Pregnancy and inflammatory bowel disease

Doctors often hear complaints that the stomach hurts during pregnancy. This is not surprising: a serious restructuring is taking place in the expectant mother’s body, and the growing uterus puts pressure on the intestines and stomach.

In addition, gastric problems are caused by a decrease in immunity. It causes:

• change in acidity level;
• susceptibility to infections.

Many women experience an increased appetite, and overeating and eating unhealthy foods also negatively affects the digestion process.

Digestion during pregnancy

Digestive problems during pregnancy are something that a considerable number of expectant mothers face. Despite the fact that hormones play a significant role in the disruption of the digestive system, the increased level of which affects not only the safety of pregnancy, but also the slowdown of digestive processes, nevertheless, the most important factor in the occurrence of such disorders is an unbalanced diet and improper diet before and during pregnancy. waiting time for the baby, as well as insufficient physical activity.

To prevent possible digestive problems during pregnancy, it is better to start preparing your body for it in advance, including improving your lifestyle and nutrition, as well as balancing your diet.

Of course, a healthy diet does not guarantee you the complete absence of other symptoms of pregnancy, except for stopped menstruation and the growing size of the abdomen and breasts - the effect of female hormones responsible for maintaining pregnancy has not been canceled. However, it can significantly reduce their severity.

If you did not manage to adjust your diet and lifestyle before pregnancy, let's figure out what you can do now to improve your condition.

Pregnancy and inflammatory bowel disease

Okhtyrskaya T.A.

Chronic inflammatory bowel diseases (IBD) include Crohn's disease and ulcerative colitis. The causes are not completely known; the clinical manifestations and treatment methods are similar.

Both diseases are most common in people of young reproductive age. The peak of the disease occurs between 20 and 40 years of age.

In inflammatory bowel disease, fertility overall is comparable to that in the human population. Although, the frequency of child births is lower than in the population. This can be either a consequence of health problems or a conscious choice. A number of married couples refuse pregnancy for fear of their children inheriting the disease, for fear of exacerbation of the disease during pregnancy, for fear of the negative impact of drugs on the course of pregnancy. Studies show that the probability of inheriting the disease is about 7% if one of the parents has Crohn's disease and less than 7% with UC. The risk of inheritance increases to 37% if both parents are affected. The risk of inheritance is higher in the Jewish race (7.8%) than in the European race (5.8%).

The high incidence of infertility, miscarriage and pregnancy complications is mainly associated with the active stage of the disease. According to various authors, pregnancy during the active stage of the disease can be accompanied by complications in up to 75% of cases.

What autoimmune diseases affect reproductive function?

Inflammatory bowel diseases, CAIT, rheumatoid arthritis, SLE, vasculitis, sugar/diabetes.

In women in the active stage of the disease, decreased fertility may be due to several mechanisms:

1. Fear and reluctance to have sex (dyspareunia), due to pain and decreased libido
2. Active inflammation in the intestines can lead to inflammation in the fallopian tubes and ovaries. Women in the active stage of the disease, as well as those who have undergone surgical treatment, are at risk for adhesive disease and tubal factor infertility.
3. Active inflammation of the intestines can lead to menstrual irregularities (anovulation, late ovulation, insufficiency of the luteal phase of the cycle, hyperprolactinemia). As a rule, achieving remission of the disease leads to an improvement in the nature of the cycle.
4. Active intestinal inflammation reflects the state of the immune system (autoimmunity), which disrupts the microenvironment in the uterine cavity and fallopian tubes involved in the migration of the fertilized egg; an active immune response can lead to impaired implantation of the fertilized egg and impaired formation of chorionic villi.

Because Since all stages of pregnancy development occur sequentially, each subsequent stage depends on the previous one. Violation of the formation of primary chorionic villi can subsequently become the basis for placental insufficiency and the development of complications in late pregnancy. Violation of the earliest stages of implantation can cause early miscarriage (biochemical pregnancy).

Medicines used to treat inflammatory bowel disease do not directly affect female reproductive function. While in men, therapy with sulfasalazine in 60% of cases will lead to a decrease in the number and motility of sperm. The effect is reversible 2 months after discontinuation of the drug.

The optimal period for conception is the period of stable remission. The length of the remission period before stopping contraception is not defined, but the most common recommendation is a period of 3 months.

If conception occurs in a state of remission, pregnancy in most cases proceeds without complications. One of the possible explanations for the maintenance of remission of the disease during pregnancy is relaxin, a hormone that is formed only during pregnancy and suppresses the function of macrophages, which reduces the activity of fibrosis and the frequency of adhesions.

There is a theory about a decrease in disease activity due to down-regulation of the immune system due to a mismatch in the HLA system of the mother and fetus. The frequency of active stages of the disease during pregnancy was higher when the mother and fetus matched certain HLA loci.

If conception occurs in the active stage of the disease, in 2/3 of cases high activity remains throughout the pregnancy, and in 33% of cases there will be a worsening of symptoms, which makes the risk of complications high - spontaneous miscarriage, premature birth, intrauterine fetal death. The active stage of the disease, which cannot be treated, may be an indication for termination of pregnancy.

According to statistics, women with inflammatory bowel diseases have a higher incidence of giving birth to children with low body weight (2500 g). Considering the immune factors underlying the development of the disease, it is necessary to remember the high risk of placental insufficiency and promptly conduct examination and prevention. An important point is examination for additional (to the main disease) factors of placental insufficiency: mutations of the hemostasis system, autoantibodies to cardiolipin, DNA, thyroid gland, homocysteine.

Diagnosis during pregnancy:

In a pregnant woman, the level of hemoglobin and albumin decreases, and the ESR increases. These are normal physiological changes. Therefore, clinical rather than laboratory data are more important for assessing health status during pregnancy. X-rays and MRIs are rarely used during pregnancy. Especially in the early stages, radiation exposure is best avoided.

Most patients are examined using sigmoidoscopy or colonoscopy. There were no cases of preterm birth caused by colonoscopy.

Therapy methods:

In the active stage of the disease, corticosteroids can be used as a method of therapy. The theoretical benefit of using CS in the active stage of the disease is higher than the potential risk to the fetus (link to article on programming). No data have been obtained on the teratogenic effect of CS on the fetus.

The main method of therapy during pregnancy is 5-aminosalicylic acid and its derivatives - sulfasalazine and mesalamine. The drugs penetrate the uteroplacental and fetal bloodstream only in small quantities. The use of sulfasalazine and 5-ASA in doses of less than 3 g per day does not have a teratogenic effect and is acceptable during pregnancy. During therapy with sulfasalazine, there is a risk of sulfasalazine-induced folate deficiency. In addition, IBD in most cases occurs with disturbances in the digestive and metabolic processes, which often leads to the development of anemia (iron deficiency, vitamin deficiency) and malabsorption syndrome (impaired absorption of nutrients) and requires a higher intake of folates and vitamins of other groups. Folate deficiency increases the risk of fetal malformations, is involved in the development of vascular disorders (thrombophilia) and can contribute to the formation of placental insufficiency.

There have been no studies on the use of immunomodulators (azathioprine, 6-mercaptopurine) for inflammatory bowel diseases during pregnancy. The use of methotrexate is accompanied by a teratogenic effect and is contraindicated during pregnancy. A woman should cancel methotrexate at least a month before stopping contraception, a man - 3 months.

In some cases, according to indications, therapy with antibacterial drugs may be recommended: ampicillin, cephalosporins, erythromycin and short courses of metronidazole.

The antidiarrheal drug Loperamide is not teratogenic in animal studies. There is no data on teratogenic effects during pregnancy, but its use during pregnancy may be associated with low birth weight of newborns and its use in late pregnancy may cause intestinal dysfunction in newborns.

Indications for surgical treatment of inflammatory bowel diseases during pregnancy are identical to indications outside pregnancy - perforation, obstruction, abscesses, bleeding.

Drug safety during pregnancy

Delivery:

Despite the fact that obstetric indications for cesarean section for inflammatory bowel diseases do not differ from the population, according to statistics, cesarean sections are performed more often. Cases of initiation of perineal disease by natural childbirth have been recorded. Stress during childbirth can provoke an exacerbation of the disease.

Breast-feeding:

Almost all drugs used to treat inflammatory bowel disease are secreted into milk. The main criterion is safety for the child.

For nursing mothers during the period of exacerbation of the disease, 5-aminosalicylic acid preparations are allowed in doses of up to 3 g/day.

