All About Gastroparesis & Pregnancy
Since giving birth in 2012, I’ve received a lot of questions related to GP and pregnancy. I’ve done my best to compile and answer all of them below.
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, conversations I’ve had with clients and doctors, and my own research. If you have questions about your personal situation, you should always consult your doctor or other healthcare provider.
General Questions
Can women with gastroparesis get pregnancy 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 woman 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 recommend having a management plan in place before becoming pregnant, when possible. (See “Before Getting Pregnant” below.)
Is pregnancy with gastroparesis considered high-risk? Can I 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, the company that makes the device, 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 important to weigh the pros and cons with your doctor before making a decision.
Before I got pregnant, I talked with a VP 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.
I would suggest having a plan in place if you need an emergency C-section. I attached a copy of an x-ray showing the placement of the device/leads to my birth plan. C-section surgery takes place significantly lower than the typical placement of a gastric neurostimulator, however, and would likely pose no problem according to the OB/GYN I consulted.
I personally wouldn’t avoid getting the device because you want to get pregnant or avoid getting pregnant because you have the device. To date, I have heard of no complications directly related to having the gastric neurostimulator in place and/or turned on during pregnancy.
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. My answer was, “not really.” Is there some of kind of genetic predisposition that makes people more likely to end up with idiopathic gastroparesis? Maybe, I really don’t know.
But, in my opinion, gastroparesis that’s not caused by an underlying medical condition (type 1 diabetes, mitochondrial disorders, etc.) is most likely the result of a combination of factors, only of one of which is genetics. Overall health, gut bacteria, medications, chronic stress, trauma, viruses, hormones… all of these things (and more) likely contribute to the development of delayed gastric emptying.
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.
Will gastroparesis 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.
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 gastroparesis eat enough to nourish themselves and the baby?
Yes, though it may take a bit more effort and planning. A nutrient-rich, GP-friendly diet, combined with a good-quality prenatal vitamin, 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 gastroparesis increase the 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 Pregnancy
What things do I need to change or consider before getting pregnant?
As with nearly everything else involving gastroparesis, a little preparation and planning will likely improve your experience during and after pregnancy. I encourage women with GP to have a management plan in place before they get pregnant. This will likely 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 management plan, please don’t worry! There are a number of resources here to help you.
A great tool for getting your management plan in place is my Quick Start Guide to Gastroparesis Management. This 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
Iron
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 increase symptoms like nausea or constipation.
Throughout my pregnancy, I alternated a gummy vitamin with a liquid vitamin. I found these worked better for me than vitamin tablets.
Gummies typically do not contain iron, which is essential during pregnancy. 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 MegaFood Blood Builder, may be a better choice for many women with gastroparesis.
During 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 Eating for Gastroparesis, that means eating meals containing a balance of protein, carbohydrates, and fat, with foods in a variety of colors, usually 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. Meal replacement drinks 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 people with GP. My recommendation is to experiment with increasing your fat intake (nut butters, egg yolks, avocado, etc.), within your personal tolerance, to increase calories and nutrition without significantly increasing volume. As with everything related to gastroparesis, it’s okay to experiment to figure out what works for you.
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 lifestyle factors, particularly 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 shift some focus to these other areas.
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 Eating for Gastroparesis. Nearly all of the recipes in that book are, or can be modified to be, gluten-free, dairy-free, and low-FODMAP, yet they provide plenty of 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, unless your healthcare provider advises you otherwise.
That said, if you are following a GP-friendly vegan diet or if you have multiple food sensitivities/allergies, 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.
Listen here – Part 1: http://bit.ly/1bhGZha and Part 2: http://bit.ly/15VWZGf.
Some drugs prescribed for gastroparesis are known 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 I use instead of prescription drugs to manage symptoms?
As mentioned above, traditional medical management of gastroparesis is not always safe during pregnancy, so other symptom management tools may become more important.
Daily mild to moderate 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
acupuncture for nausea and constipation
hypnotherapy for gastroparesis-related symptoms.
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. Will it 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. If the lower GI tract is moving slowly, the less room there is for the upper GI tract to empty.
But just as gastroparesis symptoms improve for some women while they’re pregnant, so can constipation. Anecdotally, 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 and general GI motility. 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.
After Pregnancy
Can I breastfeed my baby if I have gastroparesis?
Yes. Breastfeeding with gastroparesis should be fine for both mom and baby, provided you can maintain adequate hydration and nutrition. I recommend following the nutrient-rich diet laid out in Eating for Gastroparesis and continuing to take a high-quality vitamin/mineral supplement. Some women may also benefit from adding a high-quality meal replacement/nutritional drink 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.
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. Dehydration may impact the micronutrient content of your breast milk, as well as impact your own well-being.
Will having gastroparesis 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 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 when possible. There is a saying among midwives: “Five days in the bed, five days on the bed, five days around the bed.” But don’t put any additional pressure on the situation. It’s true that lack of sleep can exacerbate gastroparesis symptoms in the short term but so can stress and worry. Rest when you’re able to. Engage in things that bring you joy. Be gentle with yourself. Ask for and accept help.
You might consider hiring a postpartum doula, who can help with meal preparation, cooking, and also caring for and supporting you.
If you have friends and family close by and you’re interested in having visitors, consider setting up a schedule – again do this before you give birth – for them to stop by to help, visit, and offer support.
Nutrition is important in the postpartum period, whether you are nursing your baby or not. If you think you’ll struggle with having the time to eat well once the baby arrives, consider making smoothies, juices, and soups in advance and freezing them.
If you find yourself struggling with depressed or anxious thinking after giving birth, please know that you’re not alone. I struggled with severe postpartum anxiety and panic after I had my daughter. The good news is there is so much hope and help out there!
Start with my Feeling Anxious? page.
How do I stick to my management plan after the baby is born?
I want to first say that you don’t have to “stick to” anything. We’re all doing the best we can, always. Sometimes that means following a plan and sometimes it doesn’t. The biggest reason I suggest having a plan in place before your baby is born is so that you have a good idea of what works best for you. Once you know that, you can hold things loosely and do what makes sense day to day.
Before I had Lily, for example, I used to walk 5 miles a day, every single day. Many years later, I still haven’t figured out how to fit that into my schedule as a stay-at-home/work-at-home mom. Instead, I take short walks whenever I’m able and integrate that into our playtime as much as possible.
Caring for yourself is still important, of course. Maybe now more than ever. One thing that does not belong on a postpartum management plan is “mommy guilt.” Taking care of yourself isn’t selfish. The other is perfectionism. Your management plan may look very different than it used to and that’s okay.
Logistically, you will probably need to ask for help — maybe more help than you think you “should” — 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” for yourself.
The bottom line is your management plan may look different than before you had a baby but what’s important is that you continue to prioritize the things that make you feel better. For most of us, that means eating nutrient-rich, GP-friendly food, getting as much sleep as possible, 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?
This, too, is different from person to person and there’s really no way to tell what will happen. Anecdotally, I’ve heard from many women whose symptoms improved during pregnancy and, for whatever reason, continued to be more manageable after giving birth. My own experience is very similar to that.
The truth is, all we can ever do is take it one day at a time and know that whatever comes, you are capable of handling it. Just as you’ve already done every step of the way.