I recently mentioned that, with the release of the LWWGP Program, I’ve said pretty much everything I have to say about living WELL with gastroparesis. This is true with one exception: pregnancy. Throughout my own pregnancy (that’s my belly above), I did write several blog posts but I had planned to create a comprehensive eBook all about GP & Pregnancy after Lily was born. So far that hasn’t happened so I’ve decided instead to just post my answers to the most frequently asked questions about managing gastroparesis before, during, and after pregnancy.
Below the Q&As, I’ve included a list of all of the pregnancy-related blog posts I’ve written. I’ve also created an Amazon shop with direct links to the products mentioned below and my other favorite pregnancy-related items.
Please keep in mind that I am not a doctor. This post is for informational purposes only and is not to be considered medical advice. These are my opinions based on personal experience, the experiences of my clients, conversations I’ve had with doctors, and my own research. If you have questions about your personal situation, you should always consult your doctor or other healthcare provider.
Can women with gastroparesis get pregnant and have healthy babies?
Yes! It’s absolutely possible — and not uncommon — to become pregnant and give birth to a healthy baby despite a gastroparesis diagnosis. Unfortunately, there has been very little research on this topic and there are very few reputable resources available specifically for moms-to-be with GP. Partnering with an attentive, knowledgeable doctor with whom you feel comfortable is important, both for your well-being and your peace of mind.
Just like with gastroparesis in general, the experience of one pregnant women with GP may be vastly different than that of another. Typically the better your physical and mental health prior to pregnancy, the easier the pregnancy is likely to be. For this reason, I highly recommend having a comprehensive management plan in place before becoming pregnant whenever possible. (See “Before Getting Pregnant” below.)
Is pregnancy with gastroparesis considered high-risk? Can I still deliver with a midwife?
In general, having gastroparesis does not make a pregnancy high-risk but a doctor will be able to determine if your personal situation constitutes a high-risk pregnancy. When I consulted OB/GYNs prior to my own pregnancy, I was told that the best plan was to start out with a general obstetrician who would refer me to a high-risk OB (called maternal-fetal medicine specialists) if it became necessary. (It did not.)
The choice of whether to deliver with an OB/GYN, midwife, or family doctor is highly personal and should be based on your birth preferences and health circumstances. If your pregnancy is not considered high-risk, a midwife or family doctor will likely be able to follow your pregnancy and safely deliver your baby, with an obstetrician on-call in case surgical intervention is necessary.
I started my pregnancy with an OB/GYN but later switched to a hospital-based midwifery practice and then a family doctor. It was the family doctor that gave me the most personalized attention and made me feel most comfortable.
Is the gastric neurostimulator safe during pregnancy?
The gastric neurostimulator has not been studied for use during pregnancy and, as far as I know, Medtronic does not have an official recommendation on the subject. For that reason, some doctors will advise their patients to have the device turned off for the duration of the pregnancy. This may result in increased GP symptoms, compromising maternal nutrition and causing unnecessary stress. It’s vital that you weigh the pros and cons with your doctor before making a decision.
Before I got pregnant, I talked with the VP of Enterra sales at Medtronic and he said that it wasn’t necessary to turn off my device and that there were no known issues with pregnancy related to the device. Based on that information, as well as discussions with my motility specialist, the surgeon who placed the device, and several OB/GYNs, I chose to keep my device on and at my normal settings throughout the duration of my pregnancy. The only effect was some mild pain around the site of stimulator in the final trimester, which would have likely occurred even if the device had been turned off.
For more information, visit www.EnterraTherapy.com.
Is gastroparesis genetic? Will my baby have it, too?
During my pregnancy, a lot of people asked me if I was worried that my baby would have gastroparesis. Honestly, I was worried about a lot of things but that wasn’t one of them. Is there some of kind of genetic predisposition that makes people more likely to get idiopathic gastroparesis? I don’t know for sure but, even if there is, our genes aren’t everything.
In my opinion, gastroparesis that’s not caused by an underlying condition (diabetes, mitochondrial disorders, etc.) is most likely the result of a combination of factors, only of one of which is genetics. Overall gut health, gut bacteria, medications, diet, chronic stress, trauma, viruses, hormones… all of these things (and more) may contribute to the development of delayed gastric emptying.
