Pregnancy can be a wonderful time in a woman’s life, filled with expectation and promise as the body blooms before one’s very eyes. Expectant mothers are often pictured with a hand on the enlarged tummy, a head full of glossy hair, and bright, sparkling eyes. But the reality often can be much, much different. Hope and joy aside, pregnancy can be downright hellish, filled with bad hair days and swollen limbs. And that doesn’t even begin to touch the increased risk and intensity of reflux that commonly joins a resurgence of acne and the appearance of stretch made as the overlooked realities of this otherwise blessed time.
Studies regarding the incidence rates during pregnancy find varying rates, ranging from one-quarter of all pregnant women having daily symptoms from the gas go to 72 percent experiencing some level of heartburn severity in the third trimester. What some of the findings seem to have in common is that there is an increase in the number of women who have daily heartburn the further into gestation the pregnancy progresses.
No one is exactly sure why this phenomenon occurs but there are plenty of theories, all of which are plausible. For one, the shifting levels of hormones during pregnancy, particularly progesterone and estrogen, can cause changes in the way the GI tract operates. As an example, progesterone in higher levels in the pregnant body causes the GI tract to relax, not a good thing for the LES. Also, progesterone, paired with the constipating effect of the iron-rich prenatal vitamins prescribed during pregnancy, can lead to decreased bowel motility and an increase in time that food takes to leave the stomach, known factors for a rip-roaring case of acid reflux.
Another possible reason for the increase in heartburn among pregnant women can be found in the logistics of carrying a growing fetus inside the body. As the fetus develops from a tiny, nearly weightless speck to that of a multi-pound, full-sized being, the body must adjust to accommodate sharing the living space, so to speak. In many ways, it is like moving a second person into a one-person studio apartment. Just as you would have to move some furniture around to adjust to the extra resident, the female body has to slightly displace some organs in the normal anatomy to accommodate the fetus. As the fetus grows, it presses the intestines upward, placing greater pressure on the stomach. That force alone can cause the LES to open and stomach contents to reflux into the esophagus. Aside from the constant pressure of the growing fetus, additional, transient jabs can occur when the fetus licks or moves up sharply.
For diagnostic purposes, many doctors prefer to treat the symptoms without subjecting the pregnant patient to the testing they would normally undergo if they were not pregnant. This is in part due to the fact that so many women experience such digestive problems during pregnancy but also because some of the tests, especially those involving the radiation of Xrays or the sedation of the patient, could have negative effects on the fetus. If endoscopy is necessary due to such factors as bleeding or weight loss, some doctors prefer to delay it until after the first trimester, using conscious sedation that is safe for pregnant women.