GI changes during pregnancy

Physiologic Changes in Pregnancy: Gastrointestinal (GI) Tract
Pregnancyàhormonal and physical changes in the body
Mechanisms poorly understood
↑ human chorionic ↑ estrogen ↑ progesterone gonadotropin (hCG)
↑ uterus size
Uterus rises into
abdominal cavity
↑ intra-gastric pressure
↑ backup of stomach contents
Nausea & vomiting
In the extreme case:
Hyperemesis gravidarum (extreme vomiting causing weight loss, dehydration, ketosis)
Liver displaced upwards
Liver edge generally not palpable on exam
↑ blood pressure in veins within the abdomen
Veins around rectum & anus stretch under pressure
↑ blood flow to the gum tissue
↑ tendency for gingival bleeding & ulceration
↑ neo- vascularization in lesions on skin
Pyogenic granuloma of pregnancy (shiny red papule with a raspberry-like surface)
Mechanism poorly understood
Ptyalism (excessive salivation)
Difficulty swallowing excess saliva
↑ gallbladder stasis
sludge given time to solidify within gallbladder
↓ mobilization of intracellular calcium within smooth muscle cells
Smooth muscle relaxation in tissues such as the gallbladder & GI tract
Changes in taste perception
Cultural influences and psychological factors
Change in diet and dietary cravings
↓ lower esophageal sphincter tone
Retrograde transport of gastric contents into esophagus
Gastroesophageal reflux
↓ GI motility
Delayed gastric and intestinal emptying
Stool builds up in colon, and hardens as water is resorbed
Pooling of blood within rectal veins àvenous thrombosis
Fragile veins, more easily torn
Rectal bleeding
Change in gut microbiome
Authors: Simonne Horwitz, Yan Yu*
Reviewers: Claire Lothian, Crystal Liu, Ronald Cusano* * MD at time of publication
Sign/Symptom/Lab Finding
Published April 29, 2020 on