Management of Acute Gastroenteritis in Pregnancy
Pregnant women with acute gastroenteritis should receive oral rehydration as first-line therapy for mild-to-moderate dehydration, with hospitalization and intravenous fluids reserved for severe dehydration, while avoiding antiperistaltic drugs and fluoroquinolone antibiotics. 1
Initial Assessment
Clinical Evaluation
- Assess hydration status systematically: Look for orthostatic hypotension, decreased skin turgor, dry mucous membranes (mild dehydration), prolonged skin tenting >2 seconds, cool extremities, decreased capillary refill (moderate-to-severe dehydration) 2
- Obtain accurate body weight and check for adequate bowel sounds before initiating oral therapy 2
- Review travel history and recent contacts to identify potential infectious exposures requiring specific testing 1, 3
Diagnostic Testing
- Obtain stool cultures for enteroinvasive bacterial infections and Clostridioides difficile testing in pregnant women with gastroenteritis 1, 3
- Test for amoebic or Shigella dysentery in patients with relevant travel history 1, 3
- Laboratory studies (serum electrolytes) are rarely needed but should be measured when clinical signs suggest abnormal sodium or potassium concentrations 2
Rehydration Strategy
Mild-to-Moderate Dehydration
- Oral rehydration solution is the first-line therapy and is as effective as intravenous therapy for mild-to-moderate dehydration 4, 5
- This represents an underused but highly effective intervention 4
Severe Dehydration
- Hospitalize for intravenous fluid replacement and close monitoring 1, 3
- Consider nasogastric hydration if oral intake is not tolerated but intravenous access is challenging 5
Antimicrobial Therapy
When to Treat
- Treat Salmonella gastroenteritis in pregnancy to prevent extraintestinal spread of the pathogen 1, 3
- Antimicrobial therapy is indicated for C. difficile infections, severe bacterial infections, and parasitic infections 6
Antibiotic Selection
- Safe choices include ampicillin, cefotaxime, ceftriaxone, or trimethoprim-sulfamethoxazole 1, 3
- Absolutely avoid fluoroquinolones during pregnancy due to potential fetal risks 1, 3
Contact Tracing
- Evaluate household contacts of pregnant women with salmonellosis or shigellosis for asymptomatic carriage to prevent recurrent transmission 1, 3
Symptom Management
Antiemetics
- Ondansetron enhances compliance with oral rehydration therapy and decreases hospitalization rates 4
- However, some studies report congenital heart defects when ondansetron is given in the first trimester, so use as second-line therapy on a case-by-case basis before 10 weeks of pregnancy 2
- Metoclopramide can be used for nausea and vomiting with less drowsiness, dizziness, and dystonia compared to promethazine 2
Antidiarrheal Agents
- Do not use antiperistaltic drugs (such as loperamide) in pregnant women with diarrhea 1
- These agents do not reduce stool water losses, may increase electrolyte losses, and can cause serious side effects including ileus 2
Thromboprophylaxis
- Administer anticoagulant thromboprophylaxis during hospitalization for gastroenteritis 1
- Outpatients should receive VTE prophylaxis during the third trimester unless contraindicated 1
Nutritional Support
- Supplement with vitamin B6 (pyridoxine) for mild cases 2
- Give thiamine 100 mg daily for minimum 7 days, then 50 mg daily maintenance to prevent refeeding syndrome and Wernicke encephalopathy until adequate oral intake is established 2
Psychosocial Support
- Perform mental health screening with appropriate referral to support services, given the increased burden of mental health issues during pregnancy 1, 3
- Mental health professionals can help manage anxiety, depression, and emotional challenges 2