Subscribe to RSS
DOI: 10.1055/s-0030-1254294
Gastrointestinal Conditions during Pregnancy
Publication History
Publication Date:
28 May 2010 (online)
![](https://www.thieme-connect.de/media/ccrs/201002/lookinside/thumbnails/10.1055-s-0030-1254294-1.jpg)
ABSTRACT
Pregnancy causes anatomic and physiologic changes in the gastrointestinal tract. Pregnant women with intestinal disease such as Crohn disease or ulcerative colitis pose a management challenge in clinical diagnosis, radiologic evaluation, and treatment secondary to potential risk to the fetus. Heightened physician awareness on possible etiologies such as appendicitis, diverticulitis, and rarely colorectal cancer is required for rapid diagnosis and treatment to improve maternal/fetal outcome. A multidisciplinary approach to evaluation is a necessity because radiologic procedures and treatment medications commonly used in nonpregnant patients may have a potential harmful effect on the fetus. The authors review several gastrointestinal conditions encountered during pregnancy and address presentation, diagnosis, and treatment of each condition.
KEYWORDS
Gastrointestinal - pregnancy - constipation - inflammatory bowel disease
REFERENCES
- 1 Bonapace Jr E S, Fisher R S. Constipation and diarrhea in pregnancy. Gastroenterol Clin North Am. 1998; 27(1) 197-211
- 2 Greenhalf J O, Leonard H S. Laxatives in the treatment of constipation in pregnant and breast-feeding mothers. Practitioner. 1973; 210(256) 259-263
- 3 Levy N, Lemberg E, Sharf M. Bowel habit in pregnancy. Digestion. 1971; 4(4) 216-222
- 4 Singer A J, Brandt L J. Pathophysiology of the gastrointestinal tract during pregnancy. Am J Gastroenterol. 1991; 86(12) 1695-1712
- 5 West L, Warren J, Cutts T. Diagnosis and management of irritable bowel syndrome, constipation, and diarrhea in pregnancy. Gastroenterol Clin North Am. 1992; 21(4) 793-802
- 6 Creasy R, Resnik R, Iams J D, Lockwood C J, Moore T R. Maternal fetal medicine principles and practice. 6th ed. Philadelphia; WB Saunders 2008
- 7 Wald A. Constipation, diarrhea, and symptomatic hemorrhoids during pregnancy. Gastroenterol Clin North Am. 2003; 32(1) 309-322, vii
- 8 Pedrosa I, Lafornara M, Pandharipande P V, Goldsmith J D, Rofsky N M. Pregnant patients suspected of having acute appendicitis: effect of MR imaging on negative laparotomy rate and appendiceal perforation rate. Radiology. 2009; 250(3) 749-757
- 9 Basaran A, Basaran M. Diagnosis of acute appendicitis during pregnancy, a systematic review. Obstet Gynecol Surv. 2009; 64(7) 481-488 quiz 499
- 10 Sadot E, Telem D, Arora1 M, Butala1 P, Nguyen1 S Q, Celia M, Divino C M. Laparoscopy: a safe approach to appendicitis in pregnancy. Surg Endosc. 2010; 24(2) 383-389
- 11 Williams R, Shaw J. Ultrasound scanning in the diagnosis of acute appendicitis in pregnancy. Emerg Med J. 2007; 24(5) 359-360
- 12 Ames Castro M, Shipp T D, Castro E E, Ouzounian J, Rao P. The use of helical computed tomography in pregnancy for the diagnosis of acute appendicitis. Am J Obstet Gynecol. 2001; 184(5) 954-957
- 13 Creasy R, Resnik R, Creasy R, Resnik R, Iams J D, Lockwood C J, Moore T R et al.. Maternal fetal medicine principles and practice. 6th ed. Philadelphia; WB Saunders 2008: 1046-1047
- 14 Tracey M, Fletcher H S. Appendicitis in pregnancy. Am Surg. 2000; 66 555-559
- 15 Tamir I L, Bongard F S, Klein S R. Acute appendicitis in the pregnant patient. Am J Surg. 1990; 160(6) 571-575 discussion 575-576
- 16 Rudloff U, Jobanputra S, Smith-Levitin M, Kessler E. Meckel's diverticulum complicating pregnancy. Case report and review of the literature. Arch Gynecol Obst. 2005; 271(1) 89-93
- 17 Andres P G, Friedman L S. Epidemiology and the natural course of inflammatory bowel disease. Gastroenterol Clin North Am. 1999; 28(2) 255-281, vii
- 18 Hudson M, Flett G, Sinclair T S, Brunt P W, Templeton A, Mowat N A. Fertility and pregnancy in inflammatory bowel disease. Int J Gynaecol Obstet. 1997; 58(2) 229-237
- 19 Nielsen O H, Andreasson B, Bondesen S, Jarnum S. Pregnancy in ulcerative colitis. Scand J Gastroenterol. 1983; 18(6) 735-742
- 20 Nielsen O H, Andreasson B, Bondesen S, Jacobsen O, Jarnum S. Pregnancy in Crohn's disease. Scand J Gastroenterol. 1984; 19(6) 724-732
- 21 Mogadam M, Korelitz B I, Ahmed S W, Dobbins III W O, Baiocco P J. The course of inflammatory bowel disease during pregnancy and postpartum. Am J Gastroenterol. 1981; 75(4) 265-269
- 22 Morales M, Berney T, Jenny A, Morel P, Extermann P. Crohn's disease as a risk factor for the outcome of pregnancy. Hepatogastroenterology. 2000; 47(36) 1595-1598
- 23 Willoughby C P, Truelove S C. Ulcerative colitis and pregnancy. Gut. 1980; 21(6) 469-474
- 24 Khosla R, Willoughby C P, Jewell D P. Crohn's disease and pregnancy. Gut. 1984; 25(1) 52-56
- 25 Porter R J, Stirrat G M. The effects of inflammatory bowel disease on pregnancy: a case-controlled retrospective analysis. Br J Obstet Gynaecol. 1986; 93(11) 1124-1131
- 26 Mogadam M, Dobbins III W O, Korelitz B I, Ahmed S W. Pregnancy in inflammatory bowel disease: effect of sulfasalazine and corticosteroids on fetal outcome. Gastroenterology. 1981; 80(1) 72-76
- 27 Baiocco P J, Korelitz B I. The influence of inflammatory bowel disease and its treatment on pregnancy and fetal outcome. J Clin Gastroenterol. 1984; 6(3) 211-216
- 28 Hanan I M, Kirsner J B. Inflammatory bowel disease in the pregnant woman. Clin Perinatol. 1985; 12(3) 669-682
- 29 Larzilliere I, Beau P. [Chronic inflammatory bowel disease and pregnancy. Case control study]. Gastroenterol Clin Biol. 1998; 22(12) 1056-1060
- 30 Fonager K, Sørensen H T, Olsen J, Dahlerup J F, Rasmussen S N. Pregnancy outcome for women with Crohn's disease: a follow-up study based on linkage between national registries. Am J Gastroenterol. 1998; 93(12) 2426-2430
- 31 Korelitz B I. Inflammatory bowel disease and pregnancy. Gastroenterol Clin North Am. 1998; 27(1) 213-224
- 32 Cappell M S, Sidhom O. Multicenter, multiyear study of safety and efficacy of flexible sigmoidoscopy during pregnancy in 24 females with follow-up of fetal outcome. Dig Dis Sci. 1995; 40(2) 472-479
- 33 Cappell M S, Colon V J, Sidhom O A. A study at 10 medical centers of the safety and efficacy of 48 flexible sigmoidoscopies and 8 colonoscopies during pregnancy with follow-up of fetal outcome and with comparison to control groups. Dig Dis Sci. 1996; 41(12) 2353-2361
