Introduction

In this chapter, the gastrointestinal and hepatic disorders are considered in two groups:

• Common gastrointestinal and liver conditions that are specific to pregnancy:

• Gastrointestinal disorders

• Liver disorders

• Common preexisting disorders which require a proactive diagnostic or therapeutic approach. A careful consideration of the effects of maintenance drugs on the outcome of their children is justified in these patients, and this should include adequate prepregnancy counseling.

• Gastrointestinal disorders

• Liver disorders

Pregnancy-Acquired Gastrointestinal Disorders

Nausea and Vomiting; Hyperemesis Gravidarum

Nausea is one of the most common gastrointestinal symptoms during pregnancy, affecting 50–90% of pregnant women. Independent risk factors for developing nausea during pregnancy include obesity, young maternal age, first pregnancy, and smoking. The pathophysiology of nausea during pregnancy includes alterations in gastric motility, taste, smell, and vestibular function, but psychological factors may also be involved.1 Symptoms of nausea and vomiting typically arise during the first trimester. The severity can vary, with hyperemesis gravidarum (HG) being the most extreme manifestation. HG occurs in approximately 0.1% of pregnancies. Around 15% of women who experience nausea and vomiting will suffer from symptoms after the first trimester, or even for the entire duration of their pregnancy.

Diagnosis

HG is a diagnosis of exclusion. If nausea and vomiting persists into the second or third trimester, a search for other causes such as peptic ulceration, systemic infection, pancreatitis, and Addison's disease should be performed. An extensive list of diseases that are associated with nausea and vomiting during pregnancy is provided in Table 43.1. HG reccurs in 15–20% of women with a history of HG, compared to 0.7% in women without a history of HG.