in normal pregnancy: a prospective case-control study. Am J Gastroenterol 2001; 96:697.
- Ramin KD, Ramin SM, Richey SD, Cunningham FG. Acute pancreatitis in pregnancy. Am J Obstet Gynecol 1995; 173:187.
- O'Boyle AL, O'Boyle JD, Magann EF, et al. Anorectal symptoms in pregnancy and the postpartum period. J Reprod Med 2008; 53:151.
- Bradley CS, Kennedy CM, Turcea AM, et al. Constipation in pregnancy: prevalence, symptoms, and risk factors. Obstet Gynecol 2007; 110:1351.
- Derbyshire E, Davies J, Costarelli V, Dettmar P. Diet, physical inactivity and the prevalence of constipation throughout and after pregnancy. Matern Child Nutr 2006; 2:127.
- Wald A, Van Thiel DH, Hoechstetter L, et al. Effect of pregnancy on gastrointestinal transit. Dig Dis Sci 1982; 27:1015.
- Lawson M, Kern F Jr, Everson GT. Gastrointestinal transit time in human pregnancy: prolongation in the second and third trimesters followed by postpartum normalization. Gastroenterology 1985; 89:996.
- Ryan JP, Bhojwani A. Colonic transit in rats: effect of ovariectomy, sex steroid hormones, and pregnancy. Am J Physiol 1986; 251:G46.
- Kumar, D. In vitro inhibitory effect of progesterone on extrauterine human smooth muscle. Obstet Gynecol 1962; 84:1300.
- Christofides ND, Ghatei MA, Bloom SR, et al. Decreased plasma motilin concentrations in pregnancy. Br Med J (Clin Res Ed) 1982; 285:1453.
- Chaliha C, Sultan AH, Bland JM, et al. Anal function: effect of pregnancy and delivery. Am J Obstet Gynecol 2001; 185:427.
- Saleeby RG Jr, Rosen L, Stasik JJ, et al. Hemorrhoidectomy during pregnancy: risk or relief? Dis Colon Rectum 1991; 34:260.
- - Gingivitis
- - Pregnancy epulis
- Ptyalism or sialorrhea gravidarum
- ESOPHAGUS AND STOMACH
- Gastroesophageal reflux
- Aspiration of gastric contents
- BOWEL, RECTUM, ANUS
- Bloating and constipation
- Incontinence of feces and flatus
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS