Experiencing an ulcer during pregnancy can be a source of concern, but it is a condition that healthcare providers can effectively manage. While pregnancy brings many physiological changes, understanding the nature of ulcers and available management strategies can help expecting individuals navigate this challenge. This article provides an overview of ulcers during pregnancy, including their causes, symptoms, diagnosis, and treatment approaches, always with a focus on both maternal and fetal well-being.
Understanding Ulcers During Pregnancy
A stomach ulcer, also known as a gastric ulcer, forms when the protective lining of the stomach or intestine erodes, exposing the underlying tissue to digestive acids. Ulcers are primarily caused by Helicobacter pylori (H. pylori) infection and regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. While pregnancy itself does not cause ulcers, hormonal changes and the physical pressure from a growing uterus can sometimes influence digestive symptoms.
Symptoms of a stomach ulcer include a burning pain in the middle or upper abdomen, which may worsen between meals or at night. Other common symptoms pregnant individuals might experience are nausea, vomiting, bloating, and heartburn. Severe ulcers can lead to dark or black stools due to bleeding. These symptoms should be differentiated from common pregnancy discomforts like morning sickness or general acid reflux.
Peptic ulcer disease is uncommon during pregnancy, with some studies suggesting pregnancy offers protection due to decreased gastric acid and increased protective mucus, influenced by elevated progesterone. However, H. pylori infection is prevalent in pregnant women and can exacerbate gastrointestinal symptoms like dyspepsia, nausea, and vomiting. Risk factors like smoking or a history of peptic ulcers can also increase ulcer development during pregnancy.
Diagnosing Ulcers Safely
When an ulcer is suspected in pregnancy, healthcare providers prioritize diagnostic methods safe for mother and baby. Initial approach often involves non-invasive tests for H. pylori infection, a common ulcer cause. Tests include blood tests for H. pylori antibodies, stool tests for bacterial antigens, or urea breath tests. Stool antigen and serologic exams are preferred due to their ease and non-invasive nature, confirming the bacterium’s presence without invasive procedures.
If non-invasive tests are inconclusive or symptoms are severe, an upper endoscopy (EGD) may be considered. Though physicians may be reluctant, endoscopy is safe when necessary, especially for suspected bleeding or other complications. The procedure involves inserting a thin, flexible tube with a camera to visualize the stomach and duodenum for precise diagnosis and tissue biopsies. This step is reserved for cases where benefits outweigh risks. The second trimester is generally considered the safest time for gastroscopy during pregnancy, though urgent cases may necessitate the procedure during other trimesters.
Navigating Treatment Options
Managing ulcers during pregnancy involves medication and lifestyle adjustments, guided by a healthcare provider. The aim is to alleviate symptoms, promote healing, and prevent complications, ensuring safety for mother and baby. Dietary and lifestyle modifications are often the first recommendations to help manage symptoms.
Smaller, more frequent meals can reduce stomach acid. Avoiding trigger foods (spicy, fried, acidic, caffeine) can provide relief. Drinking water between meals (not with them) helps hydration and prevents stomach distension. Incorporating stress management techniques like meditation or yoga may also support digestive health.
Antacids are often first-line due to their safety during pregnancy. Calcium carbonate antacids (e.g., Tums) are safe and can contribute to daily calcium intake. However, antacids with sodium bicarbonate should be avoided as they can cause fluid retention. If antacids are insufficient, histamine-2 (H2) blockers like Pepcid (famotidine) or Zantac (ranitidine) may be prescribed, as studies suggest safe use during pregnancy without increasing risks of malformations or preterm birth.
If symptoms persist, proton pump inhibitors (PPIs) reduce stomach acid production. Omeprazole is a commonly used PPI in pregnancy, with extensive safety data showing no increased risk of birth defects or adverse outcomes. Other PPIs like lansoprazole may be used, but omeprazole is often preferred due to more available safety information. These medications help ulcers heal by lowering stomach acid levels.
Prioritizing Maternal and Fetal Health
Ulcers in pregnancy require careful attention to safeguard maternal and fetal well-being. Though uncommon, untreated or severe peptic ulcers can lead to complications. Complications include internal bleeding (dark or black stools) or, rarely, stomach lining perforation. Gastrointestinal obstruction is another possible complication.
With appropriate diagnosis and management, most pregnant individuals with ulcers experience positive outcomes. Regular monitoring by a healthcare provider tracks symptoms and ensures treatment effectiveness throughout pregnancy. While some studies report increased risks of preterm birth, low birth weight, and intrauterine growth restriction with peptic ulcer disease, proper care mitigates these risks. Effective ulcer management prevents impact on pregnancy or baby’s development.