ACG offers updated clinical guidance for managing pregnant patients

Dec 10 2007

Physician experts from the American College of Gastroenterology have released an updated educational monograph highlighting the unique clinical challenges of caring for women with chronic digestive disorders during pregnancy and managing GI complications relating to pregnancy.

“Given the large number of pregnancies each year complicated by GI disorders, gastroenterologists need to be aware of the underlying physiologic changes in GI motility during pregnancy and provide appropriate therapy for pregnant patients with special consideration being given to the safety of the mother and fetus,” according to ACG President Amy E. Foxx-Orenstein, DO, FACG.

This seven-chapter monograph entitled, “Pregnancy in Gastrointestinal Disorders,” provides up-to-date clinical recommendations on managing common gastrointestinal disorders and challenges during pregnancy:

• Constipation
• Diarrhea
• Hemorrhoids
• Heartburn
• Nausea
• Vomiting
• Hyperemesis gravidarum
• Liver diseases in pregnancy
• General guidelines for sedation and surgery
• Endoscopy in pregnancy
• Managing inflammatory bowel disease during pregnancy

The monograph explores the physiologic changes during pregnancy that may contribute to GI disorders in pregnant patients. Various studies attribute increased levels of female sex hormones, particularly progesterone, with changes in GI motility in pregnancy. Another highlighted study found elevated levels of progesterone accompanied by increased intra-abdominal pressures from the enlarging uterus, may lower esophageal sphincter (LES) pressure contributing to heartburn symptoms, one of the most commonly reported complaints of pregnant women.

Another important focus of the monograph addresses the challenges encountered in the treatment and management of chronic digestive disorders in pregnancy. It includes a discussion of pharmacologic and alternative therapies available to treat GI symptoms in pregnancy and, importantly, identifies which medications are safe for use in pregnant women and those which should be avoided.

“The major risk to the fetus is encountered during the first trimester of pregnancy,” says Dr. Foxx-Orenstein. “It is important for physicians and expectant mothers to maintain a high level of concern for the use of prescription and over-the-counter drugs to treat GI symptoms during pregnancy.”

The authors of the monograph also evaluated the safety of endoscopy during pregnancy. Based on a review of published scientific studies, they conclude endoscopy appears to be a safe modality for evaluating GI symptoms in pregnancy.

A full text of the research and findings highlighted in the monograph can be found on the ACG website at http://www.acg.gi.org/physicians/pdfs/PregnancyMonograph.pdf

About the American College of Gastroenterology

Founded in 1932, the American College of Gastroenterology (ACG) is an organization with an international membership of more than 10,000 individuals from 80 countries. The College is committed to serving the clinically oriented digestive disease specialist through its emphasis on scholarly practice, teaching and research. The mission of the College is to serve the evolving needs of physicians in the delivery of high quality, scientifically sound, humanistic, ethical, and cost-effective health care to gastroenterology patients.

The ACG is committed to providing accurate, unbiased and up-to-date health information. Visit the ACG Web site www.acg.gi.org to access educational resources for patients and their families spanning the broad range of digestive diseases and conditions - both common and not-so-common. Organized by disease, state and organ system, these educational materials, developed by ACG physician experts, are offered for the information and benefit of patients and the public.