Management of gastrointestinal and liver diseases during pregnancy

Woude, C. Janneke van der; Metselaar, Herold J.; Danese, Silvio

doi:10.1136/gutjnl-2013-305418

Cited by 42 publications

(35 citation statements)

References 129 publications

(115 reference statements)

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“…Other factors involved in pregnancy constipation are decreased colon motility, oral iron supplements, poor fl uid intake as a consequence of nausea, and pressure on the rectosigmoid colon by the gravid uterus in the third trimester, as well as functional bowel disorders [ 41 ]. Management usually involves reassurance and advice about increasing fl uid and fi ber intake, while laxatives are rarely required [ 17 ]. Moreover, dietary supplements of fi bers, as bran or wheat fi ber, are likely to help pregnant women experiencing constipation [ 37 ].…”

Section: Constipationmentioning

confidence: 99%

“…The clinical features of pregnancy-associated GERD do not differ from those seen in the general population, with predominant symptoms being heartburn and regurgitation, that aggravate following meals and when lying in a supine position. For women already diagnosed with GERD prior to pregnancy, symptoms often worsen as pregnancy progresses [ 17 ]. There are a number of functional and structural alterations that occur at the gastroesophageal junction during pregnancy that may at least explain the high prevalence of refl ux symptoms in this population.…”

Section: Gastroesophageal Refluxmentioning

confidence: 99%

“…The infection is acquired through eating foods contaminated with the organism, and appropriate dietary advice should be given to all pregnant women about the avoidance of foods such as pâtés and soft and blue-veined cheese [ 19 ]. Pregnancy has little effect on symptoms associated with infl ammatory bowel disease [ 17 ], but, similar to other chronic infl ammatory conditions, most guidelines advise optimizing lifestyle during pregnancy, such as dietary changes. Eat a variety of whole grains (like whole-wheat bread, whole-grain pasta, and brown rice).…”

Section: Diarrheamentioning

confidence: 99%

“…Weight loss or electrolyte imbalance due to nausea and vomiting represents also the fi rst cause of hospitalization in the fi rst half of pregnancy [ 15 , 16 ]. Risk factors include young age, obesity, fi rst pregnancy, smoking [ 17 ], and vitamin B6 defi ciency [ 18 ]. Adequate tests to rule out possible vitamin deficiencies are encouraged in the case of clinical suspicion.…”

Section: Nausea and Vomitingmentioning

confidence: 99%

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Gastrointestinal Symptoms and Nutritional Profile During Pregnancy

Selmi

Santis

Laghi

et al. 2015

Metabolic Syndrome and Complications of Pregnancy

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Section: Constipationmentioning

confidence: 99%

Section: Gastroesophageal Refluxmentioning

confidence: 99%

Section: Diarrheamentioning

confidence: 99%

Section: Nausea and Vomitingmentioning

confidence: 99%

See 2 more Smart Citations

Gastrointestinal Symptoms and Nutritional Profile During Pregnancy

Selmi

Santis

Laghi

et al. 2015

Metabolic Syndrome and Complications of Pregnancy

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“…In the pharmacologic treatment of diarrhea, which is more rarely seen than the other GIS diseases during pregnancy, the use of loperamide as a motility reducing agent, erythromycin, and ampicillin active ingredient if infection accompanies, should be evaluated by the physician. Although irritable bowel syndrome is rarely encountered during pregnancy, antispasm medications, tricyclic antidepressants, and selective serotonin reuptake inhibitors may be used for severe symptoms (44,46). In a study conducted, increased absorption of calcium and magnesium was reported due to the use of lactulose (47).…”

Section: Gastrointestinal System Drugsmentioning

confidence: 99%

Physiological and Pharmacokinetic Alterations and Drug-Nutrient Interactions During Pregnancy

