No one really tells you what to expect during pregnancy. Symptoms sneak up on you and you start wondering if you’re supposed to feel this way or not. And as far as the gut is concerned, it goes through a ton of changes during pregnancy- especially in the motility and how it moves food and poop along. Let’s break down what to expect and why… and how to handle it. *Most importantly ALWAYS consult your doctor about any new symptoms and DO NOT take anything without their blessing*
1. Reflux (“GERD” or heartburn)
Up to 85% of women during pregnancy
Why? Decreased lower esophageal sphincter pressure due to hormones
Treatment (stepwise)
Lifestyle/nutrition: elevate the head end of the bed, don’t eat 2-3 hours before going to sleep (especially fatty meals), avoid dietary triggers (keep a food diary!), diaphragmatic breathing (find details on my site under conditions —> GERD)
Antacids (avoid sodium bicarbonate & and magnesium triplicate) ex. TUMS
Sucralfate (Carafate) 1 g orally three times daily
Histamine 2 receptor antagonists (H2RAs)- Ranitidine or Cimetidine have the most evidence
2. Nausea and vomiting
Up to 80% of women during pregnancy report nausea and 50% report vomiting
Why? Many reasons:
Hormonal changes: Increased estrogen and progesterone relax smooth muscle, slow gastrointestinal transit time and may alter gastric emptying. Increased hCG may play a role
Abnormal gastric motility
Helicobacter pylori infection
Genetic factors
Nutrient deficiencies (zinc, vitamin b6)
What to do?
Eat as soon as you feel hungry to avoid an empty stomach, which can worsen nausea. Snack often!
Eat slowly and in small amounts every 1-2 hours to avoid over filling your stomach
Avoid foods high in sugar
Keep a food diary- some trigger foods include coffee or foods that are spicy, smelly, high fat, acidic or sweet
Focus on protein-rich meals and snacks
Peppermint tea
Drink fluids at least 30 minutes before or after food to avoid a full stomach- best if cold, clear, carbonated or sour (ex. ginger ale, lemonade, popsicles) and small amounts, try using a straw
Avoid environmental triggers: perfume, smoke, humidity… keep a trigger/symptom diary!
Take prenatal vitamins before bed with a snack instead of the morning on an empty stomach
Ginger! Ginger significantly improved the symptoms of nausea when compared to placebo (MD 1.20, 95% CI 0.56-1.84, p = 0.0002, I² = 0%), Best is to buy fresh finger and make your own tea, add to foods, sauces, drinks
Acupuncture and acupressure: p6 wristbands
Hypnosis
3. Bloating & Constipation
Up to 39% of pregnant women report constipation
Why? Hormonal changes affect small bowel and colon motility. Increased progesterone decreases the activity of colon movement. Motilin also decreases during pregnancy which usually stimulates the gut to move. In addition, the gravid uterus with baby can press against the small bowel and decrease movement. Other factors may also play a role like iron supplements and bed-rest.
What to do
Increase dietary fiber
Increase fluids, at least 3 liters of water a day
Try fiber supplementation, ex. Benefiber
Avoid carbonated beverages, fake sugars, processed food, dairy
Consider Feriva if you need a non-constipating iron supplement
4. Hemorrhoids
Up to 40% of pregnant women are affected by hemorrhoids
Why? Hemorrhoids are veins in the anal canal that grow with increased venous pressure in pregnancy and constipation/diarrhea, which causes itching, pain and bleeding.
What to do?
Avoid constipation! See above
Hydrate, hydrate, hydrate. At LEAST 3 liters of water a day
Increase dietary fiber
Try Calmol-4 suppositories. Made of just zinc oxide & cocoa butter- SO soothing. Also great for anal fissures.
And don’t forget to enrich your microbiome before your baby arrives!
This is a critical development window! Massive bacterial colonization of the newborn gut occurs during labor and vaginal delivery when the baby is exposed to the maternal vagina, feces and skin microbiota. This exposure ultimately plays an important role in the predisposition of your child to chronic inflammation! So make sure to nourish and diversify your gut microbiome during pregnancy and even before- to ensure your child gets the building blocks for a strong microbiome!
Come see me in the office and we’ll optimize your gut health and microbiome during your pregnancy!