Pregnancy can bring a mix of joy, excitement, and months of gastrointestinal (GI) issues like nausea or heartburn. But for people diagnosed with gastritis who are already grappling with digestive symptoms, it’s natural to wonder how pregnancy might worsen their condition.
Gastritis involves inflammation of the stomach lining, which doctors diagnose via biopsy. It can be triggered by a bacterial infection, long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, extreme stress, or alcohol, among other factors. With it can come symptoms such as nausea, vomiting, bloating, indigestion, and heartburn.
These happen to be common symptoms during pregnancy, too, because pregnancy can aggravate ongoing GI discomfort.
Here’s how pregnancy and gastritis can intersect, how to treat gastritis safely while expecting, and when to see the doctor.
Yes, it can, says Supriya Rao, MD, a gastroenterology, internal medicine, obesity medicine, and lifestyle medicine physician and a professor of gastroenterology at Tufts University in Massachusetts, where she treats people with digestive health issues, including gastritis.
“If you’ve had gastritis before, pregnancy can make it flare,” Dr. Rao says. “This is due to hormonal shifts, slower motility and the pressure of your growing uterus on your GI tract. Even stress can make symptoms worse.”
That said, pregnancy may not affect gastritis severity at all for some people, says the obstetrician/gynecologist Sarah Običan, MD, an associate professor of maternal-fetal medicine at the University of South Florida and medical director of MotherToBaby Florida, nonprofit providing evidence-based information on the benefit or risk of medications to pregnant and breastfeeding women.
If you’ve already been working with a gastroenterologist or a registered dietitian to manage your gastrointestinal symptoms through medication and lifestyle intervention, this could help lessen any symptoms you have, she says.
“In general, I warn [patients] that it may worsen during pregnancy, but sometimes the medication and adjustments they’re currently on will help them transition where it won’t be that bad in pregnancy at all,” Dr. Običan says.
Digestive symptoms linked to pregnancy can overlap with gastritis symptoms, she says. Researchers suggest gastroesophageal reflux disease (GERD) occurs in roughly two-thirds of all pregnancies, with a quarter of pregnant women experiencing heartburn daily. In some cases, symptoms may also include nausea and vomiting.
This is different from a true gastritis diagnosis, which is tied to inflammation in the stomach lining. “What most pregnant women are feeling is more likely due to reflux and slowed digestion, not true gastritis,” Rao says. “That being said the symptoms can overlap and it’s easy to confuse them.”
Whether you’re pregnant or not, there are several treatment options, including medical intervention and lifestyle changes, to treat and manage gastritis, Rao says. But caution with treatment choice is important during pregnancy.
“This can be a bit of a balancing act. Pregnancy changes everything including your hormones, digestion and even how your body responds to medications,” Rao says. “We just have to adjust as we go and focus on what’s safe and effective during pregnancy.”
During pregnancy, Rao recommends lifestyle changes as a first line of prevention and suggests pregnant women with gastritis try the following strategies before speaking to their doctor about medications:
Eat smaller, more frequent meals to lessen feelings of stomach discomfort and satiety
Avoid trigger foods, which are often spicy, fried, or acidic
Sit upright for the following hour after eating to encourage easier digestion
Sleep with your head elevated
Limit your caffeine intake, especially on an empty stomach
Avoid eating two hours before bedtime
Avoid NSAIDs, which pregnant people shouldn’t take anyway
Običan also recommends keeping a food journal and documenting what you eat everyday and how your body feels afterward. Keeping track of this will help you identify trigger foods that may be sparking discomfort and note what may be helping, such as taking a walk after meals to encourage digestion.
In some cases, though, medication is needed alongside these lifestyle changes during pregnancy. These may include:
Antacids. These are the first option when it comes to medication and are safe for pregnant women, Rao says. These are over-the-counter medications that neutralize stomach acid, decreasing symptoms like heartburn and indigestion quickly. They include aluminum hydroxide (Amphojel), magnesium hydroxide (Phillips' Milk of Magnesia), and calcium carbonate (Rolaids, Tums), among others.