Personally I’d say the stress of worrying about your baby developing GP is more potentially harmful than whatever unknown predisposition you might be passing on. If you have a known genetic condition underlying the gastroparesis diagnosis, it’s best to talk with a genetic counselor about the potential risks of passing those genes on to a child.
Update: since writing this post, I’ve discovered that my gastroparesis is actually not idiopathic but is secondary to Ehlers Danlos Syndrome. EDS is a genetic condition and there’s a 50% chance that I passed it onto Lily. I’m still not terribly concerned that she will develop gastroparesis, though, as I believe there are many factors that determine outcomes. For example, we now know that both my mother and my brother also have EDS and neither have gastroparesis. Of course, I will be watching her closely and will pay attention to any signs that she may be struggling with motility issues.
Will the GP symptoms get worse while I’m pregnant?
Again, there’s no research on this topic but based on the women I’ve talked to it seems that some people feel better while they’re pregnant (I was in this group), some people feel worse, and some people feel about that same. While there’s no sure-fire way to predict which group you’ll fall into, my personal opinion is that the stronger your comprehensive management plan when you get pregnant, the more likely you’ll be able to manage your symptoms and nourish yourself and your baby even if things change.
If you’re increasingly sick during the first trimester, don’t automatically assume it means the gastroparesis is getting worse and will continue to get worse throughout the pregnancy. Many women, even those without GP, experience daily nausea and vomiting during the first 12-13 weeks of pregnancy. You may find that you feel significantly better once your second trimester arrives.
Can someone with GP eat enough to nourish a baby?
Yes, though it will likely take some effort and planning. A nutrient-rich, GP-friendly diet, combined with a good-quality prenatal vitamin, all in the context of a comprehensive management plan will likely provide the nutrition that both you and your baby need during pregnancy. I discuss this in more detail in the “During Pregnancy” section below.
If symptoms are severe and nutrition becomes a concern, artificial nutrition is an option.
Does GP increase risk of miscarriage?
As far as I know, there’s no evidence that having a functional gastrointestinal disorder, including idiopathic gastroparesis, increases the risk of miscarriage. If you have an underlying condition that’s causing the gastroparesis, it’s important to talk with your healthcare practitioner about any implications that condition may have for pregnancy.
Before Getting Pregnant
What things do I need to consider or change before trying to get pregnant?
As with nearly everything else involving gastroparesis, adequate preparation and proper planning will likely improve your experience during and after pregnancy. I encourage women with GP to create and implement a comprehensive management plan before they become pregnant. This will help you improve your symptom management, nutrition, and quality of life and help you discover a number of self-care tools that you can use throughout the duration of your pregnancy when conventional medical treatment for GP may not be ideal.
If you’re currently pregnant and you don’t have a comprehensive management plan in place, don’t worry! Stressing about it is the least healthy thing you can do – for yourself and your baby. Simply start now.
The best resource I can offer for getting a management plan in place is the Living (Well!) with Gastroparesis Program. This program takes 12 weeks to complete… which means if you’re in your first or second trimester, you can complete it before the baby comes and you’ll be much better prepared for caring for yourself in the postpartum period.
Another helpful resource for getting your management plan in place is my Quick Start Guide to Gastroparesis Management. This is a free 40-page eBook that will take you through making some quick but effective changes in all areas of your management plan. It wasn’t written specifically with pregnant women in mind, but much of the information will be applicable even if you are currently pregnant.
How can I prepare for getting pregnant?
If possible, it’s helpful to talk with both your motility specialist and your OB/GYN or midwife prior to becoming pregnant so that you have a plan in place for how you’ll handle symptom management, medication, nutrition concerns, etc. You might also want to ask your doctor(s) to run some blood tests to check your general nutrition status and identify any deficiencies prior to pregnancy.
These might include:
- CBC (complete blood count)
- Metabolic Panel (measures electrolytes and blood sugar)
- Folic Acid
- Vitamin B12
- Vitamin D
- Ferritin (measures amount of iron stored in the body)
- Albumin/Prealbumin (markers for malnutrition)
Before you become pregnant, I also recommend experimenting with prenatal vitamins. Most practitioners will recommend a daily prenatal vitamin during pregnancy and this is probably even more important for those women with gastroparesis. Not all vitamins are tolerated equally well (or poorly), however, and it might take some trial and error to find one that doesn’t provoke symptoms like nausea or constipation.