During breastfeeding, glucocorticoids can be used in small doses, maintaining a four-hour interval between taking the drug and feeding.
In severe forms of IBD, it is advisable to transfer the child to artificial feeding both because of the severity of the woman’s condition and because of the risk of developing adverse effects of therapy. Tags: pregnancy

What is pregnancy toxicosis

Morning sickness, or early toxicosis of pregnancy, is a condition familiar to almost 70% of women expecting a child. Nausea, increased salivation, loss or change in appetite, reaction to certain odors and foods are typical symptoms of early toxicosis. The only positive thing about this condition is, perhaps, the fact that it is the first obvious sign of pregnancy.

There is still no clear answer to the question of the causes of this condition. Hormones, dietary habits, the presence of chronic diseases, the psychological background of pregnancy, and some neurological aspects of the health of the expectant mother all play a role.

Nausea, the most unpleasant symptom of morning sickness, begins immediately after waking up and goes away as physical activity increases, but can last all day and bother a pregnant woman even at night.

One of the causes of nausea is hCG - human chorionic gonadotropin, the most well-known pregnancy hormone, with the help of which it is determined (using a urine test). It begins to be produced by the body as soon as the fertilized egg attaches to the wall of the uterus. An exact correlation between nausea and this event has not yet been established, but the fact that both processes coincide in time speaks in favor of the assumption that a connection does exist.

According to other theories, the hormone estrogen, stress, a sensitive stomach, fatigue and other factors are to blame for the occurrence of nausea.

Early toxicosis is most active in the first months of pregnancy. It occurs around the 6th week, weakens by the end of the first trimester, and in most cases goes away completely by the 15th – 22nd week. And only a small percentage of expectant mothers will experience this condition throughout their pregnancy.

Not all morning sickness remedies are equally effective. Each pregnancy is unique and depends on the hormonal, neurological, immune, endocrinological, and psychological status of the woman. Nevertheless, we hope that from all the remedies listed below you will be able to choose for yourself something that will bring you relief. How to cope with toxicosis

• In the morning, do not rush to leave the bed immediately. Set your alarm a little earlier than your desired time and, when you wake up, have breakfast in bed. To do this, always keep crackers, cereal, crackers or an apple next to your bed. A light breakfast helps prevent morning sickness.
• Have a good breakfast, preferably choosing foods high in protein, such as cottage cheese or eggs.
• Sugary foods eaten on an empty stomach contribute to nausea.
• Eat small meals several times a day. Progesterone, which supports your pregnancy, slows the movement of food through your digestive tract. Therefore, try not to overeat. Make it a rule to drink a glass of drinking water 30 minutes before meals or 30 minutes after meals (but not during!).
• Give preference to warm, cool and cold foods (sandwiches, salads) and simple dishes (rice, toast, baked potatoes).
• The breaks between meals should not be long - do not make yourself feel hungry: nausea is often what appears as a result of this condition, so you should always have a snack on hand.
• Rest as often and as much as your body requires, especially if you get up early in the morning. However, try to avoid napping immediately after eating: this can only make nausea worse.
• Do not make sudden movements or bends: they provoke vomiting.
• Avoid foods and smells that make you feel nauseous.
• Drink enough fluids throughout the day to avoid dehydration and blood clots.
• Avoid stuffiness and excessive heat: this aggravates attacks of nausea. Ventilate the rooms in your house more often.
• In the evening menu, include non-spicy, unsalted and low-fat dishes without a pronounced aroma.
• Go to bed on time to get enough sleep and recuperate for the next day.
• Spend more time outdoors.

How long does it take for signs of pregnancy to appear?

The initial signs of pregnancy appear in the second or third week after the end of menstruation, that is, about a week before the calendar start of the next menstruation.

Mucus discharge during pregnancy

Before the onset of menstruation, most women experience thick and scanty discharge called “leucorrhoea.”

After fertilization, due to the high level of progesterone, the work of the cervical glands, which produces mucus, is activated. Therefore, from the first days of conception, mucous discharge becomes more abundant, transparent and has a liquid consistency. It is this secret that protects the pregnant woman and the fetus directly from pathogenic microorganisms.

Thrush during pregnancy

The secretion secreted by the uterus is rich in hydrogen ions, so yeast easily multiplies in it, causing thrush, accompanied by white curdled discharge, itching and burning in the vaginal area.

Candidiasis during pregnancy can also develop against the background of a disturbance in the vaginal microflora.

To avoid intrauterine infection of the fetus, if signs of thrush appear, you should immediately consult a doctor.

Frequent urination during pregnancy

Often, increased frequency of urination is observed in late pregnancy, which is caused by the growth of the fetus in the womb and its pressure on the bladder and ureter.

But even in the first weeks of bearing a child, the urge to urinate may become more frequent, both during the day and at night, which is associated with increased blood circulation in the pelvic organs.

The expectant mother feels as if her bladder is full, and a small amount of urine is released during urination.

If frequent urination does not cause any discomfort, there is no need to worry about it.

Cystitis during pregnancy

Increased urination during pregnancy, accompanied by pain in the groin, burning in the ureter and increased temperature, may be a symptom of cystitis - a disease that often develops in the early stages of pregnancy due to a sharp decrease in immunity, increased susceptibility to bacteria and exacerbation of inflammatory processes.

Temperature 37 as a sign of pregnancy

An increase in body temperature to subfebrile levels (37.2 - 37.4 ° C) in the early stages of pregnancy in the absence of symptoms of viral diseases is normal in 8 cases out of 10. And it is explained by the increased production of progesterone, which affects the thermoregulation center, as well as physiological immunosuppression, which protects the body of a pregnant woman from rejection of the fetus.

A rise in temperature to 37.5°C should be a reason to visit a doctor.

Increase in basal temperature during pregnancy

This sign of pregnancy is informative only in the first 2 weeks after conception, after which the basal body temperature stabilizes.

Pregnancy is indicated by an increase in basal temperature for several days in a row to 37.0 - 37.2 ° C.

It is important to measure basal temperature correctly: the thermometer is inserted into the rectum immediately after waking up in the morning, without getting out of bed. It is recommended to carry out this procedure every day at the same time for several days.

Bloating (flatulence) during pregnancy

Starting from the early stages of pregnancy, intestinal motility is disrupted, which leads to increased gas formation and bloating.

Thus, already in the first weeks of conception, pregnant women may experience a feeling of excessive fullness in the abdomen, accompanied by a tingling sensation radiating to the uterus.

Constipation and diarrhea during pregnancy

Sex hormones produced during pregnancy inhibit the functioning of the intestines, causing it to relax, which causes constipation or, on the contrary, diarrhea. At the same time, constipation most often torments pregnant women in the later stages of pregnancy, while diarrhea is more typical in the first month of pregnancy.

Hemorrhoids during pregnancy

Frequent constipation and blood flow to the pelvic organs can provoke the formation of hemorrhoids, which mainly form in late pregnancy.

However, if before pregnancy a woman suffered from hemorrhoids, then this pathological condition often worsens in the first few weeks after conception.

Leg cramps during pregnancy

Cramps and pain in the legs often bother pregnant women at night. Cramps are manifested by involuntary sharp and painful contraction of the calf muscles.

To eliminate cramps, follow these recommendations:

• Stand on your flattened leg. If acute pain prevents you from moving your leg, you must, overcoming the pain, pull your foot towards you.
• Rub the cramped muscle using pinching and patting.
• Make a hot foot bath with salt.

What helps with nausea

Some foods help relieve unpleasant symptoms:

• crackers, croutons;
• raw vegetables and fruits, especially sour ones;
• lemon (drink lemon juice with water, eat a slice, inhale the aroma);
• tangerine, grapefruit (especially cold ones);
• watermelon;
• ginger (herbal tea, jam and ginger gummies);
• mint (in moderation, in the form of tea or candy; according to many pregnant women, mint is the best medicine for nausea, but for some it has the opposite effect);
• jelly;
• fruit ice, sorbet (don't get carried away!);
• lollipops (especially mint, ginger, lemon).

What else can help?

• B vitamins (especially B6, 50 mg daily);
• acupuncture, if you trust this technique. One of the points is on the wrist, it is called the “P6 Pericardial point”; the effect of special anti-nausea bracelets is based on its stimulation; they are sold in pharmacies; If you are hesitant to massage the indicated area yourself, use this simple device.

Neither nausea nor vomiting is dangerous to the health of the mother and the unborn child. If there are no more than five episodes of vomiting per day, this is considered a mild degree of toxicosis and does not require serious correction, other than following the rules indicated above.

During pregnancy, tests are regularly taken, and from them the doctor can judge how well the condition of a pregnant woman experiencing bouts of vomiting corresponds to the average values. If hemoglobin and leukocytes in the blood test are normal, acetone and ketone bodies are absent in the urine, and bilirubin in the biochemical blood test remains within acceptable values, toxicosis can be corrected by normalizing diet and lifestyle.

