The document discusses gastrointestinal complications during pregnancy that are caused by hormonal changes. It outlines that progesterone and estrogen levels rise significantly during pregnancy. This contributes to common symptoms like nausea, vomiting, heartburn, bloating, constipation, and diarrhea. The document provides details on the hormonal causes and treatments of each gastrointestinal issue. It emphasizes that while uncomfortable, these symptoms are normal responses to the hormonal environment of pregnancy. The goal in treatment is to improve quality of life while avoiding risk to the mother and fetus.

1. JOGINPALLYB.R.PHARMACY COLLEGE
Yenkapally(V),Moinabad(M),R.R(Dist)
Presented by
MARTHA SRINIVAS
Assistant Professor
9160322627
HORMONAL COMPLICATIONS OF
GASTRO-INTESTINAL SYSTEM IN
PRE-NATAL PERIODs

2. Contents
 Introduction.
 Pregnancy and Symptoms.
 Pregnancy Developing Stages.
 Hormones responsible for pregnancy.
 Gastrointestinal complications.
 Nausea and vomiting.
 Acid reflux and Heart Burn.
 Abdominal Bloating and Constipation.
 Diarrhoea.
 Other Complications.
 Conclusion.
 References.

3. Introduction
 Pregnancy is supposed to be one of the happiest times of a
woman’s life. In general female life cycle is associated with a
number of hormonal milestones include: menarche, pregnancy,
contraceptive use, menopause, and the use of replacement sex
hormones. Menarche marks the onset of menses and cyclic
changes in hormone levels. Pregnancy is associated with rising non
cyclic levels of sex hormones, and menopause with declining non
cyclic levels.
 The endocrine system of human pregnancy involves hormonal and
metabolic changes that result from physiological alterations at the
boundary between mother and fetus.
 Gastrointestinal symptoms are extremely common during
pregnancy. Increased levels of hormones contribute to symptoms
such as nausea, vomiting, heartburn, acid reflux, abdominal
bloating and constipation.

4.  The correct balance of hormones is essential for a
successful pregnancy. Initially, the ovaries and then
later, the placenta are the main producers of
pregnancy-related hormones that are essential in
creating and maintaining the correct conditions
required for a successful pregnancy.
 Progesterone and estrogen have a great role along with
other hormones like human chorionic gonadotropin
(HCG), human placental lactogen (HPL), prolactin,
corticotrophin-releasing hormone, oxytocin, relaxin,
inhibin, cortisol and aldosterone.
 The goal of treatment is to improve symptoms while
minimizing risks to mother and foetus. Treatment
modalities range from simple dietary modifications to
drug therapy and total parental nutrition.

5. Pregnancy
 Pregnancy is a condition of having a
developing embryo or fetus in the body.
 It usually last around 40 weeks from the
last menstrual period.
 Symptoms of early pregnancy may include
missed periods, tender breasts, nausea,
vomiting, hunger and frequent urination.
 Pregnancy can be confirmed by pregnancy
test.

6. Pregnancy Developing
Stages:

7. Hormones Responsible For
Pregnancy
 The ovaries and then later, the placenta are the main producers
of pregnancy related hormones.
 Progesterone and estrogen have a great role.
 Other hormones……
I. Human chorionic gonadotropin (HCG)
II. Human placental lactogen (HPL)
III. prolactin
IV. Corticotrophin releasing hormone
V. Oxytocin
VI. Relaxin
VII. Inhibin
VIII. Cortisol and aldosterone.

8. Gastrointestinal
complications
GI symptoms are extremely common during pregnancy.
Increased levels of hormones contribute to symptoms such as…..
1.Nausea and Vomiting.
2.Heartburn and Acid reflux.
3.Abdominal bloating and Constipation.
4.Diarrhoea.

9. 1.Nausea and Vomiting
 Nausea is a feeling of sickness with an inclination to
vomit.
 Vomiting is the ejection of stomach content through
the mouth and commonly referred as morning
sickness in pregnancy.
 It is estimated that 70%-80% of pregnant women
experience nausea &vomiting.
 Most of the women will experience nausea &
vomiting during 1st trimester than later stages of
pregnancy.

10. Hormones responsible for
nausea and vomiting
 The main reasons for nausea and vomiting is human chorionic
gonadotropin (HCG),lack of vitamin B6,disturbances in gastric
motility.
 Estrogen and Progesterone.

11. Treatment:
1.Non pharmacological treatment
Ginger
Acupuncture
Dietary
measure
2.Pharmacological treatment
 Pyridoxine
 Doxylamine
 Trimethobenamide
 Phenothiazines
 Metoclopramide
 Domperidone
 Corticosteriods
 Granisetron and Dolasetron

12. 2.Acid reflux and Heart
burn
 Acid reflux and heartburn are the normal consequences in pregnancy with GERD.
 GERD is reported in 80% of pregnancies.
 It is generally seen in 1st trimester and 2nd trimester of pregnancy.