Ede¹,

Ünal²

2017

Istanbul Med J

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During pregnancy, a large part of the body is affected by the physiological and anatomical changes that start in early pregnancy. Many of these changes significantly affect the pharmacokinetic (absorption, distribution, metabolism, and excretion) and pharmacodynamic properties of different drugs (1-3). During treatment, the use of medicines with the content of only some active ingredients is important to ensure maternal and fetal safety during pregnancy (4-6).Drug-nutritional element interactions are defined as the physicochemical, physiological, and pathophysiological relationships between a drug and nutritional element or between a drug and multiple nutritional elements, nutrients, and constituents or the nutritional status in a broader sense (6-8). Drug-nutritional element interactions can occur in four steps: extracellular bioinactivation, decrease/increase in absorption, decrease/increase in efficacy, and decrease/ increase in excretion (elimination) (7). Therefore, the fact that health professionals consider the physiological changes and the factors affecting the distribution of the drug in the body during pregnancy is important to ensure the effectiveness of pharmacotherapy. In this review article, we aimed to investigate the effects of physiological changes during pregnancy on the pharmacokinetic properties of the drug and the interactions of drugs, nutrients, and nutritional elements. Physiological Changes and Drug Metabolism in PregnancyPregnancy is a process in which many physiological differentiations occur in the cardiovascular, respiratory, excretory, gastrointestinal, and circulatory systems, which alter the interactions of nutrition, nutritional element, and drug metabolism. In summary, the rate and volume of the heart increase, lung capacity decreases, glomerular filtration rate (GFR) increases, blood volume increases, blood circulation decreases, and gastrointestinal system (GIS) motility decreases; in addition, changes, such as nausea and vomiting, occur affecting nutrition. The physiological changes associated with pregnancy are summarized in Table 1. During pregnancy, the interactions between drug metabolism and nutrition and nutritional element may be pharmaceutical, pharmacokinetic, and pharmacodynamic. The pharmaceutical interactions occur within the delivery medium, such as enteral tube or gastrointestinal lumen. This can affect the bioavailability of the drug or nutritional element (8). The pharmacokinetic interactions include the processes of absorption, distribution, metabolism, and excretion of the drug or nutritional element. The pharmacodynamic interactions include physiological changes Physiological and Pharmacokinetic Alterations and DrugNutrient Interactions During PregnancyDuring pregnancy, many physiological and metabolic alterations occur to support the requirements of the developing fetus. Alterations associated with the respiratory, cardiovascular, hematological, urinary, and gastrointestinal systems (GIS) may result in pregnancy-related disorders and may change the pharmac...

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Twelve‐week peptide‐based formula therapy may be effective in inducing remission of active Crohn disease among women who are pregnant or preparing for pregnancy

et al. 2021

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Background: Conventional treatment for Crohn disease (CD) in pregnancy includes mesalamine, thiopurine, and anti-tumor necrosis factor (TNF)-α agents. However, women may abstain because of complications, nonresponse, or potential adverse outcomes. Peptide-based formula therapy, through oral or nasogastric feeding without other food intake, is an effective and safe therapy for active CD. Herein, We confirmed the effectiveness and safety of peptide-based formula therapy for active CD in pregnant women or those preparing for pregnancy.Method: Outcomes of peptide-based formula therapy to induce CD remission during pregnancy preparation and the conception period were evaluated retrospectively among 14 women. Efficacy was evaluated as the change in serum indices and inflammatory markers after 12-week treatment. Pregnancy outcomes were compared between 14 women treated with nutrition therapy and eight women using conventional CD drugs.Results: After 12 weeks, 85.7% (12 of 14) of patients treated with peptide-based formula achieved remission with a significant decrease in the CD activity index (P < .001) and high-sensitivity C-reactive protein level (P = .004). There were no effects of peptide-based formula therapy on pregnancy outcomes compared with conventional CD treatment (P > .05). Among the 12 patients who achieved CD remission with exclusive peptide-based formula therapy, 10 selected to continue total or partial peptide-based formula treatment to maintain CD remission throughout pregnancy. Conclusion:Peptide-based formula therapy, without other food intake, may provide a safe and effective alternative to conventional CD drugs to induce disease remission among women during conception and pregnancy.

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Management of gastrointestinal and liver diseases during pregnancy

Cited by 42 publications

References 129 publications

Gastrointestinal Symptoms and Nutritional Profile During Pregnancy

Gastrointestinal Symptoms and Nutritional Profile During Pregnancy

Physiological and Pharmacokinetic Alterations and Drug-Nutrient Interactions During Pregnancy

Twelve‐week peptide‐based formula therapy may be effective in inducing remission of active Crohn disease among women who are pregnant or preparing for pregnancy

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