Moderate toxicosis is said to occur in cases where up to 10 bouts of vomiting are observed, and the doctor prescribes medications. In addition to medications that relieve the symptoms of toxicosis, drugs from the antacid group that relieve heartburn may be prescribed.

Laboratory and instrumental diagnosis of pregnancy

Regardless of whether you have subjective or external signs of pregnancy, the fact of conception can only be reliably confirmed using laboratory and instrumental diagnostic methods: transvaginal ultrasound and a blood test for hCG.

Thus, an ultrasound examination can determine pregnancy starting from the fourth week from the moment of conception. But in the first week of pregnancy, an ultrasound will only show the presence of a corpus luteum, which cannot be a reliable sign of the birth of a new life.

In the first 7 to 9 days after conception, in 98% of cases, pregnancy can be determined by a blood test for hCG , in which the human chorionic gonadotropin level exceeds 25 mU/ml. An increase in hCG levels during pregnancy is observed up to 12 weeks, after which it begins to gradually decrease.

At home, women use rapid tests .

Pregnancy test

An express pregnancy test, which can be purchased at a pharmacy, is recommended to be carried out no earlier than 2 to 3 days before the expected start date of menstruation. At the same time, manufacturers recommend using tests to determine pregnancy after 5 days of delay in order to avoid obtaining unreliable results.

The test is positive, but there are no signs of pregnancy

Some women are faced with a situation where an express pregnancy test gives a positive result in the absence of any signs of pregnancy, confirmed by a gynecologist and ultrasound.

The reasons for a false positive pregnancy test may be the following:

• Incorrect test: biomaterial (urine) is collected in the morning, and the last part is used.
• Using expired or defective test.
• Taking medications containing human chorionic gonadotropin (hCG).
• Hormonal imbalance due to the presence of tumor diseases and cysts.
• Early pregnancy failure.
• Abortion with incomplete removal of embryonic tissue.
• Ectopic pregnancy.
• Taking alkaloids, tranquilizers, and phenothiazane derivatives.

Test negative for early signs of pregnancy

Can a rapid test show a negative result if there are early signs of pregnancy? Maybe. And here are the reasons.

• Premature testing (remember that the most reliable results will be those obtained during the test on the fifth day of a missed period or more).
• Presence of tumors.
• Malfunction of the thyroid gland.
• Taking hormonal drugs.
• Ectopic pregnancy.
• Threat of spontaneous abortion.
• Violation of the rules for using and storing the test.
• Low quality or defective test system.

And remember that if you suspect pregnancy, no matter what the test result is - false positive or false negative, only visiting a gynecologist and carrying out all the necessary examinations will reliably determine whether you are pregnant or not.

What is heartburn

Heartburn is a phenomenon accompanied by a burning sensation in the esophagus.

Up to half of all expectant mothers experience this condition, most often in the second and third trimesters. Responsibility for it lies with the hormonal and physiological changes that occur in a woman’s body in connection with pregnancy.

While expecting a baby, the placenta produces the hormone progesterone, which softens the tone of smooth muscles, including reducing the contractility of the uterine muscles, which is necessary for the preservation of pregnancy. But it also relaxes the muscles of the valve that separates the esophagus from the stomach and normally prevents stomach acid from leaking up. This phenomenon causes a burning sensation, or heartburn.

Heartburn usually appears after heavy consumption of fatty and spicy foods. It gets worse when lying down, turning from side to side, or bending forward.

This condition is corrected by changes in diet and nutrition, as well as lifestyle. Eating small portions of food 5 to 6 times a day is the starting condition for normalizing the condition. It is not recommended to lie down after eating (and therefore, eat at night) and to remain in an inclined position for a long time. The head of the bed should be 15 degrees above the level of your feet.

If changes in diet and lifestyle do not help cope with the problem, antacids can quickly and safely relieve heartburn and relieve pain.

The action of drugs from the antacid group is based on the neutralization of gastric acid by a chemical combination of the elements magnesium, aluminum and calcium. They promote the formation of a protective film in the stomach, the adsorption of bile acids and toxins, increasing the tone of the valve responsible for preventing stomach acids from entering the esophagus, and increasing the resistance of the gastric mucosa. However, they lead to constipation, which can already bother a pregnant woman, and aluminum penetrates the placenta and accumulates in the tissues of the fetus, causing various developmental disorders.

Therefore, the most effective cure for heartburn is dietary measures. Food antacids cope well with it, and they also act longer and are stronger than medicinal ones.

What are the dangers of constipation during pregnancy?

Although gestational constipation is considered a physiological phenomenon, if symptoms are severe, they should not be perceived as a normal condition8. Persistent stool retention can lead to a number of adverse consequences for both the mother and the unborn child7.

Straining during bowel movements can cause hemorrhoids and anal fissures. Also, due to fecal retention, the tone of the uterus increases, which can cause placental abruption and cause premature birth8.

Rare bowel movements disrupt the microflora of the large intestine - the number of beneficial bifidobacteria and lactobacilli decreases and the number of opportunistic microorganisms increases. Therefore, with prolonged constipation, dysbiosis often occurs, which can contribute2:

• disruption of the barrier function of the intestinal wall;
• penetration of bacterial toxins into the blood;
• the development of bacterial vaginosis (a condition in which the vaginal microflora is disrupted).

If symptoms of constipation bother you during pregnancy, the right solution would be to schedule a visit to a specialist.

Immediate consultation with a general practitioner or gastroenterologist is required if 3:

• Stool retention for more than 6 weeks;
• Bleeding from the rectum;
• Exacerbation of inflammatory bowel diseases that existed before pregnancy.

Watch our video to see what can cause constipation:

Up to contents

How to deal with heartburn

You can eat the following foods:

• protein;
• pureed and boiled vegetables;
• baked apple;
• yogurt;
• 1 tsp. honey in a glass of warm milk (not for those who are allergic to honey and/or milk);
• lean meat.

You should not eat:

• fatty and salty foods;
• pickles, smoked foods, sauces, vinegar, seasonings;
• sour fruit juices and compotes;
• citrus;
• tomatoes;
• coarse fiber (white cabbage, onions, garlic, radishes);
• mushrooms;
• black bread;
• chocolate; coffee;
• strong hot tea;
• soda.

The decision to prescribe a drug that can alleviate the symptoms of heartburn should be made only by a doctor. Discuss your condition, frequency and intensity of symptoms with him. Don't self-medicate!

Preventing constipation during pregnancy

At any stage of gestation, the basis for the prevention of defecation disorders is a rational diet with the inclusion of a sufficient amount of dietary fiber, adequate fluid intake, moderate physical activity and the formation of correct defecation reflexes13.

Up to contents

Good Habits

An important component of normalizing stool is the formation of the correct “defecation reflex.” The physiological habit of regular bowel movements is developed at a certain time of the day, preferably in the morning. To do this, you need to visit the toilet and sit on the toilet for some time, and also suppress the urge to defecate as little as possible - when the urge appears, if possible, immediately go to the toilet7. Another element in the formation of the reflex is a comfortable posture when emptying the bowel: with your knees pulled up and preferably with your feet on a stand2.

Up to contents

Physical activity

To stimulate normal bowel function, along with dietary recommendations, pregnant women need to maintain adequate physical activity. If the doctor has not identified any contraindications, you can, for example, do daily exercise, walking or swimming8.

It is worth keeping in mind that strenuous sports activities can aggravate constipation symptoms, but moderate exercise helps normalize bowel function5.

If, despite diet, drinking regimen and dosed physical activity, the intestines are difficult to empty and the symptoms are more disturbing, you should not endure it. The chair can be adjusted if you consult a doctor in time, who will select the correct treatment.

Remember that proper correction of constipation during pregnancy is an important and at the same time difficult task. Therefore, you should not self-medicate - this may be unsafe for both the woman and the fetus. Since the choice of drugs with a laxative effect during pregnancy is limited, timely consultation with a doctor is the right step to safely eliminate this delicate problem2.

Up to contents

The information in this article is for reference only and does not replace professional advice from a doctor. To make a diagnosis and prescribe treatment, consult a qualified specialist.