13. Hormones Responsible For
Acid Reflux And Heartburn
Estrogen and Progesterone are the
likely mediators of esophageal dis-
motility in pregnancy wherein
estrogen serves as a primer and
progesterone causes LES relaxation.

14. Treatment
1.Non pharmacological Treatment
 Eating smaller and more
frequent meals.
 Avoid eating near bedtime.
 Elevate the head of the bed.
 Avoid smoking and drinking of
alcohol.
 Trying pharmacologic therapy.
2.Pharmacological Treatment
 Antacids
 Metoclopramide
 Cisapride
 Cimetidine & Ranitidine
 Proton pump inhibitors
(omeprazole, rabeprazole)

15. 3.Constipation
 Constipation is a condition in which
bowel movements are infrequent or
difficult evacuation.
 It has been estimated that
approximately 11%-38% of pregnant
women experience constipation.
 Hormones responsible for constipation :
 Estrogen
 Progesterone.

16. Reasons For Constipation

17. Treatment
1.Nonpharmacological Treatment
Drinking
plenty of
water
Including
plenty of
fiber in diet
Exercise
regularly
Avoid iron
supplements
Laxatives
Cathartics
Purgatives
2.Pharmacological Treatment

18. 4.Diarrhoea
 Diarrhoea is the passage of 3 or more loose or
liquid stools per day ,or more frequently than in
normal.
 It occurs in early and late stages of pregnancy.
 Many women experience diarrhoea or frequent
bowel movements ,often within a few hours of
taking a meal, they occur along with nausea and
vomiting and food carvings.
 Passing watery stools during later pregnancy
weeks may also indicate upcoming labor.


19. Hormones Responsible
For Diarrhoea
 Estrogen and progesterone take place
during this time.
 There is a common misconception that
diarrhoea or constipation during
pregnancy can cause miscarriage but in
truth it is perfectly normal to have this
symptoms.

20. Factors causing diarrhoea
 Changes in diet to provide the foetus with all necessary
nutrients.
 The extra water intake for keeping the body hydrated.
 Food poisoning.
 Stomach flu(caused by bacteria)
 Maternal GI conditions like Inflammatory bowel disease and
Irritable bowel syndrome.
 Ectopic pregnancy is another possible cause of painful
diarrhoea.

21. Treatment
1.Non Pharmacological Treatment
 Home Remedies:
 Drinking plenty of water
 Psyllium husk.
 Consuming blend of
lemon juice, ginger
powder.
 Dietary Measures:
 BRAT diet (Banana, rice,
applesauce,toast).
 Whole wheat toast &
brown rice etc…….
2.Pharmacological Treatment
 Imodium(FDA pregnancy
category B; to be used only
for 24 hours after 12 weeks
of pregnancy).
 Polycarbophil(FDA
pregnancy category C).
 Kaopectate (Kaolin& pectin).
 Parepectolin (not classified
by FDA).

22. Other Complications In
pregnancy
 Mild itching is common in pregnancy because of the increased
blood supply to the skin.
 In late pregnancy the skin of abdomen is stretched and this may
also cause itchiness.
 Itching can however be a sign of more serious problem called
Obstetric cholestasis.
 Wearing loose clothing, avoiding hot water showers and applying
unscented moisturizer may give relief from itching.
Itching:

23. Conclusion
 Increased levels of female sex hormones during prenatal period of
pregnancy cause alterations of gastrointestinal motility, and this
concept explains, why gastrointestinal symptoms such as, nausea,
vomiting, heartburn, diarrhoea and constipation are extremely
more common during pregnancy.
 So the main risk factors of these symptoms need to be excluded in
severe cases and in patients with alarm symptoms.
 On the other hand, avoidance of precipitating factors and dietary
changes are the first line therapeutic steps to be recommended in
patients with mild symptoms.
 If symptoms do not respond adequately, drug therapy is often
warranted to improve quality of life and to prevent complications.

24. Reference
• Silberstein SD. Sex hormones and headache, Revue neurologique, 1999 -
europepmc.org
• Pratap Kumar, Navneet Magon. Hormones in pregnancy, Niger Med J. 2012 Oct-
Dec; 53(4): 179–183.
• Gerard J. Tortora and Bryan Derrickson (2009). Principles of Anatomy and Physiology
(12 ed), 1113 pg. ISBN 978-0-470-08471-7.
• Mehmet Oz, M.D., and Michael Roizen, M.D. Hormone Handbook.
www.fitpregnancy.com/pregnancy/pregnancy-health.
• O’Brien B, Zhou Q. Variables related to nausea and vomiting during pregnancy.
Birth. 1995; 22:93–100. [PubMed: 7779229].
• Schoeneck FJ. Gonadotropin hormone concentrations in hyperemesis gravidarum.
Am J Obstet Gynecol. 1943; 43:308.
• Baron TH (1993) Gastrointestinal motility disorders during pregnancy. Ann Intern
Med 118: 366–375