Pregnancy is a very exciting time during lifetime, and the pregnant women as well as the environment feel anxious about what they should (or should not) be doing for their own and their baby’s health. During pregnancy, a number of physiological changes occur, mostly related to hormonal changes and the growing fetus. These changes can occur in all body systems, such as cardiovascular, respiratory, gastrointestinal, urinary, and more, and affect multiple aspects of daily life. In many instances, these changes are following a specific schedule which is dictated by the different phases of fetal development. Most commonly, pregnant women may develop hyperemesis and are prone to develop gestational diabetes and gestational hypertension. More severe problems concerning the child’s health directly may involve preeclampsia and infections.
Gastrointestinal problems are very frequent during pregnancy and may range from occasional abdominal discomfort, decreased bowel activity, and gastroesophageal reflux disease to severe inflammatory bowel disease (IBD), liver damage, cholestasis, and even malignant diseases. In this issue, we address a number of pathological conditions, discuss their impact on both mother and child, and offer guidance for treating physicians.
Approximately two-third of pregnant women report proctological symptoms including anal pain, hemorrhoids, constipation, fissures, and incontinence which may arise from increased intra-abdominal pressure, decreased bowel movement, and inflammation. Particularly, women with a previous history of IBD are prone to experience worsening of their symptoms during pregnancy. Uncontrolled IBD has been shown to be a risk factor for complications during pregnancy, including preterm birth and fetal loss. While the therapeutic options for patients with IBD have expanded considerably in past years, choosing the correct treatment for pregnant women requires extensive knowledge about the therapeutic efficacy and the safety profile of each individual drug throughout pregnancy. In this issue, Hecker et al. [1] provide a comprehensive review on how to handle IBD during pregnancy to ensure maternal and fetal safety.
While many minor gastroenterological disorders can be treated according to standard-of-care in pregnant women, other disorders may require multidisciplinary approaches to ensure the safety of both mother and child. This is best illustrated by the case report of Zapletal et al. [2] who describes a case of acute appendicitis handled by an interdisciplinary team, thus providing an excellent example for optimal management of complex and acute surgical emergencies.
Alarmingly, recent research underscores an increase in cancer incidence in young patients, particularly for colorectal cancer. This is accompanied by an observable trend in women to postpone childbearing, leading to a potential increase in the occurrence of GI cancer in pregnant women. While we have learned a lot about fertility preservation and protection for patients diagnosed with cancer at young age, the diagnosis of a malignancy during pregnancy remains a challenge for treating physicians, posing a number of difficult questions: what therapeutic options do we have if cancer appears during pregnancy? Should we stop pregnancy or can cancer treatment be delayed? What are the options and limitations for surgical interventions at the different stages of pregnancy? Is systemic treatment possible and safe for mother and child? Little is known about anticancer treatment because usually pregnant women are excluded from cancer trials, restricting scientific evidence to case reports and publicly available registries.
Plum et al. [3] addresses these gaps in knowledge, providing comprehensive reviews for the treatment of upper and lower gastrointestinal cancers for surgeons who face the challenge of treating these cancer entities in pregnant patients [3, 4] these articles demonstrate that most patients can be treated safely during pregnancy, thus preserving the lives of both the mother and the unborn infant.
Finally, Wirth et al. [5] addresses the challenge of systemic therapies in pregnant patients with advanced gastrointestinal cancers. In the case of pregnant patients requiring systemic therapy instead of surgery, careful assessment of both benefits and risks is of particular importance. In the first trimester, systemic tumor therapy is not recommended. In the second trimester, drug-based tumor therapy is possible if indicated. With systemic tumor therapy in the third trimester, an outcome similar to a normal course of pregnancy can be expected. Some substances such as tyrosine kinase inhibitors, anti-VEGF antibodies, antihormonal substances, or immune checkpoint inhibitors are contraindicated throughout pregnancy. As a rule, if the therapy recommendations are adhered to, normal development of the children can be expected in most cases. In summary, our issue provides guidance for a number of different gastrointestinal complications during pregnancy and provides encouraging data demonstrating that most problems can be sufficiently addressed if the mentioned standards of treatment are met.
Conflict of Interest Statement
The authors have no conflicts of interest to declare.
Funding Sources
There was no funding required.