Literature

1. WHO recommendations for antenatal care for a positive pregnancy experience. Geneva: World Health Organization; 2022 - p.86. URL: https://apps.who.int/iris/bitstream/handle/10665/255150/9789244549919-rus.pdf?sequence=
2. Eremina E. Yu. Constipation in pregnant women. Medical alphabet 2015. T. 2. No. 15. P. 48-52. URL: https://www.elibrary.ru/item.asp?id=24896586
3. Verghese TS, Futaba K, Latthe P. Constipation in pregnancy. The Obstetrician & Gynecologist 2015;17:111–5.
4. Shin GH, Toto EL, Schey R. Pregnancy and postpartum bowel changes: constipation and fecal incontinence. Am J Gastroenterol. 2015 Apr;110(4):521-9
5. Body C., Christie JA. Gastrointestinal Diseases in Pregnancy. Gastroenterology Clinics of North America, 2016; 45(2), 267–283.
6. Bianco A. Maternal adaptations to pregnancy: Gastrointestinal tract. Official reprint from UpToDate 2022.
7. Solovyova A.V., Ermolenko K.S. Constipation in pregnant women. Approaches to therapy. Medical advice. 2020;(3). pp. 44–47. URL: https://www.elibrary.ru/item.asp?id=42727052
8. Turkina S.V. Intestinal dysfunction in pregnant women: gestational constipation. Experimental and Clinical Gastroenterology 2016; 132(8). pp. 88-92. URL: https://www.elibrary.ru/item.asp?id=27218512
9. Ivashkin V.T., Shelygin Yu.A., Maev I.V., Sheptulin A.A., Aleshin D.V., Achkasov S.I., Baranskaya E.K., Kulikova N.D., Lapina T. L.L., Moskalev A.I., Osipenko M.F., Poluektova E.A., Simanenkov V.I., Trukhmanov A.S., Fomenko O.Yu., Shifrin O.S. Diagnosis and treatment of constipation in adults: Clinical recommendations of the Russian Gastroenterological Association and the Association of Coloproctologists of Russia). Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2020;30(6):69–85. URL: https://www.gastro-j.ru/jour/article/view/523
10. Parfenov A.I., Indeikina L.H., Belyaeva A.A. Chronic constipation. Guidelines. Moscow 2016, 54 p. URL: https://www.gastroscan.ru/literature/pdf/parfenov-ai-gr.zap.pdf
11. Rungsiprakarn P, Laopaiboon M, Sangkomkamhang US, Lumbiganon P, Pratt JJ. Interventions for treating constipation in pregnancy. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD011448. URL: https://www.cochrane.org/CD011448/PREG_interventions-treating-constipation-pregnancy
12. Zielinski R, Searing K, Deibel M. Gastrointestinal Distress in Pregnancy. The Journal of Perinatal & Neonatal Nursing. 2015; 29(1), 23–31.
13. Clinical recommendations of the Scientific Society of Gastroenterologists of Russia and the Russian Scientific Medical Society of Therapists “Constipation in Adults” 2022. Therapy No. 4, 2022. URL: https://lib.medvestnik.ru/articles/Klinicheskie-rekomendacii-zapory-u-vzroslyh.html
14. Instructions for use of the drug MICROLAX® // Registration number N011146/01 // RF GRLS. – URL: https://grls.rosminzdrav.ru/Grls_View_v2.aspx?routingGuid=f052fb31-5426-4bc1-958f-9fce793aa43f&t=(access date: 10/19/2020)
15. Aziz I, Whitehead WE, Palsson OS, Törnblom H, Simrén M. An approach to the diagnosis and management of Rome IV functional disorders of chronic constipation. Expert Rev Gastroenterol Hepatol. 2022 Jan;14(1):39-46. doi: 10.1080/17474124.2020.1708718. — URL: https://www.tandfonline.com/doi/full/10.1080/17474124.2020.1708718
16. Shi, Wenjun & Xiaohang, Xu & Zhang, Yi & Guo, Sa & Wang, Jing & Wang, Jianjun. (2015). Epidemiology and Risk Factors of Functional Constipation in Pregnant Women. PloS one. 10.e0133521. 10.1371/journal.pone.0133521.

Up to contents

Uncontrollable vomiting of pregnancy (Hyperemesis gravidarum)

If attacks of vomiting occur more than 10 times a day, and food, like any liquid, is not retained in the body at all, this condition is considered a severe form of toxicosis and is called “uncontrollable vomiting of pregnancy.” It requires hospital stay under medical supervision and treatment.

Be sure to talk to your pregnancy doctor if your nausea is accompanied by persistent vomiting, weight loss, fever, pain, and signs of dehydration. This condition should not be corrected with folk remedies, and even less so with self-prescribed medications.

Constipation

Approximately half of women at different periods of pregnancy face a problem such as constipation.

In addition to the peculiarities of the anatomical structure of the intestine, the main causes of constipation are a sedentary lifestyle, a diet low in fiber, insufficient intake of fluid and some nutrients (B vitamins, magnesium), as well as a tense psycho-emotional state (stress, anxiety, increased anxiety).

During pregnancy, a hormonal background is added to this list, which has a relaxing effect on the muscles of the internal organs, as well as the increasing size of the uterus, which puts pressure on the intestines, as the fetus develops. Weakening the peristalsis of this organ causes food to pass more slowly through the digestive tract.

Iron supplements, which are included in the list of vitamins recommended for use during pregnancy, also make their contribution. If you are taking iron in addition to your diet, be sure to drink enough fluids (2 liters).

How to avoid constipation

• The diet should have enough coarse fiber (25 - 30 g per day from raw vegetables and fruits, whole grains, bran).
• Drink adequate fluids (2 liters per day), especially if you take iron supplements and eat enough fiber.
• Be physically active: swimming, walking, gymnastics for pregnant women, other moderate exercise stimulates intestinal function. Set aside 30 minutes for exercise 3 – 5 times a week.
• Reduce or divide the daily dose into several doses throughout the day. If tests show good hemoglobin levels, discuss with your doctor the possibility of doing without chemically synthesized vitamins. In this case, you will need to make sure that your diet contains enough foods - sources of iron: beef, chicken, turkey, pork, eggs, green vegetables, prunes, figs, grapes, dried fruits, nuts, grains.

About the problem of pregnancy with Crohn's disease and ulcerative colitis

The relevance of the problem of managing women with inflammatory bowel diseases (IBD) during pregnancy is beyond doubt due to the fact that almost all women suffering from ulcerative colitis (UC) or Crohn's disease (CD) develop these diseases during their childbearing years.

The question of the possibility of pregnancy in women with IBD is still controversial. The lack of information from doctors about the peculiarities of the course of pregnancy and the safety of modern treatment methods leads to unfounded conclusions about the inadmissibility of pregnancy in this category of patients. At the same time, refusal to bear children leads to severe psychosocial consequences and negatively affects the quality of life of women.

Most of the works accumulated to date on the study of IBD during pregnancy are uncontrolled and performed on small clinical material. Based on the results of these studies, it is not always possible to judge the characteristics of the course of IBD in women during pregnancy. From this point of view, a large prospective controlled randomized study completed in 2008 under the leadership of ECCO (European Crohn's and colitis organization) deserves attention. The study involved 500 patients [10]. The purpose of this and a few other controlled multicenter studies: to find an answer to a number of hitherto unresolved questions related to the course of IBD in women of reproductive age. The first step was to determine whether IBD affects fertility.

IBD and fertility. Until recently, it was believed that fertility in patients with UC and CD was significantly reduced (66% in CD and 49% in UC) [21]. However, the data accumulated and summarized to date indicate that a decrease in fertility in patients with IBD is observed only in 7–12% of cases [28, 50].

An analysis of the results of a number of studies shows that a smaller number of pregnancies in patients with established IBD may be due to the woman’s reluctance to have a pregnancy against the background of IBD and their compliance with contraception [14, 25].

In patients with CD, a decrease in the pregnancy rate may be associated with impaired menstrual function against the background of high disease activity and as a result of the development of adhesions in the pelvis after surgical interventions [4, 14, 25, 33].

As for UC, it is currently believed that in women suffering from this disease, the ability to conceive is not significantly impaired [25]. However, it should be noted the possibility of decreased fertility after surgical interventions (total or subtotal colectomy, resection of the colon with ileoanal anastomosis or ileostomy), due to the development of adhesions in the abdominal cavity [27, 43, 45].

Thus, in patients with IBD, the lower number of pregnancies is determined by a number of reasons. Analysis of the data available in modern literature and the experience of our own observations give reason to conclude that the positive outcome of pregnancy largely depends on the degree of activity of the process in the intestines at the time of its onset, therefore, it is necessary to include recommendations for the management of patients in the pregnancy management program at the stage of planning conception .

The second equally important issue discussed in the literature concerns the influence of the inflammatory process in the intestines on the course of pregnancy.

The impact of IBD on the course of pregnancy. To date, the prevailing opinion is that the impact of IBD on the course and outcome of pregnancy is determined by the activity of UC and CD at the time of conception and during pregnancy [5, 7, 12, 13, 14, 19, 20].

Among the complications of pregnancy are: miscarriage (premature birth, spontaneous miscarriages) and fetal malnutrition [6, 14, 21, 28, 39, 48].