Throughout my pregnancy, I alternated VitaFusions Prenatal Gummies and Oxylent Prenatal powder. I found these worked better for me than vitamin tablets. The gummies do not contain iron, which is essential. The type of iron used in most supplements can be constipating, however, which can significantly worsen gastroparesis symptoms. An additional supplement with easier-to-tolerate iron, such as Blood Builder, may be a better choice for many GPers. (I’ve linked directly to these products in my Amazon shop.)
Again, my best piece of advice if you’re struggling to get your body ready for pregnancy, would be to go through the Living (Well!) with Gastroparesis Program. The 12-week program will help you better manage your symptoms, change the way you think about life with GP, and provide you with a number of tools that you can use to optimizing your nutrition and overall well-being before, during, and after pregnancy.
Should I eat differently while I’m pregnant?
Nutrition during pregnancy matters, particularly for moms. I recommend following a nutrient-rich, GP-friendly diet while pregnant. As I discuss in the new edition of Eating for Gastroparesis, that means eating small meals containing a balance of protein, carbohydrates, and fat mostly from whole foods about 4-6 times per day. You may need to eat more frequently while you’re pregnant, perhaps adding nutrient-rich liquids as snacks between meals.
Juicing is a great way to increase nutrition and fruit/veggie intake without increase fiber consumption. (More info about juicing here.) Meal replacement drinks, specifically Orgain, can also be helpful for increasing both protein and nutrient intake without increasing solid food consumption.
While pregnant you may find that you’re hungrier than normal. This can be challenging for those with gastroparesis because your stomach may still be emptying slowly. This results in a “hungry but full” feeling that’s familiar to many GPers. My recommendation is to experiment with an increase in healthy fat intake (nut butters, coconut oil, egg yolks, avocado, etc.), within the GP-friendly guidelines, to increase calories and nutrition without significantly increase volume. As with everything related to gastroparesis, experimentation may be required to figure out exactly what works for you.
I suggest getting a nutrient-rich, GP-friendly diet in place prior to becoming pregnant, if possible. If often does involve a fair amount of experimentation and it may be more difficult to do that once pregnancy symptoms start. You’ll find all of the guidelines of a GP-friendly diet, as well as a sample 4-day meal plan, and 80 nutrient-rich, GP-friendly recipes in the new edition of Eating for Gastroparesis.
**Coupon for Mamas-to-Be (or soon to be mamas-to-be!) –> Enter code PREGNANT to save 20% on the Eating for Gastroparesis eBook.**
You may find that you can tolerate more foods and/or a larger volume of food while you’re pregnant. If this is the case, enjoy it! Eating foods that are not GP-friendly will not make gastroparesis worse in the long-term even if your typical symptoms and tolerances return after your baby is born. Whatever you tolerate while you’re pregnant, eat it with pleasure!
It’s important to know that dietary tolerances are not static, even before pregnancy. For many people, their dietary tolerances are significantly impacted by their lifestyle choices, particularly adequate sleep, stress management, and physical activity. If you know that you need to improve your nutrition before or during pregnancy, that’s even more reason to focus on these other areas of your management plan.
Can I still eat gluten-free/dairy-free/low-FODMAP, etc. while pregnant?
In my opinion, yes, so long as you are eating a varied, nutrient-rich diet similar to what I describe in the new edition of Eating for Gastroparesis. Nearly all of the recipes in that book are gluten-free, dairy-free, soy-free, and low-FODMAP, yet they provide plenty of real-food nutrition.
If you feel significantly better without wheat/dairy/high-FODMAP foods in your diet, I personally see no reason to add them back in just because you’re pregnant. All of the nutrients that you get from those foods can be obtained elsewhere. Calcium, for example, can be obtained through fortified non-dairy milks, leafy greens (cooked, juiced, or in a smoothie), bone broth, and blackstrap molasses. Eating foods that exacerbate your symptoms will likely make your experience more difficult, if not compromise your overall nutrition in the long-run.
