Digestive Problems in Pregnancy: What's Normal, When to Call

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Digestive problems in pregnancy are among the most common reasons pregnant people feel unwell, and most of them, including nausea, heartburn, constipation, and hemorrhoids, are a normal response to the hormonal and physical changes of carrying a baby. A smaller group of symptoms points to something that needs a closer look, and a few conditions that existed before pregnancy, such as inflammatory bowel disease or liver disease, need planning with both an obstetric provider and a gastroenterologist. This page explains what is common, what the current gastroenterology guidance says, and which warning signs deserve a prompt call, for expectant parents in Arlington, Annandale, and the rest of Northern Virginia.

Your obstetrician, midwife, or other obstetric care provider is the first call for any symptom during pregnancy. Please check with them before starting, stopping, or changing any medicine or supplement, including products sold over the counter. This article is general education, not medical advice.

Why digestive problems in pregnancy are so common

Pregnancy changes how the whole digestive tract works. The American College of Obstetricians and Gynecologists (ACOG) explains in its patient guide to digestive problems that higher hormone levels during pregnancy can slow down the digestive system and cause constipation. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) lists pregnancy among the factors that can affect the valve at the bottom of the esophagus and lead to acid reflux, and among the causes of hemorrhoids. Later in pregnancy, the growing uterus also takes up room in the abdomen.

The main source for this page is the AGA Clinical Practice Update on Pregnancy-Related Gastrointestinal and Liver Disease, published by the American Gastroenterological Association in Gastroenterology in 2024. It is an expert review rather than a formal guideline: its 13 practice advice statements come from the published research and expert opinion, and because the authors did not perform formal systematic reviews, the statements do not carry ratings of evidence quality. A search of the medical literature in November 2026 found no newer US gastroenterology society document on the topic. The AGA lists all 13 statements on its website.

One of those statements sets the tone for everything below. The AGA advises that procedures, medications, and other care that protect the mother's health should not be withheld solely because a patient is pregnant, and that each decision should be individualized after weighing the risks and benefits. In plain terms, being pregnant does not mean a real digestive problem has to go untreated. It means the plan is made carefully, together with the obstetric team.

Nausea and vomiting in pregnancy

Nausea is often the first digestive problem of pregnancy. ACOG's guide to morning sickness notes that it can happen at any time of day despite the name. It usually starts before 9 weeks of pregnancy and, for most women, goes away by 14 weeks, though for some it lasts for weeks or months, and for a few it lasts the whole pregnancy. ACOG says it usually does not harm the fetus, but it can make it hard to work or get through the day.

ACOG's suggested first steps are practical: a prenatal vitamin, dry toast or crackers before getting out of bed, five or six small meals a day so the stomach is never empty, bland foods, added protein, steady fluids through the day, and staying away from smells that trigger nausea. ACOG also mentions ginger.

The AGA's fourth statement adds why early attention matters: early treatment of nausea and vomiting of pregnancy may reduce progression to hyperemesis gravidarum, the most severe form. The AGA describes stepwise treatment that starts with diet and lifestyle measures, vitamin B6 and doxylamine, hydration, and adequate nutrition, with prescription anti-nausea medicines and other treatment needed in moderate to severe cases. ACOG says hyperemesis gravidarum occurs in up to 3 percent of pregnancies and may be diagnosed when a woman has lost 5 percent of her prepregnancy weight along with other problems related to dehydration. Which medicine fits, and at what dose, is a decision for your obstetric provider.

Nausea that does not follow the usual pattern can have another cause. ACOG lists ulcers, foodborne illness, and thyroid or gallbladder disease, and names clues that suggest one of them: nausea and vomiting that start for the first time after 9 weeks of pregnancy, abdominal pain or tenderness, fever, headache, or swelling in the front of the neck. Our page on chronic nausea and vomiting covers the wider list of causes.

Heartburn and reflux during pregnancy

Heartburn is one of the most common digestive problems in pregnancy. The American College of Gastroenterology's 2022 GERD guideline reports that about two-thirds of pregnant women experience heartburn, which can begin in any trimester. Most have never been diagnosed with reflux before, although a history of reflux makes it more likely. The guideline adds that heartburn during pregnancy usually resolves after delivery, and that pregnancy and the amount of weight gained are risk factors for frequent reflux symptoms a year after delivery.

The diagnosis is almost always made from symptoms alone. The ACG notes that endoscopy and pH monitoring are rarely needed for reflux in pregnancy.