At the same time, the degree of activity of the inflammatory process in the intestines largely determines the prognosis of the course and occurrence of pregnancy complications. It is believed that with high CD activity, the percentage of uncomplicated pregnancies is only 54%, while with inactive disease it is 80% [1, 17]. It is known that the percentage of complicated pregnancies increases manifold with IBD activity during pregnancy. Thus, with active CD, the risk of premature birth increases by 3.5 times, spontaneous miscarriages - by 2 times [17]. With this disease, artificial termination of pregnancy and cesarean section are more often performed [10].

In UC, the likelihood of developing adverse pregnancy outcomes also depends on the activity of the inflammatory process. With an active process in the intestine, the frequency of premature birth increases by 2 times, and spontaneous miscarriages by 2.3 times compared with pregnancies occurring against the background of an inactive disease [17]. The onset of IBD during pregnancy significantly increases the risk of complications, both pregnancy and the disease itself [7, 41].

Thus, in general, the prognosis for perinatal outcomes in IBD is favorable if there is no activity of UC and CD during pregnancy.

Researchers studying the problem of IBD in women of childbearing age have been trying for many years to find out whether pregnancy has an impact on the course of the process in the intestines. Below is the status of this problem at this stage.

The influence of pregnancy on the course of IBD. It is known that when IBD is in remission at the time of pregnancy, in 2/3 of cases remission remains during pregnancy [29, 36, 39, 50]. The incidence of exacerbations of UC and CD does not differ from that observed in non-pregnant patients. If at the time of conception there was an exacerbation of IBD, then in approximately 30% of cases the activity remains, in 35% it increases and in 35% it subsides. Exacerbations often develop in the first trimester of pregnancy, after abortion and after childbirth. In a study by Modagam et al. exacerbation of IBD in the postpartum period was observed in 13% of cases in patients with inactive disease during pregnancy, while in patients with active disease - in 54% of cases [36].

Relapses of IBD often occur as a result of women refusing to take medications during pregnancy [7]. Despite the fact that taking 5-aminosalicylic acid (5-ASA) drugs (mesalazine) is approved by the FDA (Food and Drug Administration, USA) for use during this period (at a dose of up to 2–3 g/day), many patients stop treatment from the moment of pregnancy.

The clinical example presented below demonstrates the active course of UC during pregnancy, which occurred against the background of moderate disease activity and the absence of adequate therapy.

Case 1. Patient X., 20 years old. He has been suffering from UC since the age of 17, when he first began to experience frequent, pasty stools up to 15 times a day mixed with blood and mucus. During the examination, a total form of UC was diagnosed. Treatment was carried out with sulfasalazine and suppositories with prednisolone with a positive effect. Subsequently, exacerbations of the disease occurred 3–4 times a year. Three years after the onset of the disease, the first pregnancy occurred against the background of moderately active inflammation in the intestines. The patient refused to take maintenance therapy with 5-ASA drugs due to fear of adverse effects of therapy on fetal development. From 8 weeks of pregnancy and throughout its entire duration, frequent bowel movements were observed up to 7–8 times a day, mixed with blood and mucus. The pregnancy proceeded with signs of threatened miscarriage, and laboratory signs of iron deficiency anemia and hypoproteinemia were observed. However, the patient refused treatment. From 34 weeks of pregnancy, sulfasalazine was started at a dose of 1.5 g per day without significant clinical effect. Spontaneous birth occurred at 39 weeks of gestation. A boy was born weighing 3100 g and 50 cm tall. In the postpartum period, the patient continued to have frequent stools up to 7–8 times a day mixed with blood. During therapy with 5-ASA drugs (Salofalk) and hydrocortisone enemas, remission of the disease occurred. 5-ASA (Salofalk) at a dose of 2 g/day was prescribed as maintenance therapy.

This clinical case shows that moderate activity of UC at the time of conception with inadequate treatment can contribute to the persistence and increase in activity of IBD both during pregnancy and in the postpartum period. All this indicates the need to plan pregnancy during the period of IBD remission, and if an exacerbation occurs, to carry out appropriate therapy.

In order to study the characteristics of reproductive function, the course of pregnancy and childbirth in women suffering from IBD, we examined 219 women of reproductive age. From this number of patients, an in-depth study group of 64 people was selected (38 UC, 26 CD). Depending on the presence of IBD at the time of pregnancy, two subgroups were identified: women who had a pregnancy before the onset of IBD - subgroup I, and women in whom pregnancy occurred against the background of IBD or the disease arose during pregnancy - subgroup II.

In general, women in the observed group had a total of 180 pregnancies. Of this number, 100 pregnancies (55.6%) occurred before the development of IBD and 80 (44.4%) occurred against the background of IBD. Based on the results of the survey, the reasons for the lower number of pregnancies in the second subgroup were identified: the woman’s reluctance to have a pregnancy, problems with pregnancy and changes in the sexual sphere against the background of an active disease.

Difficulties in achieving pregnancy with IBD were more often observed in patients of the second subgroup.

It was noted that only 90 pregnancies (50%) were wanted and prolonged. Of this number, 52 pregnancies (57.8%) occurred before the onset of the first symptoms of IBD and 38 (42.2%) - against the background of established IBD.

Wanted pregnancies resulted in normal births in the study group in 53 cases (60%), while in the control group - in 89%. Complicated pregnancy occurred in 11 cases (21.2%) in subgroup I and in 19 cases (50.0%) in subgroup II of observation. In the control group this figure was 30.1%. In the group of women with IBD, a wide range of complications was identified (miscarriage, congenital malformations of the fetus, antenatal fetal death, fetal malnutrition). 26 women who had pregnancies before developing IBD had 42 children during that period, while 28 women who had pregnancies with IBD had 32 children. Congenital malformations of the fetus were observed in 1.9% of cases in the first subgroup and in 5.3% in the second. Termination of pregnancy for medical reasons was carried out in 1.9% of cases in the first subgroup and in 13.2% in the second. Cases of fetal malnutrition in the first subgroup were identified in 18.2% of cases, in the second - in 27.8% of cases. In the second subgroup, the average weight of newborns was lower than in the first: in patients with UC this difference was 427 ± 114 g, in patients with CD - 352 ± 123 g.

Antenatal fetal death was not observed in the first subgroup, while in the second subgroup it was 5.3%. A significant percentage of pregnancy complications in women suffering from IBD was observed mainly against the background of pronounced activity of the inflammatory process in the intestines (78% of cases).

Thus, women with active IBD during pregnancy constitute a risk group for perinatal complications.

The results of our study showed that pregnancy does not have a significant effect on the course of IBD. However, if an exacerbation occurs during pregnancy (37.9%), then in the absence of adequate treatment in 72.7% of cases, the activity of the inflammatory process in the intestine remains and may be accompanied by the development of complications, especially in the postpartum period. In 27.3% of cases, spontaneous remission occurs. This gives grounds for the conclusion that it is necessary to plan pregnancy during the period of remission of UC and CD, and if an exacerbation occurs during pregnancy, to carry out adequate therapy for the disease.

The question of the method of delivery in IBD remains a subject of debate.

Childbirth in patients with IBD . It is known that patients with IBD are more likely to be delivered by cesarean section than in the general population [26, 32]. The reasons for such interventions: the presence of an ileostomy or an active form of CD with perianal lesions and cicatricial changes in the perineum.

The choice of method of delivery in women with IBD is determined by obstetric indications. The exception is patients with perianal forms of CD, in the presence of an intestinal stoma and pouch anastomosis. In these cases, a caesarean section is advisable.

The issue of an increased risk of developing perianal complications of CD after episiotomy remains controversial. Recent data indicate that there is no significant risk of perianal fistulas after episiotomy [17].

There are a number of features of examining patients with IBD during pregnancy.

Diagnosis of IBD during pregnancy. Opportunities for diagnostic measures during pregnancy are limited. The diagnostic value of laboratory tests (hemoglobin and albumin levels) during pregnancy is reduced due to physiological hemodilution. Determination of the level of C-reactive protein can be used as a marker of the activity of the inflammatory process [49]. Of the endoscopic research methods, gastroscopy and sigmoidoscopy are relatively safe. In the second and third trimesters, sigmoidoscopy is difficult due to the displacement of the colon by the pregnant uterus and should be carried out with extreme caution, as it can cause contractions.

The use of radiation diagnostic methods during pregnancy is undesirable due to possible adverse effects on the fetus and should be reserved only for emergency situations in the development of complications of IBD.

Ultrasound examination of the abdominal cavity and intestines is noninvasive, safe for the mother and fetus, and provides valuable information about disease activity, extent of lesions, and development of complications.