All of that said, if you have any questions about your personal nutrition requirements or restrictions, it’s best to talk with a nutrition professional.
NOTE: If you are following a GP-friendly vegetarian or vegan diet, I recommend working with a nutrition professional throughout your pregnancy to ensure that you can meet all of your and your growing baby’s nutritional needs.
Can I take my medications during pregnancy?
I’m neither a doctor nor a pharmacist, so I recommend talking with your healthcare practitioner directly about the medications that you’re currently taking and whether or not they are safe during pregnancy. There are many gray areas in which the pros of symptoms management must be weighed against the cons of lack of information regarding impact on the baby.
Chelsey McIntyre, the “Gastroparesis Pharmacist,” is a great resource. She and I recorded a Q&A in which we talk about several drugs commonly used to treat gastroparesis and their use during pregnancy/breastfeeding.
Some drugs prescribed for gastroparesis are know to be safe during pregnancy. Zofran, for example, is commonly prescribed to those without gastroparesis to treat nausea and vomiting associated with “morning sickness.”
Likewise, erythromycin has been widely studied and found to be safe during pregnancy. It should not be used while breastfeeding, however, as it is secreted in breast milk and has potentially serious side effects for the baby.
There’s very little information on the use of domperidone in pregnancy because it’s not approved by the FDA. If you’re currently taking domperidone and you hope to become pregnant, it’s important to talk with your doctor about whether or not you should continue taking it once you become pregnant. In terms of breast feeding, domperidone is known to be transferred in breast milk but there haven’t been any reports of toxicity in babies. Because of the potential cardiac side effects of domperidone, however, it’s important to be aware of any possible heart issues.
Reglan is not well studied in pregnancy. It has been shown to be safe when used for 1-2 weeks but it has not been studied longer than that. Using Reglan during pregnancy is typically only recommended when the benefit far outweighs the potential risks. Reglan is secreted in breast milk but studies have shown that the amount that a baby consumes is much lower than normal doses and side effects are unusual. Still, it would be wise to monitor your baby closely and pay attention to their muscle movements in particular if you’re taking Reglan while breastfeeding.
What can I use instead of my prescription drugs to manage symptoms?
As mentioned above, traditional medical management of gastroparesis is not always safe during pregnancy, so the other areas of the comprehensive management plan become even more important during this time. Daily mild physical activity (such as walking), gentle prenatal yoga or a similar relaxation practice, supplements, and certain complementary therapies can help to alleviate symptoms associated with both GP and pregnancy.
Drug-free remedies/treatments that you might helpful include*:
- Iberogast for nausea, heartburn, and fullness.
- vitamin B6 to reduce nausea.
- magnesium for constipation and restless leg syndrome.
- acupuncture for nausea, constipation, and fatigue.
- hypnotherapy for gastroparesis-related symptoms.
Though not ideal, by the end of my third trimester I was taking Tums almost daily for heartburn. Acid neutralizing medications like Tums have less of an impact on digestion and absorption of vitamins/minerals (especially vitamin B12 and iron) than prescription or over-the-counter acid suppressing medications (PPIs, H2 blockers, etc).
*This is not medical advice. Please talk with your healthcare provider to determine what’s appropriate for you.
I already struggle with constipation. Won’t this get worse during pregnancy?
Possibly. Constipation is a common symptom in pregnancy, even for those without functional gastrointestinal disorders. Constipation is problematic for people with gastroparesis, not just because it’s uncomfortable, but also because it can further delay gastric emptying. The more slowly the lower GI tract is moving, the more slowly the upper GI tract will move.
But just as gastroparesis symptoms improve for some women while they’re pregnant, so can constipation. I struggled with constipation for nearly as long as gastroparesis and was diagnosed with colonic inertia (slow motility of the large intestine) a couple of years before I got pregnant.
At that time I needed stimulant laxatives regularly (up to 12 at a time) in addition to a high dose of Prucalopride, a prescription drug for chronic constipation that’s not currently available in the US. Neither of these interventions are considered safe during pregnancy and had to be discontinued as soon as I found out I was pregnant.