Treatment starts with daily habits. ACOG's suggestions for reflux include raising the head of the bed, eating smaller and more frequent meals, avoiding foods and drinks that make symptoms worse, and not lying on your back right after eating. When those changes are not enough, the ACG names antacids, alginates, and sucralfate as the first-line medicines during pregnancy, and it discusses acid-reducing medicines as a further step. Because the choice depends on how far along you are and what else you take, ask your obstetric provider which product, if any, is right for you. Our pages on GERD and acid reflux and reflux that does not respond to medication explain reflux outside of pregnancy.

Constipation in pregnancy

Constipation is another common digestive problem in pregnancy. The AGA's fifth statement says constipation in pregnant people may result from hormonal, medication-related, and physical changes. Iron supplements are one medication-related example: the NIDDK lists iron among the medicines that can cause constipation, and it lists pregnancy among the life changes that can alter bowel habits.

ACOG defines constipation as fewer than three bowel movements a week, with stools that may be hard or difficult to pass. Its prevention advice is plain: drink plenty of water, eat fiber from fruits, vegetables, beans, and whole grains, stay active, and do not hold in a bowel movement when you feel the urge. ACOG notes that current guidelines recommend women eat 25 grams of fiber per day.

When diet is not enough, the AGA names dietary fiber, lactulose, and polyethylene glycol-based laxatives as treatment options in pregnancy. That is a list of options a clinician considers, not a do-it-yourself instruction. ACOG cautions that laxatives, especially stimulant types, should be used with care. Talk with your obstetric provider before starting any laxative or stool softener. Our page on chronic constipation explains the evaluation when constipation lasts beyond pregnancy.

Hemorrhoids and rectal bleeding during pregnancy

Hemorrhoids are swollen blood vessels in and around the anus and lower rectum. The NIDDK and ACOG both list pregnancy as a cause, and constipation and straining add to the pressure. ACOG says hemorrhoids can become painful, itchy, and irritated, and that passing stool may injure them and cause bleeding.

ACOG's comfort measures include ice packs for swelling and sitting in a warm bath, and it notes that creams and suppositories are available. Ask your obstetric provider before using any product. Keeping stools soft with fiber and fluids helps prevent hemorrhoids from getting worse. Our page on hemorrhoids treatment covers options after pregnancy, when hemorrhoids that have not settled can be treated more fully.

Bright red blood on the toilet paper is common with hemorrhoids, but bleeding should still be reported, especially if it is heavy, mixed into the stool, or comes with dark or black stools, dizziness, or abdominal pain. Our page on blood in stool and rectal bleeding explains the other causes a clinician will want to rule out.

Itching, liver changes, and gallstones: less common digestive problems in pregnancy

A few less common digestive problems in pregnancy involve the liver and gallbladder. They are less familiar to most people, and they are the reason some symptoms should not be brushed off as normal discomfort.

Itching in late pregnancy

Intrahepatic cholestasis of pregnancy is a liver condition that typically causes itching in the second or third trimester. The AGA's tenth statement says the diagnosis is based on a blood test showing a raised bile acid level in someone with itching, and that treatment with a medicine called ursodeoxycholic acid should be offered. Itching in pregnancy has many harmless causes, but persistent itching is worth reporting to your obstetric provider so that this blood test can be considered. Yellowing of the skin or eyes should be reported promptly. Our page on jaundice in adults explains how yellowing is evaluated.

Liver conditions unique to pregnancy

The AGA's eleventh statement names three serious liver conditions that occur only in pregnancy: pre-eclampsia; HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets); and acute fatty liver of pregnancy. It says their management requires planning for delivery. These conditions are managed by the obstetric team and the hospital, not in a gastroenterology office. The AGA also advises daily aspirin from week 12 for people at risk of pre-eclampsia or HELLP syndrome, a decision your obstetric provider makes. Follow your obstetric provider's instructions about which late-pregnancy symptoms need same-day care.

Gallstones in pregnancy

Gallstones can cause abdominal pain and, less often, block a bile duct or inflame the pancreas. The AGA's ninth statement says gallbladder removal is safe during pregnancy, that a laparoscopic approach is the standard of care regardless of trimester, and that the second trimester is ideal. Its eighth statement says ERCP, a procedure to clear a blocked bile duct, may be performed during pregnancy for urgent reasons such as a stone in the bile duct, infection of the bile duct, and some cases of gallstone pancreatitis, ideally in the second trimester. Our pages on gallstones and ERCP explain both in more detail.

IBD and other GI conditions before and during pregnancy

For people who already live with a digestive condition, the AGA's first statement advises counseling before pregnancy, ideally by a team that includes both the gastroenterologist and the obstetric provider, so the condition is as well controlled as possible before conception.