In recent years, particular attention has been paid to the problem of treating IBD in pregnant women.

Treatment of IBD during pregnancy . Standard therapy for IBD, depending on the severity, includes 5-ASA drugs (mild and moderate forms), corticosteroids (moderate and severe forms), immunosuppressants (moderate and severe forms when steroids are ineffective). The problem of treating patients with IBD during pregnancy remains a subject of debate. Most drugs cross the placental barrier and may affect the developing fetus. Recommendations for drug use and dosage are often theoretical due to a lack of clinical trials. However, it must be emphasized that treatment of IBD during pregnancy poses a lower risk of adverse effects than active disease. Currently, to assess the risk of adverse effects of drug therapy in pregnant women, classifications of risk categories for the use of drugs during this period have been developed. The most convenient to use and often used in practice is the FDA classification, although there are others (FASS classification - Swedish Catalog of Approved Drugs (Sweden) and ADEC classification (Australia) - Australian Drug). According to the results of most controlled studies, 5-ASA drugs (Mesalazine, Sulfasalazine), glucocorticoids, and Cyclosporine are approved for the treatment of patients with IBD during pregnancy.

However, there are a number of conditions under which the above drugs can be used during pregnancy. This primarily applies to Sulfasalazine, which consists of sulfapyridine combined with 5-ASA (Mesalazine). Sulfasalazine and its metabolites cross the placental barrier, inhibit the transport and metabolism of folic acid and can displace bilirubin from its protein binding, which may increase the risk of fetal kernicterus. Despite the fact that numerous observations have not revealed cases of side effects in pregnant women [35], treatment with Sulfasalazine should be carried out with simultaneous administration of folic acid (2 mg/day) to prevent defects in the formation of the neural tube in the fetus [25].

As for 5-ASA drugs (Salofalk and others), controlled studies have proven the effectiveness and safety of their use during pregnancy in women with IBD at a dose not exceeding 2–3 g/day (category B). In this case, drugs are used both for the treatment of active forms of IBD and for the prevention of relapses [16, 17].

There are many objections to the use of corticosteroids (category B) in pregnant women, based mainly on experimental data. According to many authors, their use during pregnancy should be limited as much as possible, and the prescribed doses should be reduced as much as possible [1]. The effectiveness of immunosuppressants (6-mercaptopurine and azathioprine (category D)) has been proven for the treatment of complicated, steroid-dependent and steroid-resistant forms of IBD. However, the potential teratogenic and mutagenic effect of these drugs, obtained in the experiment, dictates the need to exclude their use during pregnancy [3, 23].

Methotrexate (category X) has mutagenic and teratogenic properties. Its use is strictly contraindicated during pregnancy [20].

Cyclosporine (category D) is a powerful immunosuppressive drug with a high incidence of side effects on the fetus [8]. Its use is considered acceptable in cases of steroid-refractory forms of the disease as an alternative to surgical treatment [35].

In many controlled studies, metronidazole (category B) has been shown to be effective in the treatment of active forms of CD, especially in lesions located in the colon and perianal region. The use of Metronidazole during pregnancy is limited to the second and third trimesters of pregnancy with short courses due to the potential risk of adverse effects on the fetus [1, 17].

In recent years, infliximab (Remicade), which is an antibody to tumor necrosis factor (category B), has been used to treat fistulous and resistant forms of Crohn's disease. The same drug has now begun to be used in the treatment of UC. However, the number of studies regarding the use of infliximab in pregnant women with IBD is extremely small.

The high risk of developing pregnancy complications in the group of women with IBD, according to literature data and the results of our own observations, allowed us to develop schemes for a differentiated approach to the treatment of IBD depending on the reproductive plans of women. Three schemes have been identified.

The first scheme provides for the treatment of women of reproductive age who are not planning a pregnancy. In this group, IBD therapy does not differ from generally accepted regimens and depends on the severity of the disease and the presence of complications.

The second regimen is used to treat women planning pregnancy. The results of our research indicate that the optimal time for conception is the period of stable remission of IBD. Therefore, in the presence of an inflammatory process in the intestines, this group of women is given aggressive therapy depending on the severity of the disease. Upon achieving remission, it is acceptable to prescribe 5-ASA drugs in doses not exceeding 2 g/day as maintenance therapy. The use of immunosuppressants must be stopped at least three months before the intended conception due to the high risk of developing teratogenic effects. An important place in preparing for pregnancy is occupied by the method of hyperbaric oxygenation (HBO). Our experience of including HBO in complex therapy for IBD at the end of an exacerbation and as a measure to maintain remission indicates a gradual improvement in the state of the intestinal microflora and restoration of the intestinal mucosa with annual use of HBO for at least 6 years [2]. This allows you to maintain remission for a long time, which is especially important for patients planning pregnancy. Therefore, women with IBD who are preparing for pregnancy are recommended to undergo annual HBOT courses consisting of 10 sessions.

The third regimen is used in a situation where an exacerbation of IBD occurs during pregnancy or the postpartum period. In these cases, 5-ASA preparations are used in doses not exceeding 3 g per day. For moderate and severe forms of IBD, glucocorticoid drugs can be used. If conservative therapy is ineffective, cyclosporine can be used as an alternative to surgical treatment in combination with folic acid 2000 mcg per day to prevent malformations of the fetal nervous and cardiovascular systems. With the development of complications of IBD or severe exacerbations that are resistant to conservative therapy, surgical treatment is performed.

In case of severe exacerbations in the postpartum period, requiring the administration of high doses of glucocorticoids, it is necessary to transfer the child to artificial feeding.

The indications for surgical treatment during pregnancy are the same as outside pregnancy. After colectomy and ileostomy operations performed during pregnancy, pregnancy usually proceeds without complications.

In our message dedicated to the problem of pregnancy in IBD, we cannot ignore the group of men of childbearing age suffering from UC and CD, and bring to the attention of doctors the need to inform men planning to become fathers.

IBD in men. It is believed that the ability to have children is generally intact in men with IBD. At the same time, abscesses and fistulas in the pelvic area in CD in some cases lead to erectile dysfunction and ejaculation [1, 17]. Similar disorders can occur in patients after surgical interventions, especially after the formation of an ileoanal anastomosis. In some patients, oligozoospermia may be the result of prolonged exposure to active disease, malabsorption syndrome.

With long-term (at least two months) use of sulfasalazine, in 85% of patients, the volume of seminal fluid decreases, the content of sperm in it decreases, and their structure and motility are impaired [44]. According to the results of published studies, three months after discontinuation of the drug or when switching to mesalazine, sperm count and motility are normalized [37].

Data on the effect of glucocorticoids on male fertility are limited. Increased levels of endogenous steroids can lead to decreased sperm concentration. Therefore, the use of glucocorticoids should not be prolonged.

The question of the adverse effect of 6-Mercaptopurine and Azathioprine on pregnancy outcomes if the father took these drugs is controversial. Although there has been no increase in the risk of pregnancy complications in this situation, a few studies have reported an increase in the number of spontaneous miscarriages and congenital anomalies of the fetus in cases where the father received these drugs within three months before conception [46].

According to the FDA classification, Methotrexate is classified as safety category X during pregnancy. In this regard, it is recommended to stop taking Methotrexate at least three months before the expected conception.

Conclusion

Thus, the high risk of developing pregnancy complications in people suffering from UC and CD dictates the need to counsel patients even at the stage of starting a family and planning pregnancy. The optimal period for conception is a period of stable remission of UC and CD.

Patients of childbearing age require a differentiated approach to treatment at different stages of the reproductive period and joint monitoring by a gastroenterologist and obstetrician-gynecologist during pregnancy.