Fortunately, the constipation slowly improved during pregnancy and it continued to improve after I gave birth. I did have to take a small dose of stimulant laxatives and/or use enemas on a handful of occasions during pregnancy. This wasn’t ideal but my doctor and I determined the pros outweighed the cons until later in pregnancy. Overall, the constipation was significantly less problematic than it had been in the years prior.
Two-and-a-half years later, despite taking no prescription or over-the-counter medication for constipation, I still have fairly regular bowel movements. I do have “flare ups,” particularly around my menstrual cycle, but the difference is night and day from what I dealt with before I got pregnant.
If you’re struggling with constipation prior to pregnancy, I highly recommend listening to this FAQ video as a starting point. Just like with GP, the more strategies you have in place, the better your experience is likely to be if you do find that you become increasingly constipated during pregnancy.
Can I breastfeed my baby if I have GP?
Absolutely. Breastfeeding is healthy for both mom and baby, provided you’re working to obtain adequate hydration and nutrition. I recommend following the nutrient-rich diet laid out in the new edition of Eating for Gastroparesis (published September 2014) and continuing to take a high-quality vitamin/mineral supplement. Some women may also benefit from adding a high-quality meal replacement/nutritional drink, such as Orgain, as a snack or additional meal during the day.
Juicing is also a great way to increase both fluid and nutrient intake. I highly recommend juicing both during and after pregnancy. You can find more information about juicing for gastroparesis here.
If you struggle with dehydration as part of gastroparesis and you want to breastfeed your baby, it’s important to talk with your doctors about this and have a plan in place before giving birth. Severe/on-going dehydration may impact the micronutrient content of your breast milk, as well as impact your own well-being.
Will having GP affect my recovery postpartum?
The postpartum period tends to be exhausting and often overwhelming even in the best of circumstances. Many of us plan for pregnancy and birth but never plan for what comes next. I think it’s really important to have a “postpartum plan” in place before you give birth, both for managing gastroparesis and for recovery from pregnancy/birth.
The most important thing you can plan to do for at least two weeks following the birth of your baby is rest. There is a saying among midwives: “Five days in the bed, five days on the bed, five days around the bed.” When dealing with a condition like GP, this rest and recovery time becomes even more important. Lack of sleep and on-going physical, mental, or emotional stress are significant triggers for gastroparesis symptoms. It’s a cliche to say “sleep when the baby sleeps,” but it’s good advice. Sleep as much as you can and engage in activities that make you feel calm and/or joyful as frequently as possible.
You might consider hiring a postpartum doula, who can help with meal preparation, cooking, and also caring for and supporting you. In our culture, this may be seen as unnecessary or indulgent but it’s only in the recent past that women have been expected to get right back to their household responsibilities while recovering from birth and taking care of a newborn. Add caring for yourself to this list and it’s an unrealistic expectation at best.
Support is really important during this time. If you have friends and family close by, consider setting up a schedule – again do this before you give birth – for them to stop by to help, visit, and offer support. If you don’t have a support system locally and it’s not possible for loved ones to be with you in person, at least set up appointments for Skype or FaceTime. Feeling alone or isolated increases stress, which impacts both postpartum recovery and gastroparesis management.
Nutrition is important in the postpartum period, whether you are nursing your baby or not. As I mentioned above, I recommend following the guidelines in the 2014 edition of Eating for Gastroparesis and continuing to take a high-quality vitamin/mineral supplement. If you think you’ll struggle with having the time to eat well once the baby arrives, consider making smoothies, juices, soups, bone broths, and/or purees in advance and freezing them. (You’ll find recipes for all of these things in the 2014 edition of Eating for Gastroparesis.)
**Coupon for Mamas-to-Be (or soon to be mamas-to-be!) –> Enter code PREGNANT to save 20% on the Eating for Gastroparesis eBook.**
If you experience trauma related to giving birth, it’s important to address this with a qualified mental health practitioner as soon as possible. If you find yourself struggling with symptoms of depression or anxiety, common both after pregnancy and among those with gastroparesis, talk with your doctor right away. Whether or not medication is deemed necessary, keeping up with all areas of your comprehensive management plan — including a nutrient-rich diet, physical activity, purposeful relaxation, support, and self-care — is likely to help with your mental health, as well.
How do I stick to my management plan after my baby is born?
