Guide
Pregnancy and your gut: common problems and what to eat
Pregnancy changes how the whole digestive system works. Hormones slow the gut and relax the valve at the top of the stomach, and the growing baby presses on the stomach and bowel. Most of these changes are normal and settle after delivery, and simple habits help a lot. A few problems, especially of the liver, need prompt care.
In short
Nausea, acidity, constipation and bloating are very common in pregnancy and are usually not harmful. Small, frequent meals, plenty of water, fibre and gentle activity help most women. Yellow eyes, severe upper belly pain, vomiting that stops you keeping fluids down, or itching of the palms and soles need prompt medical care.
What to expect, trimester by trimester
Weeks 1 to 13
First 3 months
- Nausea and vomiting, often worst in the morning
- Dislike of some foods and smells
- Bloating and fullness
Weeks 14 to 27
Middle 3 months
- Nausea usually settles by 16 to 20 weeks
- Constipation and gas
- Acidity starts for many women
Weeks 28 to 40
Last 3 months
- Heartburn, worse after meals and lying down
- Constipation and piles
- Itching: tell your doctor, as it can be a liver problem
Common problems and what helps
Nausea and vomiting
Up to 8 in 10 women feel sick in early pregnancy. It usually starts by 6 weeks and settles by 16 to 20 weeks.
What helps
- Eat something dry, such as plain biscuits, khakhra or roasted chana, before getting out of bed
- Small meals every 2 to 3 hours, so the stomach is never empty
- Sip water, nimbu paani, coconut water or ORS through the day, between meals
- Ginger in tea or food can ease nausea
- Avoid strong smells and oily food when nausea is bad
See your doctor if you cannot keep fluids down for a day, pass very little urine, feel dizzy or are losing weight. This may be hyperemesis gravidarum, a severe form that needs treatment.
Acidity and heartburn
Very common, especially in the last 3 months, as hormones relax the stomach valve and the baby presses on the stomach.
What helps
- Smaller meals, and dinner at least 2 to 3 hours before lying down
- Sit upright after eating; a short, slow walk helps
- Raise the head end of the bed or sleep propped up on pillows, and try lying on your left side
- Cut down on fried food, very spicy food, tea, coffee and fizzy drinks if they trigger it
- Ask your doctor before taking any antacid or acidity tablet; several are safe in pregnancy
See a doctor if heartburn does not settle, swallowing is painful, or you vomit blood. Upper belly pain in the last months with headache, blurred vision or swelling is not acidity: get checked the same day.
Constipation and piles
Pregnancy hormones slow the bowel, and iron tablets can make stools harder. Straining can lead to piles, especially late in pregnancy and after delivery.
What helps
- 8 to 10 glasses of water a day, unless your doctor has advised otherwise
- Fibre at every meal: fruit, vegetables, dal, whole grains, and soaked raisins or figs
- A daily walk, or prenatal exercise your doctor has approved
- Go when you feel the urge, and rest your feet on a low stool in the toilet
- Isabgol with plenty of water is a gentle option; ask your doctor before any other laxative
- Do not stop iron tablets on your own; your doctor can change the timing or type
See a doctor for bleeding from the back passage, severe pain, or constipation lasting more than a week despite these steps.
Gas and bloating
Slower digestion makes gas and a feeling of fullness common throughout pregnancy.
What helps
- Eat slowly and avoid fizzy drinks
- Add new fibre gradually
- Take a gentle walk after meals
- Wear clothes that are loose around the waist
Bloating with severe or constant belly pain, fever or vomiting needs a check-up.
Liver and gallbladder problems that need attention
A few liver problems are specific to pregnancy or more serious during it. They are not common, but finding them early protects both mother and baby.
Itching without a rash
Itching of the palms and soles, often worse at night and usually in the last 3 months, can be a sign of intrahepatic cholestasis of pregnancy (ICP). Blood tests for bile acids and liver function confirm it. Tell your obstetrician within a day or two, because it needs monitoring for the baby's safety.
Jaundice or yellow eyes
Jaundice is never normal in pregnancy. In India, hepatitis E from contaminated water and food is a common cause, and it can be very serious in pregnancy, especially in the last 3 months. Drink only boiled or filtered water, avoid street food, and see a doctor the same day if your eyes turn yellow.
Severe upper belly pain
Pain under the right ribs or in the upper belly in the second half of pregnancy, especially with headache, blurred vision, swelling of the face or hands, or vomiting, can be a sign of pre-eclampsia or HELLP syndrome. This is an emergency.
Gallstones
Pregnancy makes gallstones more likely. Pain under the right ribs after fatty meals, sometimes with vomiting, is typical. Most women are treated with diet and pain relief. If more is needed, gallbladder surgery is safest in the middle 3 months, and an ERCP can be done during pregnancy, with special care to keep X-ray use to a minimum, to clear a stone blocking the bile duct.
