Clinics in Mother and Child Health

Clinical Approaches to Pregnancy in Women with Chronic Bowel Disorders

Daniel Wilson^* Department of Virology, University of Birmingham, Birmingham, United Kingdom
^*Correspondence: Daniel Wilson, Department of Virology, University of Birmingham, Birmingham, United Kingdom, Email:

Received: 01-Jul-2024, Manuscript No. CMCH-24-26491; Editor assigned: 04-Jul-2024, Pre QC No. CMCH-24-26491 (PQ); Reviewed: 18-Jul-2024, QC No. CMCH-24-26491; Revised: 25-Jul-2024, Manuscript No. CMCH-24-26491 (R); Published: 01-Aug-2024, DOI: 10.35248/2090-7214.24.21.489

About the Study

Pregnancy and childbirth represent significant physiological events that can profoundly influence pre-existing bowel conditions. Conditions such as Inflammatory Bowel Disease (IBD), Irritable Bowel Syndrome (IBS), and other chronic gastrointestinal disorders present unique challenges during pregnancy [1]. Understanding the interaction between pregnancy and these conditions are essential for optimizing maternal and fetal health outcomes.

Impact on Inflammatory Bowel Disease (IBD)

Inflammatory bowel disease, which includes Crohn's disease and ulcerative colitis, is characterized by chronic inflammation of the gastrointestinal tract. Pregnancy can have varying effects on IBD, and the course of the disease during this period can be unpredictable. Generally, if IBD is in remission at the time of conception, it is more likely to remain stable throughout pregnancy [2-3]. Conversely, active disease at conception may continue to flare.

Managing IBD during pregnancy

The management of IBD during pregnancy requires a delicate balance to control disease activity while minimizing potential risks to the fetus. Medications used to treat IBD, such as amino salicylates, corticosteroids, and certain immune modulators, are generally considered safe during pregnancy. However, biologic therapies, such as anti-TNF agents, require careful consideration. Recent studies suggest that these medications can be continued during pregnancy, as the risk of uncontrolled disease often outweighs the potential risks of the medications [4].

Regular monitoring and collaboration between gastroenterologists and obstetricians are essential. Pregnant women with IBD should have frequent assessments to monitor disease activity and adjust treatment plans as needed [5]. Additionally, nutritional support is critical, as malnutrition and vitamin deficiencies can adversely affect both maternal and fetal outcomes.

Impact on Irritable Bowel Syndrome (IBS)

Irritable bowel syndrome is a functional gastrointestinal disorder characterized by abdominal pain and altered bowel habits. The relationship between pregnancy and IBS is complex, with some women experiencing relief from symptoms, while others may see a worsening of their condition [6].

Managing IBS during pregnancy

Management of IBS during pregnancy focuses on dietary and lifestyle modifications to control symptoms. High-fiber diets, adequate hydration, and regular physical activity are beneficial. Pharmacologic treatments are more limited due to potential risks to the fetus, so non-pharmacological approaches are preferred [7]. Stress management techniques, such as mindfulness and cognitive-behavioral therapy, can also be effective in managing IBS symptoms during pregnancy.

Impact on other chronic gastrointestinal disorders

Other chronic gastrointestinal disorders, such as celiac disease and chronic constipation, can also be affected by pregnancy. Celiac disease, an autoimmune disorder triggered by gluten, requires strict dietary management. Pregnant women with celiac disease must adhere to a gluten-free diet to avoid complications such as miscarriage, preterm birth, and low birth weight. Regular follow-up with a dietitian and healthcare provider is essential to ensure nutritional adequacy [8].

Chronic constipation is common during pregnancy due to hormonal changes and the physical pressure of the growing uterus on the intestines. Management includes dietary adjustments, increased fluid intake, and regular physical activity. In some cases, laxatives may be used, but their use should be discussed with a healthcare provider to ensure safety.

Childbirth considerations

Childbirth itself can pose specific challenges for women with pre-existing bowel conditions. The mode of delivery may be influenced by the severity and location of gastrointestinal disease. For women with IBD, particularly those with perianal disease or a history of colorectal surgery, a cesarean section may be recommended to avoid complications such as perianal tears or fistula formation [9].