Literature

1. Adler G. Crohn's disease and ulcerative colitis (translated from German). M.: GEOTAR-MED, 2001. 527 p.
2. Grigorieva G. A. Crohn's disease and ulcerative colitis (clinic, diagnosis, differential diagnosis, treatment, medical examination). Dissertation doc. M., 1990. 294 p.
3. Shekhtman M. M. Guide to extragenital pathology in pregnant women. M.: Triada-X, 1999. 790 p.
4. Arkuran C., McComb P. Crohn's disease and tubal infertility: the effect of adhesion formation // Clin Exp Obstet Gynecol. 2000; 27:12–13.
5. Asimakopoulos G. Pregnancy and inflammatory bowel disease // Rev Med Chir Soc Med Nat Iasl. 2004; 108:46–50.
6. Baiocco PJ, Korelitz BI The influence of inflammatory bowel disease and its treatment on pregnancy and fetal outcome // J Clin Gastroenterol. 1984; 6:211–216.
7. Beniada A., Benoist G., Maurel J., Dreyfus M. Inflammatory bowel disease and pregnancy: report of 76 cases and review of the literature // J Gynecol Obstet Biol Reprod. 2005; 34:581–588.
8. Bermas BL, Hill JA Effects of immunosuppressive drugs during pregnancy // Arthritis Rheum. 1995. Vol. 17. P. 1722–1732.
9. Bomford JAL, Ledger JC, O'Keefe BJ et al. Ciprofloxacin used during pregnancy // Drugs. 1993. Vol. 45. P. 461–462.
10. Bortoli A. Inflammatory bowel disease and pregnancy. Preliminary results of a European multicenter prospective case-control study // Journal of Crohn`s and colitis. 2008; 2:2–3.
11. Brandt LJ, Estabrook SG, Reinus JF Results of a survey to evaluate whether vaginal delivery and episiotomy lead to perineal involvement in women with Crohn's disease // Am J Gastroenterol. 1995; 90: 1918–1922.
12. Bush MC, Patel S., Lapinski RH, Stone JL Perinatal outcomes in inflammatory bowel disease // J Matern Foetal Neonatal Med. 2004; 15: 237–241.
13. Calderwood AH, Kane SV IBD and pregnancy // MedGenMed. 2004; 6:14.
14. Caprilli R., Gassull MA, Escher JC et al. European Crohn's and Colitis Organisation. European evidence based consensus on the diagnosis and management of Crohn's disease: special situations // Gut. 2006;55(Suppl. 1):i36–58.
15. De Dombal FT, Watts JM, Watkinson G., Goligher JC Ulcerative colitis and pregnancy // Lancet. 1965; 25:599–602.
16. Diav-Citrin O., Park YH, Veerasuntharam G. et al. The safety of mesalamine in human pregnancy: a prospective controlled cohort study // Gastroenterol. 1998. Vol. 114(1). P. 23–28 and 32–34.
17. Dignass A. Crohn's Disease, Ulcerative colitis and pregnancy // Materials of Falk Symposium. 2002. Freiburg (Germany). P. 51.
18. Dominitz JA, Young JC, Boyko EJ Outcomes of infants born to mothers with inflammatory bowel disease: a population-based cohort study // Am J Gastroenterol 2002; 97:641–648.
19. Elbaz G., Fich A., Levy A., Holcberg G., Sheiner E. Inflammatory bowel disease and preterm delivery // Int J Gynaecol Obstet. 2005; 90: 193–197.
20. Ferrero S., Ragni N. Inflammatory bowel disease: management issues during pregnancy // Arch Gynaecol Obstet. 2004; 270:79–85.
21. Fielding JF, Cooke WT Pregnancy and Crohn's disease // BMJ. 1970; 2:76–77.
22. Fonager K., Sorensen HT, Olsen J., Dahlerup JF, Rasmussen SN Pregnancy outcome for women with Crohn's disease: a follow-up study based on linkage between national registries // Am J Gastroenterol. 1998; 93:2426–2430.
23. Gullibrand PN Systemic lupus erythematosus in pregnancy treated with azathoprine // Proc. R. Soc. Med. 1966. Vol. 59. P. 834.
24. Homan WP, Thorbjarnarson B. Crohn disease and pregnancy // Arch Surg. 1976; 111:545–547.
25. Hudson M., Flett G., Sinclair TS, Brunt PW, Templeton A., Mowat NA Fertility and pregnancy in inflammatory bowel disease //Int J Gynaecol Obstet. 1997; 58:229–237.
26. Ilnyckyji A., Blanchard JF, Rawsthorne P., Bernstein CN Perianal Crohn's disease and pregnancy: role of the mode of delivery //Am J Gastroenterol. 1999; 94:3274–3278.
27. Johnson P., Richard C., Ravid A. et al. Female infertility after ileal pouch-anal anastomosis for ulcerative colitis // Dis Colon Rectum. 2004; 47: 1119–1126.
28. Khosla R., Willoughby CP, Jewell DP Crohn's disease and pregnancy // Gut. 1984; 25:52–56.
29. Korelitz BI Inflammatory bowel disease and pregnancy // Gastroenterol Clin North Am. 1998; 27: 213–224.
30. Kornfeld D., Cnattingius S., Ekbom A. Pregnancy outcomes in women with inflammatory bowel disease—A population-based cohort study //Am J Obstet Gynecol. 1997; 177:942–946.
31. Lamah M., Scott HJ Inflammatory bowel disease and pregnancy // Int J Colorectal Dis. 2002; 17: 216–222.
32. Lene Riis, Ida Vind, Patrizia Politi et al. On behalf of the European Collaborative study group on inflammatory bowel disease (EC-IBD). Does pregnancy change the disease course? A Study in a European Cohort of Patients with Inflammatory Bowel Disease // Am J Gastroenterol. 2006; 101:1539–1545.
33. Mayberry JF, Weterman IT European survey of fertility and pregnancy in women with Crohn's disease: a case control study by European collaborative group // Gut. 1986; 27:821–825.
34. Miller JP Inflammatory disease in pregnancy: a review // JR Soc Med. 1986; 79: 221–225.
35. Modigliani R. Drug therapy for ulcerative colitis during pregnancy // Eur. Gastroenerol. Hepatol. 1997. Vol. 9. P. 854–857.
36. Mogadam M., Korelitz BI, Ahmed SW, Dobbins W. O, 3 rd, Baiocco PJ The course of inflammatory bowel disease during pregnancy and post partum // Am J Gastroenterol. 1981 a; 75:265–269.
37. Narendranathan M., Sandler RS, Suchindran CM, Savitz DA Male infertility in inflammatory bowel disease // J Clin Gastroenterol. 1989; 11:403–6.
38. Nielsen OH, Andreasson B., Bondesen S., Jacobsen O., Jarnum S. Pregnancy in Crohn's disease // Scand J Gastroenterol. 1984; 19: 724–732.
39. Nielsen OH, Andreasson B., Bondesen S., Jarnum S. Pregnancy in ulcerative colitis // Scand J Gastroenterol. 1983; 18: 735–742.
40. Norgard B., Czeizel AE, Rockenbauer M., Olsen J., Sorensen HT Population-based case control study of the safety of sulfasalazine use during pregnancy // Aliment Pharmacol Ther. 2001; 15:483–486.
41. Norgard B., Fonager K., Sorensen HT, Olsen J. Birth outcomes of women with ulcerative colitis: a nationwide Danish cohort study // Am J Gastroenterology 2000; 95:3165–3170.
42. Nwokolo CU, Tan WC, Andrews HA, Allan RN Surgical resections in parous patients with distal ileal and colonic Crohn's disease //Gut. 1994; 35: 220–223.
43. 43. Olsen KO, Joelsson M., Laurberg S., Oresland T. Fertility after ileal pouch-anal anastomosis in women with ulcerative colitis // Br J Surg. 1999; 86:493–495.
44. O'Morain C., Smethurst P., Dore CJ, Levi AJ Reversible male infertility due to sulphasalazine: studies in man and rat // Gut. 1984; 25:1078–1084.
45. Ording Olsen K., Juul S., Berndtsson I., Oresland T., Laurberg S. Ulcerative colitis: female fecundity before diagnosis, during disease, and after surgery compared with a population sample // Gastroenterology. 2002; 122: 15–19.
46. Rajapakse RO,Korelitz BI,Zlatanic J.,Baiocco PJ,Gleim GWOutcome of pregnancies when fathers are treated with 6-mercaptopurine for inflammatory bowel disease//Am J Gastroenterol.2000;95:684-688
47. Rogers RG, Katz VL Course of Crohn's disease during pregnancy and its effect on pregnancy outcome: a retrospective review // Am J Perinatol. 1995; 12: 262–264.
48. Schofield PF, Turnbull RB, Hawk WA Crohn's disease and pregnancy // BMJ. 1970; 1:364.
49. Subhani JM, Hamiliton MI Review article: the management of inflammatory bowel disease during pregnancy // Aliment Pharmacol Ther. 1998; 12: 1039–1054.
50. Willoughby CP, Truelove SC Ulcerative colitis and pregnancy // Gut. 1980; 21: 469–474.
51. Woolfson K., Cohen Z., McLeod RS Crohn's disease and pregnancy // Dis Colon Rectum. 1990; 33:869–873.

Key words: inflammatory bowel diseases, pregnancy, colitis, Crohn's disease, 5-aminosalicylic acid (5-ASA), hyperbaric oxygenation method.

Yu. B. Uspenskaya , Candidate of Medical Sciences G. A. Grigorieva , Doctor of Medical Sciences, Professor of MMA named after. I. M. Sechenova , Moscow

Flatulence

Flatulence during pregnancy is a common phenomenon; it is not surprising that this topic does not leave the agenda on online platforms open for virtual meetings of expectant mothers.

