Nine months of what?

Many women suffer from gastrointestinal problems like heartburn, nausea and constipation throughout their pregnancies. The good news is the suffering doesn’t have to last nine months. As the weeks go by and your stomach expands, your uterus isn’t the only organ making room for a baby. To accommodate an average 7.6-pound baby invading its territory, the digestive organs shift and adjust in their otherwise smoothly functioning sanctuary. In addition, multiple hormonal changes occur that alter gastrointestinal (GI) tract motility, or muscle contraction, causing nausea, vomiting, constipation and heartburn. There are even some rare liver complications of pregnancy of unknown cause. Whether you suffer from the occasional episode of nausea or from a more serious GI problem related to pregnancy, the experience can hamper your ability to enjoy what is supposed to be one of the most exciting times in your life – carrying a child. Armed with information, you can make those precious nine months a little easier and a lot safer for both you and your baby.

Nausea And Vomiting Of Pregnancy

When you started planning a family, morning sickness wasn’t something you thought would affect your life. A patient at 28 has not been easy to handle. Pregnant with her first child, she developed such a severe form of nausea and vomiting during pregnancy (NVP) that she had to take a two-month leave of absence from work. Approximately 70 percent of women experience NVP at some point during their pregnancies, according to American Family Physician. First accounts of NVP date back 4,000 years, but the quest to find the cause has not turned up many answers. Years ago, doctors blamed severe cases on psychological problems. Thankfully, that belief has been discarded in favor of clinically studied causes like abnormal stomach muscle contraction or bacterial infection of the stomach. During pregnancy, the sex hormones progesterone and estrogen rise, contributing to a delay in digestion processes.

The delay may cause NVP, according to a 1996 study published in the American Journal of Physiology. The study demonstrated that non-pregnant women who took progesterone often responded with nausea and vomiting. Another culprit may be bacteria called Helicobacter (H. pylori), which nest in the stomach lining. More than 61 percent of women with a serious form of NVP tested positive with the H. pylori genome, compared with less than 30 percent who tested negative in a 2000 study published in the American Journal of Perinatology. To make matters worse, excess saliva, also called ptyalism, may arise as a result of NVP. Ptyalism became so troublesome that she carried a foam cup with her everywhere to collect her saliva. Then one evening after picking up relatives at the airport, she dropped her saliva-filled cup on their hotel bed. In addition to being constantly sick, she was really, embarrassed.

Tips for relief: For most women, NVP begins to recede after the first trimester, but the 12 weeks pass slowly when suffering with such an exhausting condition. The standard treatment is vitamin B6, but ginger is also safe and effective, according to 2004 endorsement from the American College of Obstetricians and Gynecologists. Just one daily gram of ginger in tea or tablet form has proven as effective as high doses of vitamin B6. Currently, no medications are FDA-approved to treat NVP, but your obstetrician may recommend anti-nausea medication such as ondansetron (Zotran) for more severe cases. Adjusting your eating habits may provide some relief, according to a 2003 article published in American Family Physician. Try eating small meals, avoid smells of food textures that trigger nausea. Choose bland tasting solid foods with extra carbohydrates and reduced fat. Eat salty foods in the morning, and drink sour or tart liquids instead of water. Every body is different, so you may have to learn symptom relief through good old-fashioned trial and error.

When to call your doctor: While most women gain weight during the first trimester, they knew that their NVP had become serious when they lost 15 pounds over the course of a few weeks. They had developed a serious form of NVP known as hyperemesis gravidarum. On the day they had admitted to the hospital, they vomited 14 times and remained hospitalized for three days.

Cases like this affect about 5 percent of women. Women should be concerned if they are having a hard time gaining weight. Weight loss is a red flag. You should also call your doctor if you begin experiencing NVP after nine weeks of gestation – to help rule out other possible causes including gallbladder, liver and kidney disorders.

Constipation And Hemorrhoids

Some women manage to avoid NVP only to spend the same amount of time in the bathroom dealing with constipation and painful hemorrhoids. Again, progesterone plays a role in this digestive malady. The hormone relaxes the wall of the bowel, which inhibits its ability to move waste out. Other instigators include calcium-based antacids and the iron in prenatal vitamins. Finally, the physical growth of the uterus pressing against the bowel can slow the passage of waste. Approximately 50 percent of pregnant women will also develop hemorrhoids, which are varicose veins in the rectum that can become itchy, red and swollen. This is likely due to compression of pelvic veins by the enlarging uterus and by the common symptoms of constipation.