- 34 Nørgård B, Czeizel A E, Rockenbauer M, Olsen J, Sørensen H T. Population-based case control study of the safety of sulfasalazine use during pregnancy. Aliment Pharmacol Ther. 2001; 15(4) 483-486
- 35 Nørgård B, Puho E, Pedersen L, Czeizel A E, Sørensen H T. Risk of congenital abnormalities in children born to women with ulcerative colitis: a population-based, case-control study. Am J Gastroenterol. 2003; 98(9) 2006-2010
- 36 Nørgård B, Pedersen L, Christensen L A, Sørensen H T. Therapeutic drug use in women with Crohn's disease and birth outcomes: a Danish nationwide cohort study. Am J Gastroenterol. 2007; 102(7) 1406-1413
- 37 Burtin P, Taddio A, Ariburnu O, Einarson T R, Koren G. Safety of metronidazole in pregnancy: a meta-analysis. Am J Obstet Gynecol. 1995; 172(2 Pt 1) 525-529
- 38 Caro-Patón T, Carvajal A, Martin de Diego I, Martin-Arias L H, Alvarez Requejo A, Rodríguez Pinilla E. Is metronidazole teratogenic? A meta-analysis. Br J Clin Pharmacol. 1997; 44(2) 179-182
- 39 Berkovitch M, Pastuszak A, Gazarian M, Lewis M, Koren G. Safety of the new quinolones in pregnancy. Obstet Gynecol. 1994; 84(4) 535-538
- 40 Bomford J AL, Ledger J C, O'Keeffe B J, Reiter C. Ciprofloxin use during pregnancy. Drugs. 1993; 45(Suppl 3) 461-462
- 41 Loebstein R, Addis A, Ho E et al.. Pregnancy outcome following gestational exposure to fluoroquinolones: a multicenter prospective controlled study. Antimicrob Agents Chemother. 1998; 42(6) 1336-1339
- 42 Schluter G. Osterotoxic effect of ciprofloxacin on Beagle dogs. Paper presented at: 1st International Ciprofloxacin Workshop November 6–8, 1985 Leverkusen, Germany;
- 43 Linseman D A, Hampton L A, Branstetter D G. Quinolone-induced arthropathy in the neonatal mouse. Morphological analysis of articular lesions produced by pipemidic acid and ciprofloxacin. Fundam Appl Toxicol. 1995; 28(1) 59-64
- 44 Schacht P, Arcieri G, Hullmann R. Safety of oral ciprofloxacin. An update based on clinical trial results. Am J Med. 1989; 87(5A) 98S-102S
- 45 Decosta E J, Abelman M A. Cortisone and pregnancy; an experimental and clinical study of the effects of cortisone on gestation. Am J Obstet Gynecol. 1952; 64(4) 746-767
- 46 Koren G, Pastuszak A, Ito S. Drugs in pregnancy. N Engl J Med. 1998; 338(16) 1128-1137
- 47 Norjavaara E, de Verdier M G. Normal pregnancy outcomes in a population-based study including 2,968 pregnant women exposed to budesonide. J Allergy Clin Immunol. 2003; 111(4) 736-742
- 48 Källén B, Rydhstroem H, Aberg A. Congenital malformations after the use of inhaled budesonide in early pregnancy. Obstet Gynecol. 1999; 93(3) 392-395
- 49 Alstead E M, Ritchie J K, Lennard-Jones J E, Farthing M J, Clark M L. Safety of azathioprine in pregnancy in inflammatory bowel disease. Gastroenterology. 1990; 99(2) 443-446
- 50 Francella A, Dyan A, Bodian C, Rubin P, Chapman M, Present D H. The safety of 6-mercaptopurine for childbearing patients with inflammatory bowel disease: a retrospective cohort study. Gastroenterology. 2003; 124(1) 9-17