Gas formation, of course, is a problem not only for pregnant women, but it is during this period that it has its own special character and other reasons.

One of them is the increased level of progesterone (a hormone responsible for relaxing the muscles of the whole body, including internal organs).

As a result, the muscles in your intestines relax and digestion, including the movement of digested food through the lower part of the tract, slows down. This can now take 30% longer than before. This circumstance contributes to gas formation.

The tendency to flatulence increases in proportion to the increase in the size of the fetus in the womb, as the expanding uterus puts pressure on the walls of the abdominal cavity. This further slows down digestion and activates gas formation.

Since progesterone has a relaxing effect on the muscles of a pregnant woman, it is not easy for her to retain gases. One day you may find yourself in a situation where something similar happened in a public place, and it probably did not cause you great delight, even if you laughed it off and scolded the baby in your stomach.

Therefore, check out the possible solutions to this problem.

Unfortunately, it is impossible to get rid of gases during pregnancy. But to some extent, you can learn to manage this condition. Your main task is to minimize the frequency.

Some foods make you gassy, ​​no matter what you do. The following have been noted to have this effect on the body: legumes, peas, whole grains, broccoli, cabbage and Brussels sprouts, and zucchini.

Flatulence is caused by different foods in different people. You can start keeping a personal diary to track foods that give you gas.

Causes of stomach pain during pregnancy

For each pregnant woman, the causes of pain in the stomach are individual. The presence of pain syndromes is influenced by:

• Uterine growth

With each month of pregnancy, the size of a woman's uterus increases. This process provokes a rapid displacement of other organs in the human body. To rule out an inflammatory process and diagnoses, a pregnant woman should visit a doctor if she experiences stomach pain.

• Binge eating

Overeating affects the condition of the gastrointestinal tract. Pregnant women's hormonal levels completely change. In this regard, they do not always control the amount of food they eat. When overeating, a common result is severe stomach pain. Experts advise being careful with your menu and eating foods that contain minerals and vitamins. They are found in fruits and berries, vegetables, meat and seafood. A pregnant woman should have an individual menu. The medical professional will inform you about the characteristics of the body

• Toxicosis

In the first months of pregnancy, most pregnant women experience toxicosis - frequent nausea. This process is accompanied by severe stomach pain and cramps. Each body is individual, it is impossible to determine the cause of your pain without the help of a medical professional. This can only be done by an experienced doctor when conducting diagnostic examinations and studying your tests.

• Emotional condition

The hormonal background of a pregnant woman affects her emotional state. Many expectant mothers experience sudden changes in mood, frequent stress and aggression, and panic for no reason. All systems in the human body are interconnected. In this regard, any reaction of the nervous system and mood of the pregnant woman affects other systems. Mood changes in some cases cause cramps and cutting pain in the stomach.

• Acute pain in the stomach in pregnant women is caused by bowel dysfunction

Experts classify gastrointestinal tract disorders, popularly as diarrhea and constipation. A pregnant woman is advised to pay attention to her diet, exclude fried, flour, and sweet foods. A specialist will help you create an individual diet.

• Infection

A pregnant woman's body is weak. During this period, women are most susceptible to infections. Acute pain in the stomach indicates the presence of an infectious process in the body.

• Allergy

If pain syndromes appear in a pregnant woman, the doctor may determine the development of allergies. An immunologist will help establish an accurate diagnosis.

• Appendicitis

During pregnancy, the stomach may hurt due to appendicitis. A woman experiences severe cutting pain in her lower abdomen. The pain intensifies with movement. Severe pain is characterized by nausea, vomiting, fever, lack of appetite and weakness.

How to avoid gas formation

General recommendations for reducing and, if you're lucky, preventing gas formation are as follows:

• avoid or limit the consumption of foods and liquids that traditionally cause flatulence - legumes, cabbage, zucchini, carbonated drinks - and those that have a similar effect on you;
• do not eat fatty fried foods;
• drink from a glass without using a straw;
• avoid tight, tight clothing around the waist;
• eat small meals 5-6 times a day;
• give yourself physical activity, do exercises for pregnant women;
• limit or eliminate artificial sweeteners;
• drink more fluids;
• eat slowly, chewing your food thoroughly.

The last point is one of the most reliable ways to combat flatulence. Basically, gas is caused when the bacteria that lives in the intestines and is responsible for breaking down food that has not been thoroughly chewed by you and digested by enzymes in the stomach does not have time to cope with its function.

Increased gas production does not cause any harm to your baby. It may bother you a lot, but he doesn’t care at all. Therefore, concentrate on consuming foods that have high biological and energy value, which will provide you and your baby with all the necessary vitamins.

In conclusion, we would like to remind you of the principles of healthy eating during pregnancy, which are advisable to adhere to in order to prevent or alleviate digestive problems.

Nutrition for good digestion

Traditional dietary recommendations for pregnant women include the following:

Proteins:

• lean meat,
• fish,
• bird,
• eggs,
• legumes;

Carbohydrates:

• vegetables and fruits,
• bread and cereals are the main source of energy;

healthy fats - polyunsaturated fatty acids:

• vegetable oils,
• fish fat,
• nuts;

Dairy and fermented milk products:

• pasteurized milk,
• kefir,
• cottage cheese,
• cheese,
• yogurt;

Vitamins and minerals:

• folic acid,
• vitamin C,
• calcium,
• magnesium,
• iron,
• B vitamins are the most important during pregnancy;
• liquid - 2 liters per day (with normally functioning kidneys);
• refusal of alcohol, high doses of caffeine, sweet carbonated drinks, preservatives, food colorings, taste improvers, semi-finished products, processed meat products (sausages), trans fats (fast food), raw, dried, smoked meat and fish, raw eggs, unpasteurized milk , fermented cheeses, salty, fatty, spicy foods, products of questionable quality and freshness;
• 5 – 6 meals a day in small portions. This is especially important as the fetus grows: the usual serving size in the second half of pregnancy will make you feel heavy, lead to bloating and excess gas formation. It is also important not to skip meals, not to take long breaks between meals, and not to eat at night. It is recommended to take the liquid 30 minutes before or 30 minutes after meals, but not during;
• biologically and energy-rich food from fresh and high-quality food products.

A balanced diet is the best guarantee that you and your baby will get all the necessary nutrients from food. Vitamin supplements are a good addition to a properly formulated diet (however, they should not replace it!).

A set of measures to improve digestion will be incomplete without mentioning physical exercises, which can alleviate the condition, as well as create a psychological attitude towards a positive attitude towards life and the changes occurring in the body of the expectant mother.

Gymnastics for pregnant women

Here are exercises that have proven effective in normalizing the functioning of the gastrointestinal tract.

• Cat pose. This is one of the best asanas in yoga; it increases the flexibility of the spine and relieves muscle tension that affects the functioning of internal organs. The pose is so good that even ardent opponents of yoga have included it in the list of recommended exercises for pregnant women.

Technique: position on all fours, knees exactly under the pelvic bones, hands under the shoulders, legs and arms are in the same line. We alternately bend and bend in the lumbar and thoracic spine. When the back is rounded, the head is tilted down, the eyes look at the floor. When a bend is made, the head rises and the gaze is directed upward. Inhalation is done in the position of an arched back, exhalation - in a concave position.

• Kegel exercises.
• Gentle exercises for pregnant women to warm up all the muscles of the body. Exercises in a squatting position, stretching, gentle turns, and gentle twists are especially useful. Exercises that affect the muscles of the neck, back and especially the pelvis directly affect the functioning of internal organs, including the digestive system.

In addition to physical exercise, the following have a good tonic effect on the body and a relaxing effect on the muscles:

• aerobics;
• callanetics;
• dancing;
• swimming (water aerobics for pregnant women);
• walking is the simplest and most accessible type of physical activity for every pregnant woman; Walking at an intense pace in the fresh air is especially good;
• jogging (for those who were actively jogging before pregnancy);
• yoga - when performing some poses, not only positive changes in physical fitness were noticed, but also improved mood, better sleep and increased overall endurance (including psychological), which is very important for a pregnant woman.

Remember that before you start engaging in any physical activity, you need to consult a doctor, and it is better to familiarize yourself with the technique of performing specific exercises in special classes for pregnant women.

Whatever type of physical activity you choose for yourself, remember about moderation (30 minutes a day is the optimal level of exercise for non-athletes), listen to the signals that your body sends you, and avoid physical fatigue, dizziness, and irregular heartbeat and breathing. Physical exercise should bring not only health to the body, but also joy to the spirit - only in this case will the expected positive effect be felt.