Inflammatory bowel disease is the clearest example. The AGA's seventh statement says that being in remission before conception, during pregnancy, and after delivery is essential for better pregnancy outcomes, and that biologic medicines should be continued throughout pregnancy and the postpartum period. The same statement says three specific medicines, methotrexate, thalidomide, and ozanimod, must be stopped at least 6 months before conception, which is why planning ahead matters. If you have Crohn's disease or ulcerative colitis and are thinking about pregnancy, please do not stop any IBD medicine on your own: talk with your gastroenterologist first, since the AGA treats staying in remission as the priority. Our pages on Crohn's disease and ulcerative colitis and diet in IBD cover the condition itself.

The AGA also addresses chronic liver disease. Its twelfth statement advises blood testing for people with chronic hepatitis B during pregnancy and says treatment should be considered in the third trimester for those with a high virus level who are not already being treated. Its thirteenth statement says people taking immune-suppressing medicine for liver disease or after a liver transplant should generally continue it at the lowest effective dose. Our page on chronic hepatitis B and C explains testing and treatment. For people with advanced cirrhosis, complex IBD, or a liver transplant, the AGA's third statement advises that birth be coordinated by a team, preferably at a hospital with specialized services.

Endoscopy and colonoscopy during pregnancy

Many people worry about whether a scope procedure is possible while pregnant. The AGA's sixth statement says elective endoscopic procedures should be put off until after delivery, while procedures that are necessary but not emergencies are ideally done in the second trimester. For urgent procedures, such as ERCP for a blocked or infected bile duct, the AGA advises that if waiting could harm the patient or the fetus, a team that includes the obstetric side decides together.

The same statement says pregnant people with cirrhosis should be evaluated and treated for varices, enlarged veins in the esophagus that can bleed, with an upper endoscopy suggested in the second trimester if one was not done within a year before conception. Our pages on upper endoscopy and colonoscopy explain the procedures themselves. A routine screening colonoscopy is an elective procedure, so under the AGA's advice it generally waits until after delivery.

When to call about digestive problems in pregnancy

Most digestive problems in pregnancy are uncomfortable but not dangerous. These signs call for a prompt call to your obstetric provider:

• Signs of dehydration, which ACOG lists as a small amount of dark urine, being unable to urinate, being unable to keep down liquids, feeling dizzy or faint when standing, or a racing or pounding heartbeat.
• Nausea and vomiting that start for the first time after 9 weeks, or that come with abdominal pain, fever, or headache.
• Weight loss because you cannot keep food down.
• Persistent itching, or yellowing of the skin or eyes.
• Rectal bleeding that is heavy or persistent, or black or tarry stools.
• Diarrhea that lasts more than 2 days or comes with blood, fever, or severe pain, based on ACOG's general advice.
• Heartburn that does not improve with the changes your provider recommends, or trouble swallowing.

Severe or constant abdominal pain, vomiting blood, heavy bleeding, or fainting is an emergency: call 911 or go to an emergency department, and tell the staff you are pregnant.

When digestive problems in pregnancy need a gastroenterologist

Most digestive problems in pregnancy are handled by the obstetric team. A gastroenterologist usually joins the conversation in a few situations: a condition that existed before pregnancy, such as IBD, celiac disease, chronic hepatitis, or cirrhosis; a symptom that does not follow the usual pattern or does not respond to standard measures; bleeding; suspected gallstone or bile duct problems; or a question about whether a procedure is needed now or can wait until after delivery. After delivery, a gastroenterologist can also evaluate reflux, constipation, or hemorrhoids that have not settled.

Planning a pregnancy with a digestive condition is a good reason for a visit before conception. Questions worth bringing:

• Is my condition controlled well enough to plan a pregnancy now?
• Do any of my current medicines need to change before conception?
• Which of my medicines should continue through pregnancy and breastfeeding?
• Will I need any procedure or testing before pregnancy, so it does not fall during it?
• How will you and my obstetric provider share information?

Care for digestive problems in pregnancy in Northern Virginia

Gastroenterology Center of Northern Virginia cares for adults across Arlington, Annandale, and the surrounding communities, including people with IBD, liver disease, reflux, and other digestive conditions who are planning a pregnancy, are pregnant, or have recently given birth. Our five gastroenterologists work alongside each patient's obstetric provider rather than in place of one. Our page on your first gastroenterologist visit explains what to bring.

We see patients at our Arlington office at 1715 N George Mason Drive, adjacent to VHC Health, and our Annandale office at 3299 Woodburn Road in the Woodburn Medical complex. To schedule a visit, call Arlington at (703) 522-7476 or Annandale at (703) 560-6106, or learn more at gcofnova.com.

This article is for general education and is not medical advice. Talk with a qualified gastroenterologist about your symptoms, diagnosis, and treatment options.