- 51 Cleary B J, Kallen B. Early pregnancy azathioprine use and pregnancy outcome. Birth Defects Res Part A. 2009; 85 647-654
- 52 Angelberger S, Reinisch W, Dejaco C. Prevention of abortion by ciclosporin treatment of fulminant ulcerative colitis during pregnancy. Gut. 2006; 55(9) 1364-1365
- 53 Bertschinger P, Himmelmann A, Risti B, Follath F. Cyclosporine treatment of severe ulcerative colitis during pregnancy. Am J Gastroenterol. 1995; 90(2) 330
- 54 Reindl W, Schmid R M, Huber W. Cyclosporin A treatment of steroid-refractory ulcerative colitis during pregnancy: report of two cases. Gut. 2007; 56(7) 1019
- 55 Lichtiger S, Present D H, Kornbluth A et al.. Cyclosporine in severe ulcerative colitis refractory to steroid therapy. N Engl J Med. 1994; 330(26) 1841-1845
- 56 Bermas B L, Hill J A. Effects of immunosuppressive drugs during pregnancy. Arthritis Rheum. 1995; 38(12) 1722-1732
- 57 Armenti V T, Ahlswede K M, Ahlswede B A, Jarrell B E, Moritz M J, Burke J F. National Transplantation Pregnancy Registry—outcomes of 154 pregnancies in cyclosporine-treated female kidney transplant recipients. Transplantation. 1994; 57(4) 502-506
- 58 Armenti V T, Jarrell B E, Radomski J S, McGrory C H, Gaughan W J, Moritz M J. National Transplantation Pregnancy Registry (NTPR): cyclosporine dosing and pregnancy outcome in female renal transplant recipients. Transplant Proc. 1996; 28(4) 2111-2112
- 59 Radomski J S, Ahlswede B A, Jarrell B E et al.. Outcomes of 500 pregnancies in 335 female kidney, liver, and heart transplant recipients. Transplant Proc. 1995; 27(1) 1089-1090
- 60 al-Khader A A, Absy M, al-Hasani M K, Joyce B, Sabbagh T. Successful pregnancy in renal transplant recipients treated with cyclosporine. Transplantation. 1988; 45(5) 987-988
- 61 Bar Oz B, Hackman R, Einarson T, Koren G. Pregnancy outcome after cyclosporine therapy during pregnancy: a meta-analysis. Transplantation. 2001; 71(8) 1051-1055
- 62 Lichtenstein G, Cohen R D, Feagan B G et al.. Safety of infliximab in Crohn's disease: data from the 5000-patient TREAT Registry. [abstract]. Gastroenterology. 2004; 126(suppl) A54
- 63 Katz J A, Antoni C, Keenan G F, Smith D E, Jacobs S J, Lichtenstein G R. Outcome of pregnancy in women receiving infliximab for the treatment of Crohn's disease and rheumatoid arthritis. Am J Gastroenterol. 2004; 99(12) 2385-2392
- 64 Anderson J B, Turner G M, Williamson R C. Fulminant ulcerative colitis in late pregnancy and the puerperium. J R Soc Med. 1987; 80(8) 492-494
- 65 McEwan H P. Ulcerative colitis in pregnancy. Proc R Soc Med. 1972; 65(3) 279-281
- 66 Bohe M G, Ekelund G R, Genell S N et al.. Surgery for fulminating colitis during pregnancy. Dis Colon Rectum. 1983; 26(2) 119-122
- 67 Boulton R, Hamilton M, Lewis A, Walker P, Pounder R. Fulminant ulcerative colitis in pregnancy. Am J Gastroenterol. 1994; 89(6) 931-933
- 68 Scott H J, McLeod R S, Blair J, O'Connor B, Cohen Z. Ileal pouch-anal anastomosis: pregnancy, delivery and pouch function. Int J Colorectal Dis. 1996; 11(2) 84-87
- 69 Brandt L J, Estabrook S G, Reinus J F. Results of a survey to evaluate whether vaginal delivery and episiotomy lead to perineal involvement in women with Crohn's disease. Am J Gastroenterol. 1995; 90(11) 1918-1922
