Jain Abhinav, Ramchandani Shraddha, Bhatia Shobna
Gastro1 Hospital, Ahmedabad, 382 470, India.
Department of Gynecology, AIG Hospital, Hyderabad, 500 032, India.
Indian J Gastroenterol. 2025 Jan 4. doi: 10.1007/s12664-024-01705-z.
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.
胃肠道（GI）症状在孕妇中频繁出现，导致生活质量下降。这些患者常常需要产科医生与内科医生/胃肠病专家共同管理。其病因复杂且具有多因素性。这是孕期母亲身体变化以及胎儿 - 胎盘激素对胃肠道（胎儿 - 胎盘 - 肠道轴）影响共同作用的结果。其他因素，如肠 - 脑相互作用、遗传、免疫反应以及孕期母亲补充剂的影响，也对症状的产生有作用。这些症状中最常见的包括恶心和呕吐，其次是烧心。常见的下消化道症状包括便秘和痔疮。肠易激综合征（IBS）在孕妇中也很常见。但是关于IBS管理的文献和高质量研究匮乏。本综述探讨了常见上消化道和下消化道症状的病理生理学、临床及实验室评估以及它们的管理。大多数症状较轻，采用非药物措施进行生活方式调整应作为一线管理方法，而在无反应或症状严重的情况下应谨慎使用药物。母亲和胎儿的营养状况需要密切监测。讨论了孕期常规使用药物对母亲和胎儿的安全性。部分患者可能需要胃肠内镜检查，并讨论了孕期内镜检查和结肠镜检查的适应证以及与妊娠相关的特殊注意事项。大多数症状在产后会恢复到孕前状态。