Get emergency care if you have
- Vomiting blood, or black, tar-like stools
- Severe or constant belly pain
- Upper belly pain with headache, blurred vision or swelling of the face or hands
- Yellow eyes or skin
- Vomiting so much that you cannot keep fluids down, or passing very little urine
- Heavy bleeding from the back passage
- Fever with belly pain, or diarrhoea that does not stop
Call 112 or go to the nearest emergency department, and inform your obstetrician. Itching of the palms and soles is not an emergency, but tell your doctor within a day or two.
If you already have a gut or liver condition
Plan the pregnancy with your gastroenterologist and obstetrician together. Most women with these conditions have healthy pregnancies.
Hepatitis B
Every pregnant woman should be tested for hepatitis B (HBsAg). If the test is positive, the baby is given the hepatitis B vaccine and immunoglobulin soon after birth, ideally within 12 hours, which protects most babies. Some mothers also need a tablet in the last months of pregnancy to lower the risk further. Breastfeeding is safe.
Ulcerative colitis and Crohn's disease
Pregnancy goes best when the disease is calm at the time of conception. Most IBD medicines are safe and should be continued, because a flare is a bigger risk to the baby than the medicine. A few medicines must be changed before pregnancy, so plan ahead and never stop treatment on your own.
Fatty liver, cirrhosis and other liver disease
Fatty liver raises the risk of diabetes and high blood pressure in pregnancy, so diet and weight gain need extra attention. Women with cirrhosis need careful planning, including a check for enlarged veins (varices) before or during pregnancy.
What to eat during pregnancy
A balanced Indian diet covers most needs. You do not need to eat for two: in the middle and last 3 months, about one extra small meal a day is enough, such as a bowl of dal with a roti, or a glass of milk with a fruit.
Eat more
- Dal, chana, soya, paneer, curd and milk for protein and calcium
- Green leafy vegetables and seasonal fruits
- Whole grains: atta with chokar, millets such as bajra and ragi
- Eggs, fish and chicken, well cooked, if you eat them
- A small handful of nuts and seeds, such as almonds, walnuts or til
- 8 to 10 glasses of water, plus nimbu paani, chaach or coconut water
Cut down
- Alcohol and smoking: none at all
- Tea and coffee: keep to about 2 cups a day
- Street food, cut fruit from vendors and unboiled water
- Raw or undercooked eggs, meat and sprouts
- Unboiled milk, and paneer or cheese from unknown sources
- Fried snacks, sweets, sugary drinks and packaged juices
Good to know
- Ripe papaya in normal amounts is generally considered safe; avoid raw or semi-ripe papaya
- Extra ghee does not make delivery easier; it only adds weight
- Take the iron, folic acid and calcium tablets your doctor prescribes
- With diabetes in pregnancy, your doctor or dietitian will adjust portions
- Ask your doctor before taking any herbal or home remedy
A simple day of eating
- On waking
- A few soaked almonds or roasted chana, especially if you feel sick
- Breakfast
- Vegetable poha, upma or besan chilla with curd, or a stuffed roti
- Mid-morning
- A fruit, or a glass of chaach or coconut water
- Lunch
- Roti or rice, dal, a green vegetable, salad and curd
- Evening
- Roasted makhana or chana, a fruit, or steamed sprouts chaat
- Dinner
- Light and early: khichdi, dal and roti, or vegetable dalia, 2 to 3 hours before bed
- Bedtime
- A glass of warm milk, if it suits you
Medicines, tests and endoscopy in pregnancy
Do not start or stop any medicine on your own, including antacids, laxatives and herbal products. Many digestive medicines are safe in pregnancy, but the right choice depends on the stage of pregnancy and your health, so check with your obstetrician or gastroenterologist.
Ultrasound is safe at any stage, and is the first test for most belly problems.
An endoscopy is done only when the result will change treatment, for example for bleeding, severe vomiting that does not settle, or a blocked bile duct. When it can wait, the middle 3 months are the safest time. It is planned with your obstetrician, and the medicines used are chosen with the baby in mind.
Working with your obstetrician
Your obstetrician leads your pregnancy care. For digestive and liver problems during pregnancy, or for planning a pregnancy with a gut or liver condition, I work alongside your obstetrician so that every decision is safe for you and your baby.
Common questions
Are acidity medicines safe in pregnancy?
Several are, but not all. Try the habit changes first, and ask your doctor which medicine suits your stage of pregnancy before taking any, including antacids bought over the counter.
Can an endoscopy be done during pregnancy?
Yes, when it is truly needed, for example for bleeding or a blocked bile duct. It is planned with your obstetrician and, when possible, done in the middle 3 months.
Will the acidity and constipation last until delivery?
For many women, yes. Both usually improve within a few weeks after the baby is born. Symptoms that continue after delivery should be checked.
Can I breastfeed if I have hepatitis B?
Yes. Once the baby has had the vaccine and immunoglobulin at birth, breastfeeding is safe.