If you’re planning or pregnant — especially with your first child — life will definitely change after the baby comes and this will likely affect your management plan. Your priorities and your limitations, particularly those on your time and possible finances, will change. It’s about doing the best you can with what you have and remembering that something is always better than nothing.
Before I had Lily, for example, I used to walk 5 miles a day and practice yoga several times a week. Two-and-a-half years later, I still haven’t to figure out how to fit that into my schedule as a stay-at-home/work-at-home mom. Instead, I try to be as active as possible throughout the day and I fit in formal exercise whenever I can. I feel noticeably better when I practice yoga regularly, so that’s something I try to make a real priority in the small amount of free time that I have.
It’s really important to remember that caring for yourself is still important — maybe even more important — when you’re caring for a baby. The better you feel physically, mentally, and emotionally, the more present, attentive, and loving you can be for your family. The one thing that does not belong on a postpartum management plan is “mommy guilt.” Taking care of yourself isn’t selfish. Is is essential.
Logistically, regular self-care may not be easy (unless you are blessed with a good sleeper!). You will probably need to ask for help with cleaning, cooking, and/or childcare from your spouse/partner, family members, or friends. Again, set this up advance and actually schedule in help at a specific day and time for those first several weeks so that you know you have “x number of hours per week” to devote completely to self-care. (And then use them for self-care!)
If you can afford it, hired help may be even better. You can hire people to clean your home, cook your meals, run your errands, even get your groceries. Consider asking friends and family to contribute to a “Postpartum Fund” as part of your baby shower in lieu of things that you really don’t need (like a wipe warmer). Use that money to hire help, get a postpartum massage, or otherwise engage in activities that nourish you.
The bottom line is that though your management plan may look different after your little one born, what’s important is that you continue to prioritize your own well-being and make time to do the things that you know make you feel better. For most of us, that means eating nutrient-rich, GP-friendly food, getting as much sleep as possible, practicing purposeful relaxation (meditation, breathing exercises, prayer, etc.) for at least 5-10 minutes per day, regular physical activity in some form, engaging in activities that bring us joy, and spending time with people we love.
Will my symptoms change after I give birth?
Again, this is different from person to person. I have heard of women who experienced a resolution of their symptoms during pregnancy that didn’t return afterward. I have also heard of women who first experienced gastroparesis during pregnancy and it didn’t go away afterward. There’s really no way to tell what will happen, though it seems most common – based solely on my observations – that symptoms improve during pregnancy and may get worse again afterward, though the extent to which that happens varies a great deal.
In my personal experience, my symptoms improved significantly during pregnancy. When my daughter was about 6 months old, I started to notice an increase in reflux symptoms again, along with stomach and non-cardiac chest pain. Lily is two-and-a-half now and my symptoms are worse than they were during pregnancy but not as bad as they were prior to pregnancy.
I think it’s important to note, however, that my comprehensive management plan is far less strong now than it was before or during pregnancy, particularly when it comes to sleep and physical activity (both of which have a significant impact on digestive symptoms). My diet is also much “looser” than it’s been in the past decade, particularly when it comes to fat intake. My guess is all of that has more to do with how I experience symptoms than an actual change in gastric emptying and if I were “tighten up” my plan all the way around, I might feel pretty close to how I did during pregnancy.
Since we cannot predict what will happen at any stage of pregnancy, my advice is to take the time before the baby comes to figure out how you will continue with your management plan (as best as you can) and how you will handle a potential increase in symptoms. The stress of worrying and anticipating those symptoms will almost certainly negatively impact your experience (and your digestion), so do your best to know that you have a plan in place and then relax and enjoy this transformative time in your life.
Blog Posts Related to Pregnancy
- http://livingwithgastroparesis.com/gp-pregnancy-food-rut/ (17 weeks + Nutrition)
- http://livingwithgastroparesis.com/gastroparesis-pregnancy-appreciation (1/2 way update)
Be Your Own Advocate during Pregnancy
- http://livingwithgastroparesis.com/always-be-your-own-advocate-a-k-a-blood-for-my-birthday/ (25 weeks)
Traveling while Pregnant
Birth & After Story
Be Your Own Advocate Post Pregnancy
Post Pregnancy (Coping)
Nutrition while Breast Feeding