H2 blockers. H2 blockers are also pretty safe and widely used during pregnancy, Rao says. They decrease how much stomach acid is secreted by glands in your stomach lining and include famotidine (Pepcid AC, Zantac 360), cimetidine (Tagamet), or nizatidine (Axid AR).
Proton pump inhibitors. PPIs are used in pregnant people whose symptoms are more severe, Rao says. They can be bought over-the-counter or with a prescription, and they help to reduce stomach acid that may be triggering uncomfortable symptoms. Common PPIs include include esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), and Pantaprazole (Protonix).
Antibiotics. In people who aren’t pregnant, doctors will prescribe antibiotics for seven to 14 days to treat infections like Helicobacter pylori (H. pylori).The most common antibiotics prescribed for H. pylori are amoxicillin, clarithromycin (Biaxin), metronidazole (Flagyl) and tetracycline. Doctors typically prescribe two at a time for H. pylori. This isn’t the case for pregnant women, though. “We typically reserve antibiotics only if we know there’s an H. pylori infection and even then, only certain ones are okay in pregnancy. It’s always a risk-benefit discussion,” Rao says.
Gastritis itself doesn’t directly harm the baby, says Rao. The potential issues are any gastritis symptoms that can cause additional problems for you, such as an inability to eat, dealing with ongoing inflammation, or feeling nauseous and throwing up, leading to dehydration.
“That can start to affect your overall health and potentially indirectly affect the pregnancy,” Rao says.
This is usually only in extreme cases of severe GI symptoms during pregnancy, which are rare, says Običan. Usually pregnant people can manage their GI symptoms via lifestyle changes and medicine.
If it does get to this level, an obstetrician/gynecologist may refer you for an upper endoscopy exam. That’s when a long, thin tube with a tiny camera is passed down the GI tract from the throat to examine the stomach and small intestine. From there, doctors will look for signs of inflammation and conduct a biopsy (remove a small sample of intestinal tissue for further examination.)If you become pregnant while dealing with an H. pylori infection, you may also encounter complications such as hyperemesis gravidarum, iron deficiency anemia, pregnancy-specific hypertensive disease like pre-eclampsia, and fetal growth restriction, according to research. Doctors will work carefully to treat your infection with a course of antibiotics that are pregnancy safe.
But if you're managing symptoms well and maintaining good nutrition and hydration levels, there’s typically no cause for concern when it comes to fetal development, Običan says.
Don’t brush off ongoing symptoms. According to Rao, you should reach out to your healthcare provider if you’re experiencing:
Upper abdominal pain that doesn’t go away
Severe nausea that persists past the first trimester
Unexplained weight loss
A noticeable decline in quality of life
Difficulty keeping liquids down and staying hydrated
In these cases, you may benefit from a referral to a gastroenterologist for further evaluation and personalized treatment. “Don’t tough it out. That’s when I’d prefer to be involved and dig a little deeper,” Rao says.
It’s also important to get these symptoms checked out before conceiving, too. A GI doctor can check for, diagnose, and treat gastritis or other GI conditions before you get pregnant, providing you with a personalized approach to manage lingering symptoms.
Pregnancy can worsen existing a variety of GI symptoms, including gastritis, as your body manages hormonal shifts, slower gut motility, and the pressure of your growing uterus on your GI tract.
Treatment of gastritis during pregnancy often involves lifestyle changes first, followed by options like antacids, H2 blockers, and, and PPIs. Lifestyle adjustments, such as eating smaller, more frequent meals, avoiding trigger foods, and sitting upright after eating can go a long way in managing gastritis in expectant moms.
Gastritis generally doesn’t harm the baby directly, but persistent symptoms should be managed to protect your overall health and your growing baby’s health.
