Gastrointestinal Disorders During Pregnancy – A Brief Overview from the Perspective of Internal Medicine
a) Hyperemesis Gravidarum
Hyperemesis gravidarum is a serious condition that occurs in about 0.5% of all pregnancies. It typically presents in the first trimester with severe nausea, vomiting, and other clinical signs. This condition is associated with a high mortality rate due to electrolyte and fluid imbalance. Thiamine deficiency can lead to Wernicke’s encephalopathy. There is a high likelihood of recurrence in subsequent pregnancies. The exact cause of hyperemesis gravidarum is unknown, and diagnosis requires excluding other causes of severe nausea and vomiting, especially if symptoms appear after the first trimester.
Treatment:
- Lifestyle modification.
- Intravenous fluids and electrolytes.
- Antiemetic medications.
- In severe cases, thiamine and glucocorticoids may be necessary.
b) Inflammatory Bowel Disease
Women with inflammatory bowel disease (IBD) should seek medical consultation before planning a pregnancy. Treatments such as azathioprine, sulfasalazine, aminosalicylic acid, glucocorticoids, and TNF-α inhibitors can be continued during pregnancy, but methotrexate should be discontinued at least 3 months before conception due to its teratogenic potential.
Disease Management:
- It is crucial to achieve good disease control before conception, as poorly controlled IBD increases the risk of preterm birth and delivering a low-birth-weight baby.
- The activity of IBD may increase during pregnancy, with ulcerative colitis flares being more likely than Crohn’s disease.
- Women experiencing disease flares should be closely monitored by both internists and obstetricians.
- TNF-α inhibitors like infliximab and adalimumab actively cross the placenta in the third trimester, potentially leading to immunosuppression in newborns.
Precautions:
- Infants whose mothers were treated with TNF-α inhibitors in the second and third trimesters should not receive live vaccines.
- These infants should be closely monitored for early signs of infection.
- Most women with uncomplicated IBD can have vaginal deliveries and do not require cesarean sections. However, the delivery plan should be a joint decision made by internists and obstetricians.