- 70 Minter A, Malik R, Ledbetter L, Winokur T S, Hawn M T, Saif M W. Colon cancer in pregnancy. Cancer Control. 2005; 12(3) 196-202
- 71 Harma M, Harma M, Uzunkoy A. Colorectal cancer presenting with uncommon soft tissue invasion during pregnancy. Acta Obstet Gynecol Scand. 2005; 84(5) 491-493
- 72 Bernstein M A, Madoff R D, Caushaj P F. Colon and rectal cancer in pregnancy. Dis Colon Rectum. 1993; 36(2) 172-178
- 73 Girard R M, Lamarche J, Baillot R. Carcinoma of the colon associated with pregnancy: report of a case. Dis Colon Rectum. 1981; 24(6) 473-475
- 74 Cappell M S. Colon cancer during pregnancy. Gastroenterol Clin North Am. 2003; 32(1) 341-383
- 75 Lolis E D, Likoudis P, Voiniadis P, Hassiakos D, Samanides L. Synchronous rectal and colon cancer caused by familial polyposis coli during pregnancy. J Obstet Gynaecol Res. 2007; 33(2) 199-202
- 76 Mechery J, Ikhena S E. Cancer of the descending colon during pregnancy. J Obstet Gynaecol. 2007; 27(3) 311-312
- 77 Slattery M L, Samowitz W S, Holden J A. Estrogen and progesterone receptors in colon tumors. Am J Clin Pathol. 2000; 113(3) 364-368
- 78 Cappell M S. Gastrointestinal endoscopy in high-risk patients. Dig Dis. 1996; 14(4) 228-244
- 79 Cappell M S. Colon cancer during pregnancy. The gastroenterologist's perspective. Gastroenterol Clin North Am. 1998; 27(1) 225-256
- 80 Gonzalez A B, Stafford I, Mancuso P, Carney S. Delivery of a polyp. Obstet Gynecol. 2008; 112(2 Pt 2) 488-490
- 81 Walsh C, Fazio V W. Cancer of the colon, rectum, and anus during pregnancy. The surgeon's perspective. Gastroenterol Clin North Am. 1998; 27(1) 257-267
- 82 Mason III M H, Kovalcik P J. Ovarian metastases from colon carcinoma. J Surg Oncol. 1981; 17(1) 33-38
- 83 Pitluk H, Poticha S M. Carcinoma of the colon and rectum in patients less than 40 years of age. Surg Gynecol Obstet. 1983; 157(4) 335-337
- 84 Knoepp Jr L F, Ray J E, Overby I. Ovarian metastases from colorectal carcinoma. Dis Colon Rectum. 1973; 16(4) 305-311
- 85 Holzer E, Haigermoser A, Pickel H. [Metastatic ovarian tumor on both sides as acute puerperium complication]. Gynakol Rundsch. 1976; 16(3) 211-216
- 86 Heres P, Wiltink J, Cuesta M A, Burger C W, van Groeningen C J, Meijer S. Colon carcinoma during pregnancy: a lethal coincidence. Eur J Obstet Gynecol Reprod Biol. 1993; 48(2) 149-152
- 87 Stephens J D, Golbus M S, Miller T R, Wilber R R, Epstein C J. Multiple congenital anomalies in a fetus exposed to 5-fluorouracil during the first trimester. Am J Obstet Gynecol. 1980; 137(6) 747-749
- 88 Antonelli N M, Dotters D J, Katz V L, Kuller J A. Cancer in pregnancy: a review of the literature. Part II. Obstet Gynecol Surv. 1996; 51(2) 135-142
- 89 Woods J B, Martin Jr J N, Ingram F H, Odom C D, Scott-Conner C E, Rhodes R S. Pregnancy complicated by carcinoma of the colon above the rectum. Am J Perinatol. 1992; 9(2) 102-110
Sherri A LongoM.D.
Department of Obstetrics and Gynecology, Section of Maternal-Fetal Medicine, Ochsner Clinic Foundation
1514 Jefferson Hwy., New Orleans, LA 70121
Email: slongo@ochsner.org