When to call your doctor: If your constipation becomes severe and is accompanied by abdominal pain, or if your hemorrhoids become too painful, call your doctor for treatment.

Heartburn And Reflux

Nope, all that heartburn is not a sign that your baby is going to have a lot of hair. It is a sign; however, that progesterone and estrogen have succeeded in relaxing yet another muscle in the GI tract – the lower esophageal sphincter (LES). The LES is the gate that opens to allow food to pass from the esophagus to the stomach; it also keeps the food from coming back up once it enters the stomach. During pregnancy, the LES may relax, making women vulnerable to reflux of food or acid back into the esophagus. The increased intra-abdominal pressure from the large uterus may also be a contributing cause. If you’ve experienced heartburn in the past, that painful burning behind the breastbone is all too familiar, but many women experience heartburn for the first time during pregnancy. Other symptoms include regurgitation of fluid or solid food from the stomach into the throat or mouth, especially when bending over. An acidic or bitter taste in the mouth, or even laryngitis, asthma or a chronic cough may all point to heartburn.

Tips for relief: First, try making a few lifestyle and dietary modification. In their book, Healing Heartburn, suggest the following: eat a light evening meal; wait at least three or four hours between the end of dinner and going to bed; avoid nighttime snacks; and avoid fatty and greasy foods. Of course, avoid alcohol and smoking. You may try elevating the head of your bed by about six inches with blocks or bricks to help position the esophagus above the stomach, which makes it much harder for acidic gastric secretions to reflux while you sleep. Antacids are next in line. The best types of antacids to use during pregnancy contain alginic acid, but always consult your doctor before trying any treatments. Beware of antacids containing sodium bicarbonate (baking soda) or magnesium. The former can cause excess fluid retention, and the latter can offset labor in some individuals. An antacid and aluminum salt might work well, but may also intensify constipation. When to call your doctor: When your heartburn is keeping you up at night, or if you are having difficulty swallowing, your doctor may be able to recommend an over-the-counter or prescription H2 blocker or proton pump inhibitor (PPI) that is safe to use during pregnancy.

Liver Problems

Rarely, otherwise healthy pregnant women can develop serious liver problems caused directly by pregnancy. You should be aware of three rare liver disorders that often striken unexpectedly: intrahepatic cholestasis of pregnancy, HELLP syndrome and Acute Fatty Liver of Pregnancy (AFLP). Intrahepatic cholestatis occurs in less than 1 percent of pregnancies when the hormone estrogen impairs the liver’s ability to process certain chemicals, according to the American Liver Foundation. Symptoms include a yellow (jaundiced) color in the skin or eyes, pain in the upper right abdomen, nausea and vomiting. In severe cases, risk increases for premature delivery, early fetal death or stillbirths. Most often, the mother and baby suffer no lasting effects HELLP syndrome (Hemolysis, Elevated Liver tests and Low Platelets in the blood) most often begins in the last trimester of pregnancy, according to the American Academy of Family Physicians. The cause of this syndrome is unknown, but its effects can be fatal to both mother and baby. Watch out for symptoms similar to those found in intrahepatic cholestasis patients, along with swelling of the face and hands. The condition recedes only after delivery of the baby.

Acute Fatty Liver of Pregnancy (AFLP) is rare, but serious. The condition occurs in one in 13,000 pregnancies and has an 18 percent incidence of maternal fatality and a 23 percent incidence of fetal fatality, according to the American Academy of Family Physicians. In addition to symptoms found in cholestasis and HELLP syndrome, patients with AFLP may experience confusion or general discomfort. Delivery of the baby is necessary as soon as possible, and the AFLP improves soon after.

Tips for relief: Don’t hassle with self-induced treatments. Improve your chances of a positive outcome by seeking regular prenatal care and watching for warning symptoms of these serious conditions.

When to call your doctor: If you ever turn yellow or your eyes turn yellow, call a doctor. If you experience severe itching all over, of if you have severe pain in the upper right part of your abdomen, consult with a doctor right away. If you feel fatigued and generally lousy, consult a physician.

Here’s To An Easier Nine Months

In an effort to accommodate a healthy pregnancy, your digestive system may sometimes seem like it’s letting you down. Fortunately, GI problems during pregnancy tend to resolve after birth, but until you reach the end of your nine months, take steps toward better GI functioning. Treating the problem sooner rather than later may allow you to more fully enjoy your pregnancy.