What is the management of gastroenteritis in pregnant women?

Management of Gastroenteritis in Pregnant Women

The management of gastroenteritis in pregnant women requires prompt assessment and treatment, with a focus on hydration, symptom control, and appropriate antimicrobial therapy when indicated, while ensuring the safety of both mother and fetus.

Initial Assessment and Management

Hydration and Supportive Care

• Rehydration is the cornerstone of treatment for gastroenteritis in pregnancy, with isotonic solutions (0.9% saline) recommended for moderate to severe dehydration 1
• For mild dehydration, oral rehydration solutions should be used to maintain hydration status 2
• Pregnant women with severe dehydration should be hospitalized for intravenous fluid replacement and close monitoring 3
• Frequent small meals and snacks are recommended to maintain nutrition while minimizing nausea 4

Diagnostic Evaluation

• Stool cultures should be obtained for enteroinvasive bacterial infections and Clostridioides difficile testing in pregnant women with gastroenteritis 3
• Travel and contact history should be carefully reviewed, with appropriate testing for amoebic or Shigella dysentery in patients with relevant travel history 3
• In cases of severe or persistent symptoms, flexible sigmoidoscopy or colonoscopy may be considered if results will affect management [@18@]
• Radiologic investigations should be limited to ultrasound and MRI when possible, avoiding radiation exposure [@19@]

Antimicrobial Therapy

Bacterial Gastroenteritis

• For pregnant women with Salmonella gastroenteritis, treatment is recommended to prevent extraintestinal spread of the pathogen 3
• Appropriate antibiotic choices include ampicillin, cefotaxime, ceftriaxone, or TMP-SMZ; fluoroquinolones should be avoided during pregnancy 3
• In cases of perianal sepsis requiring antibiotic therapy, metronidazole and/or ciprofloxacin may be used, though fluoroquinolones should be used with caution 4

Campylobacter Infections

• Treatment of Campylobacter jejuni infections is important as they can lead to bacteremia during pregnancy, potentially causing intrauterine infection, abortion, stillbirth, or neonatal complications 5
• Appropriate antibiotic therapy should be initiated promptly in confirmed cases to prevent long-term complications 5

Management of Complications

Thromboprophylaxis

• Pregnant women hospitalized for gastroenteritis should receive anticoagulant thromboprophylaxis during hospitalization [@17@]
• Outpatients with active inflammatory bowel disease should receive VTE prophylaxis during the third trimester, unless contraindicated 3

Specialized Care

• Pregnant women requiring hospitalization for severe gastroenteritis should be transferred to a tertiary center with access to both gastroenterology and high-risk obstetric care 3
• A multidisciplinary team approach involving gastroenterologists and obstetricians is recommended for optimal management 3

Symptom Management

Nausea and Vomiting

• Non-pharmacological approaches include eating frequent small meals, avoiding fatty/spicy foods, and consuming dry foods before rising in the morning 4
• Keeping well hydrated is essential, particularly when experiencing vomiting 4

Diarrhea

• Antiperistaltic drugs are not recommended for pregnant women with diarrhea 3
• Focus should be on maintaining hydration and electrolyte balance 2

Constipation

• Increase dietary fiber, fluids, and exercise as first-line therapy 6
• If ineffective, consider bulk-forming agents, lubricant laxatives, or stool softeners 6
• Osmotic and stimulant laxatives should be used only short-term or occasionally to avoid dehydration or electrolyte imbalances 6

Follow-up and Prevention

• Household contacts of pregnant women with salmonellosis or shigellosis should be evaluated for asymptomatic carriage to prevent recurrent transmission 3
• Pregnant women should be educated about food safety practices to prevent foodborne illnesses, particularly Campylobacter infections 5
• Mental health screening should be performed with appropriate referral to support services, given the increased burden of mental health issues during pregnancy 3

Pitfalls and Caveats

• Fluoroquinolones should be avoided during pregnancy due to potential risks to the fetus 3
• Iron tablets should not be used in those with active inflammatory bowel disease as systemic inflammation inhibits absorption 3
• Avoid gadolinium as part of MR imaging during pregnancy 3
• Do not delay urgent surgery to manage complications solely due to pregnancy [@20@]