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ABSTRACT - Gastrointestinal (GI) conditions are common in women of childbearing age. They often present before pregnancy but can arise de novo during pregnancy. The physiological changes that occur during pregnancy can influence the differential diagnosis of common GI presentations, affect the interpretation of diagnostic tests and restrict the use of diagnostic or therapeutic procedures. In this article, we summarise the clinical features, investigation and management of common GI and liver conditions that are incidental to pregnancy, and describe the specific features of pregnancy-related disorders that are less frequently encountered by general physicians. Newer developments in areas that are increasingly encountered in obstetric medical practice, including pregnancy after bariatric procedures, are also described.
KEY WORDS: Pregnancy, liver disease, HELLP syndrome, hypertensive disorders of pregnancy, obstetric cholestasis, hyperemesis gravidarum
Introduction
There are many gastrointestinal (GI) and liver conditions in the non-pregnant population that take a benign course and are unaffected when an individual becomes pregnant. Others can occur during pregnancy for the first time, but the pregnant state does not alter the time course of the condition or the management options. However, there are some disorders that, for reasons that are still unclear, can have a relatively benign course outside pregnancy but become life threatening during pregnancy, such as hepatitis E. There are several pregnancy-specific conditions that are described in this article that can be challenging not only for the general physician who only infrequently encounters this in day-today practice, but also for the obstetrician who rarely encounters the non-pregnancy-related medical conditions that can have similar presenting features to gestational disorders.
Gastrointestinal conditions
Diseases incidental to pregnancy
GI diseases that are incidental to pregnancy and the pregnancyspecific considerations relevant to these conditions are summarised in Table 1. The reader is referred to more detailed texts for more comprehensive descriptions of these disorders.1,2
Pregnancy-specific conditions
Hyperemesis gravidarum. Although transient nausea and vomiting affect up to 50% of pregnant women, the development of severe nausea and vomiting sufficient to cause dehydration, biochemical derangement and nutritional deficiencies occurs in less than 1%. It is important to consider alternative diagnoses at the time of initial presentation because many other underlying pathologies can cause vomiting during pregnancy, including intracranial spaceoccupying lesions, peptic ulcer disease and hyperthyroidism. In each triennium...