Postpartum care is essential for women with pre-existing bowel conditions. The immediate postpartum period can set off flares in IBD due to hormonal fluctuations and the physical stress of childbirth. Close monitoring and appropriate management of symptoms are necessary to prevent severe complications [10]. Breastfeeding is generally encouraged, as it provides numerous benefits for both mother and baby, but it should be done in consultation with healthcare providers to ensure it is safe with the medications being used.

Psychological impact

The psychological impact of managing a chronic bowel condition during pregnancy and postpartum cannot be overlooked. Anxiety and depression are common among individuals with chronic illnesses, and these conditions can be exacerbated by the added stress of pregnancy and new parenthood. Psychological support, including counseling and support groups, can be invaluable for these women.

Conclusion

Pregnancy and childbirth have significant implications for women with pre-existing bowel conditions. Effective management requires a comprehensive, multidisciplinary approach involving obstetricians, gastroenterologists, dietitians, and mental health professionals. With careful planning and regular monitoring, most women with chronic gastrointestinal disorders can experience healthy pregnancies and positive childbirth outcomes. Educating patients about the potential impacts of pregnancy on their condition and providing ongoing support are key components to ensuring both maternal and fetal well-being.

References

1. T Hirota, King BH. Autism spectrum disorder. JAMA. 2023;329(2023):157-168.

   [Crossref] [Google Scholar] [PubMed]

2. Ji Y, Azuine RE, Zhang Y, Hou W, Hong X, Wang G, et al. Association of cord plasma biomarkers of in utero acetaminophen exposure with risk of attention-deficit/hyperactivity disorder and autism spectrum disorder in childhood. JAMA Psychiatry. 2020;77(2):180-189.

   [Crossref] [Google Scholar] [PubMed]

3. Cooper M, Langley K, Thapar A. Antenatal acetaminophen use and attention-deficit/hyperactivity disorder: An interesting observed association but too early to infer causality. JAMA Pediatr. 2014;168(4):306-317.

   [Crossref] [Google Scholar] [PubMed]

4. US Food and Drug Administration. FDA Drug Safety Communication: FDA has reviewed possible risks of pain medicine use during pregnancy. FDA official site. 2015.
5. Bauer AZ, Swan SH, Kriebel D, Liew Z, Taylor HS, Bornehag CG, et al. Paracetamol use during pregnancy-A call for precautionary action. Nat Rev Endocrinol. 2021;17(12):757-766.

   [Crossref] [Google Scholar] [PubMed]

6. Addo KA, Palakodety N, Fry RC. Acetaminophen modulates the expression of steroidogenesis-associated genes and estradiol levels in human placental JEG-3 cells. Toxicol Sci. 2021;179(1):44-52.

   [Crossref] [Google Scholar] [PubMed]

7. McCarthy MM. Estradiol and the developing brain. Physiol Rev. 2008;88(1):91-134.

   [Crossref] [Google Scholar] [PubMed]

8. Xie L, Qin J, Wang T, Zhang S, Luo M, Cheng X, et al. Impact of prenatal acetaminophen exposure for hippocampal development disorder on mice. Mol Neurobiol. 2023;60(12):6916-6930.

   [Crossref] [Google Scholar] [PubMed]

9. Posadas I, Santos P, Blanco A, Munoz-Fernandez M, Cena V. Acetaminophen induces apoptosis in rat cortical neurons. PloS One. 2010;5(12):e15360.

   [Crossref] [Google Scholar] [PubMed]

10. Anand NS, Raghavan R, Wang G, Hong X, Azuine RE, Pearson C, et al. Perinatal acetaminophen exposure and childhood Attention-Deficit/Hyperactivity Disorder (ADHD): Exploring the role of umbilical cord plasma metabolites in oxidative stress pathways. Brain Sci. 2021;11(10):1302.

    [Crossref] [Google Scholar] [PubMed]