Gastroparesis is a gastrointestinal disorder that requires serious lifestyle changes and great discipline. People with the disorder have limited food choices and a structure of feeding that must be strictly followed to avoid developing serious complications. Women are often more at risk for gastroparesis, which can be more problematic for pregnant women.
It is possible to have gastroparesis during pregnancy. However, there is no scientific evidence showing that gastroparesis can place pregnancy at risk. There is also no conclusive evidence showing that gastroparesis is genetically acquired.
This article will explain gastroparesis, its symptoms, factors, and causes as well as risks and complications. It will also explain how gastroparesis can affect pregnancy and how to manage gastroparesis for pregnant women.
What is Gastroparesis?
Gastroparesis, also referred to as stomach paralysis, is a gastrointestinal disorder where-in inadequate processing of food materials in the stomach hinders gastric emptying. Normally, the stomach muscles perform spontaneous movement using muscular contraction to churn food and deliver it to the small intestine in a consistent manner to allow the food to mix with the digestive juices found in the small intestine, liver, and pancreas. However, weakened stomach muscles as a result of gastroparesis prevents the stomach from processing food thoroughly, reducing or stopping motility.
Gastroparesis occurs mostly in women, occupying almost 80% of cases. Statistics have also shown that 40 women and 10 men experience gastroparesis out of a population of 100,000 people.
Some of the major symptoms of gastroparesis involve nausea, vomiting, acid reflux, bloating, and abdominal pains. However, a lot of people do not have noticeable signs of gastroparesis as some of the symptoms are similar to dyspepsia.
Gastroparesis, however, can culminate in vomiting recognizable food after a meal due to lack of stomach grinding. Some individuals can also vomit even with an empty stomach because of the accumulation of stomach acid.
Gastroenterologist, Dr. Nanda notes that gastroparesis has several categories: diabetic gastroparesis, idiopathic gastroparesis, and post-surgical gastroparesis.
Diabetic gastroparesis refers to the type of gastroparesis that occurs due to the damage to the vagus nerve that controls stomach muscle contraction. A damaged vagus nerve cannot send signals to the stomach muscles to process food. This nerve can be impaired as a complication of diabetes.
Some people also experience gastroparesis after a surgical operation, mostly on the gastrointestinal tract. This can be caused by an inadvertent disruption of the vagus nerve during operations like fundoplication, heart or lung transplant, or peptic ulcer surgery.
Idiopathic gastroparesis, however, is the second-most common type of gastroparesis after diabetes with no known cause or factors. Many people who do not have diabetes, have not undergone any surgical operations, and do not have any neurological or endocrine problems are categorized as having idiopathic gastroparesis.
Other suspected causes of gastroparesis involve blood mineral imbalance, specifically potassium, magnesium, and calcium. Hypothyroidism or the lack of production of thyroid hormones is also a possible cause as well as high glucose within the body.
More serious considerations for causes of gastroparesis are viral infection within the GI tract like gastroenteritis; connective tissue diseases like scleroderma; autoimmune GI dysmotility (AGID); or Parkinson’s Disease and multiple sclerosis. It is also possible for people with anorexia nervosa to temporarily experience gastroparesis until they resume their normal food and liquid intake.
Some medications are also suspected to cause gastroparesis. This can include narcotic pain medication, anti-depressants, and opioid pain relievers.
Gastroparesis complications can lead to hospitalization due to dehydration and malnutrition. It can also make diabetes symptoms worse as it hinders the ability to maintain optimal blood sugar levels.
In some cases, unprocessed food can ferment and lead to bacterial growth in the stomach. It can also harden inside the stomach and form bezoars.
Most importantly, gastroparesis symptoms can hinder day-to-day activities and make it difficult to keep up with tasks and responsibilities. People with gastroparesis require effective symptom management planning and lifestyle changes to mitigate its impact on overall life quality.
Risk on Pregnancy
People with gastroparesis can have a normal pregnancy and can give birth successfully. However, the experience of pregnancy for women with gastroparesis can widely differ.
