- Pregnancy can exacerbate many chronic gastrointestinal disorders; the central goal of evaluation is to control symptoms and rule out an urgent need for surgery while minimizing exposure to excessive tests and medications.
- Inflammatory bowel disease (IBD) patients should be in remission while trying to conceive, and most IBD medications are safe in pregnancy.
- Appendicitis is the most common indication for surgery during pregnancy.
- Indications for urgent surgery are the same in pregnant as in nonpregnant patients.
- Incidence of gallstone-related disease is increased in pregnancy.
- Efforts should be made to minimize risk to mother and fetus when performing diagnostic endoscopic and radiologic tests.
The management of gastrointestinal disease during pregnancy poses multiple challenges. First, gastrointestinal diseases are common during pregnancy, and many predisposing gastrointestinal disorders are aggravated by pregnancy. Second, diagnostic options are often limited in pregnancy as there is a need to minimize testing out of concern for both maternal and fetal exposure. Finally, the management of these diseases is more complex due to the need to consider additional risks to both the pregnant mother and the fetus incurred by medications, endoscopic procedures, and surgeries. Data on safety and efficacy of both medications and procedures during pregnancy are often scarce or inadequate; few controlled trials have included pregnant women, and fewer still were designed specifically to study gastrointestinal disease in this population. Table 7–1 summarizes the U.S. Food and Drug Administration (FDA) categories for medication use in pregnancy.
Table 7–1. FDA Categories for the Use of Medications in Pregnancy. |Favorite Table|Download (.pdf)
Table 7–1. FDA Categories for the Use of Medications in Pregnancy.
|FDA Pregnancy Category||Interpretation|
|A||Controlled studies in animals and women have shown no risk in the first trimester, and possible fetal harm is remote|
|B||Either animal studies have not demonstrated a fetal risk but there are no controlled studies in pregnant women, or animal studies have shown an adverse effect that was not confirmed in controlled studies in women in the first trimester|
|C||No controlled studies in humans have been performed, and animal studies have shown adverse events, or studies in humans and animals are not available; give if potential benefit outweighs the risk|
|D||Positive evidence of fetal risk is available, but the benefits may outweigh the risk if life-threatening or serious disease|
|X||Studies in animals or humans show fetal abnormalities; drug contraindicated|
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Cohen-Kerem R, Railton C, Oren D, et al. Pregnancy outcome following non-obstetric surgical intervention. Am J Surg.
Malangoni MA. Gastrointestinal surgery and pregnancy. Gastroenterol Clin North Am. 2003;32:181–200. ...