Currently, there is no scientific study that shows that gastroparesis can put a woman’s pregnancy at risk. There is also no evidence showing that GI disorders like gastroparesis increase the risk of miscarriage.
However, consulting an obstetrician to monitor the status of pregnancy can relieve the stress that can often aggravate the symptoms of gastroparesis. Also, it is good to consult a motility specialist to learn more about proper symptom management that will not put the pregnancy at risk.
Some women with gastroparesis have a gastric neurostimulator which is an implanted device that sends electric impulses to the stomach to facilitate churning and alleviate gastroparesis symptoms. Some Doctors would advise not using the device during pregnancy due to the possible risk to the baby. However, increased stress and risk to maternal health due to gastroparesis symptoms can also put the pregnancy at risk.
There is no established scientific evidence showing the risks of using gastric neurostimulators on pregnancy. There is also no evidence of any complication on pregnancy that occurred due directly to gastric neurostimulators.
While medication such as erythromycin, which can alleviate symptoms of gastroparesis, is generally accepted as safe during pregnancy, it is still best to prioritize lifestyle changes, mild activities such as yoga, and intake of supplements over conventional medicine to maintain a proper margin of safety during pregnancy.
Is it Genetic?
Idiopathic gastroparesis may be genetic, but genetics alone cannot account for the complex nature of this disorder. If it is not caused by diabetes or surgery, it is likely a confluence of a multitude of factors including gut health, gut microbiome, hormones, diet, lifestyle, and genetics.
It can also be a result of pregnancy given that some women have only begun to experience symptoms of gastroparesis during pregnancy and did not exhibit symptoms afterward. Some women have also experienced symptoms during pregnancy and have continually experienced symptoms even after giving birth.
How to Manage Gastroparesis During and After Pregnancy
Despite the lack of study on gastroparesis and pregnancy, a lot of women have successfully given birth despite having the disorder. They have also been able to take care of their baby while managing the symptoms of the disorder.
It is important to have a comprehensive plan for symptom management and self-care during pregnancy. This will help remove the unnecessary burden and stress of enduring gastroparesis while nourishing the body during pregnancy.
A large part of the comprehensive plan is diet. A gastroparesis-friendly diet plan of pureeing and juicing can help increase nutrient, protein, and fiber intake without making it hard for the stomach to process the food. It is also important to avoid high-fiber and high-fat diets that can cause bloating and constipation
Taking prenatal vitamins along with a gastroparesis-friendly diet can also help nourish the body and the baby. However, you should consult with a Doctor to help avoid types of iron that can cause constipation.
Artificial nutrition can also help to supply ample nutrients into the bloodstream. Intravenous or parenteral nutrition involves injecting essential nutrients into the bloodstream using a catheter. This can help bypass the stomach for people with severe cases of gastroparesis.
Similarly, enteral nutrition uses a similar technique of avoiding the stomach for digestion. Nasojejunal tubes pass through the nostrils and into the GI tract, bypassing the stomach and injecting food directly into the jejunum, or the part of the small intestines that absorbs amino acids and fatty acids. Doctors often prefer enteral nutrition over parenteral nutrition because of the risk of infection.
Another part of the comprehensive plan is asking help whenever necessary. Hiring a doula during the pregnancy and after childbirth can help relieve stress, which can often trigger symptoms of gastroparesis. Consulting with a nutrition specialist can also help narrow down food choices that are both good for the mother and the baby.
Another component of the comprehensive plan is lifestyle changes. Drinking plenty of fluids including juice, broth, and low-fat soup throughout the day can help the stomach process solid foods and pass it on to the small intestines. Also, avoiding lying down for 4-5 hours or taking a gentle walk after eating can help take advantage of gravity to facilitate gastric emptying and also prevent acid reflux and other gastroparesis symptoms.
There is still no cure for gastroparesis given the difficulty of determining the exact cause of the disorder. However, lifestyle changes and medication can alleviate some of the symptoms.
Pregnant women with the disorder must ensure that they have a comprehensive management system for managing the symptoms of the disorder while maintaining a healthy lifestyle to take care of their mind and body, both for themselves and the baby.