Gastrointestinal Symptoms in Pregnancy: The Influence of Thyroid-Stimulating Hormone and Modifiable Risk Factors

Year 2025, Issue: Early Access

Büşra Körpe , Caner Kose , Sümeyye Mermi , Büşra Demir Çendek , Samet Kutluay Ergörün , Kadriye Erdoğan , Hüseyin Levent Keskin

https://doi.org/10.18678/dtfd.1565941

Abstract

Aim: This study aimed to evaluate the prevalence of gastrointestinal (GI) symptoms during pregnancy and identify hormonal, nutritional, and lifestyle factors contributing to their severity.
Material and Methods: The study was conducted involving 612 pregnant women aged 20 to 40 years, with gestational ages between 5 and 36 weeks. Participants were categorized into three groups based on their trimester. GI symptoms were assessed using the gastrointestinal symptom rating scale (GSRS). A structured questionnaire was used to collect data on demographic characteristics, obstetric history, prior GI conditions, and lifestyle factors.
Results: The study found that indigestion (77.6%, n=475), reflux (68.5%, n=419), and abdominal pain (69.9%, n=428) were the most common GI symptoms reported. While indigestion (78.4%, n=171) followed by nausea (76.1%, n=166) was the most common symptoms in the first trimester, abdominal pain (78.1%, n=171) and reflux (76.3%, n=167) were most frequent in the second trimester, In the third trimester, indigestion (81.1%, n=142) was again the most common symptom, followed by reflux (76.6%, n=134). High GSRS scores were found to be significantly associated with excessive tea consumption (OR: 4.22, 95% CI: 1.44-12.35, p<0.001), employment status (OR: 2.32, 95% CI: 1.63-3.32, p<0.001), and TSH levels (OR: 1.26, 95% CI: 1.13-1.41, p<0.001).
Conclusion: GI symptoms are highly prevalent during pregnancy and are influenced by modifiable factors such as tea consumption, weight gain, and work-related stress. Monitoring thyroid function, managing weight, reducing tea intake, and addressing stress may help alleviate these symptoms, thereby improving the quality of life for pregnant women.

Keywords

Gastrointestinal disease, Pregnancy, Risk factors

Gebelikte Gastrointestinal Semptomlar: Tiroid Uyarıcı Hormonun Etkisi ve Değiştirilebilir Risk Faktörleri

Abstract

Amaç: Bu çalışmanın amacı gebelik sırasında gastrointestinal (GI) semptomların yaygınlığını değerlendirmek ve bu semptomların şiddetine katkıda bulunan hormonal, beslenme ve yaşam tarzı faktörlerini belirlemektir.
Gereç ve Yöntemler: Bu çalışma, 20 ila 40 yaşları arasında, gestasyonel yaşları 5 ila 36 hafta arasında olan 612 gebe kadın ile yapılmıştır. Katılımcılar, trimesterlerine göre üç gruba ayrılmıştır. GI semptomlar, gastrointestinal semptom derecelendirme ölçeği (gastrointestinal symptom rating scale, GSRS) kullanılarak değerlendirilmiştir. Demografik özellikler, obstetrik geçmiş, önceki GI durumlar ve yaşam tarzı faktörleri hakkında veri toplamak amacıyla yapılandırılmış bir anket uygulanmıştır.
Bulgular: Çalışmada en sık görülen GI semptomların sindirim bozukluğu (%77,6, n=475), reflü (%68,5, n=419) ve karın ağrısı (%69,9, n=428) olduğu bulundu. İlk trimesterde sindirim bozukluğu (%78,4, n=171) ve bunu izleyen bulantı (%76,1, n=166) en sık görülen semptomlar iken, ikinci trimesterde karın ağrısı (%78,1, n=171) ve reflü (%76,3, n=167) en sık idi. Üçüncü trimesterde ise sindirim bozukluğu (%81,1, n=142) yine en sık görülen semptomdu ve bunu reflü (%76,6, n=134) izlemekteydi. Yüksek GSRS skorlarının aşırı çay tüketimi (OR: 4.22, %95 CI: 1.44-12.35, p<0.001), çalışma durumu (OR: 2.32, %95 CI: 1.63-3.32, p<0.001) ve TSH düzeyleri (OR: 1.26, %95 CI: 1.13-1.41, p<0.001) ile anlamlı şekilde ilişkili olduğu bulundu.
Sonuç: GI semptomlar gebelik sırasında oldukça yaygındır ve çay tüketimi, kilo artışı ve iş kaynaklı stres gibi değiştirilebilir faktörlerden etkilenmektedir. Tiroid fonksiyonlarının izlenmesi, kilo yönetimi, çay tüketiminin azaltılması ve stresle başa çıkma yöntemleri, bu semptomları hafifletmeye yardımcı olabilir ve böylece gebe kadınların yaşam kalitesini iyileştirebilir.

Keywords

Gastrointestinal hastalıklar, Gebelik, Risk faktörleri

References

• Gomes CF, Sousa M, Lourenço I, Martins D, Torres J. Gastrointestinal diseases during pregnancy: what does the gastroenterologist need to know?. Ann Gastroenterol. 2018;31(4):385-94.
• Longo SA, Moore RC, Canzoneri BJ, Robichaux A. Gastrointestinal conditions during pregnancy. Clin Colon Rectal Surg. 2010;23(2):80-9.
• Patrick SK, Schneider KM. Gastrointestinal disorders in pregnancy. In: Olsen M, editor. Obstetric care. Cambridge University Press; 2017. p.375-86.
• Zielinski R, Searing K, Deibel M. Gastrointestinal distress in pregnancy: prevalence, assessment, and treatment of 5 common minor discomforts. J Perinat Neonatal Nurs. 2015;29(1):23-31.
• Parangi S, Levine D, Henry A, Isakovich N, Pories S. Surgical gastrointestinal disorders during pregnancy. Am J Surg. 2007;193(2):223-32.
• Boregowda G, Shehata HA. Gastrointestinal and liver disease in pregnancy. Best Pract Res Clin Obstet Gynaecol. 2013;27(6):835-53.
• Liu C, Zhao G, Qiao D, Wang L, He Y, Zhao M, et al. Emerging progress in nausea and vomiting of pregnancy and hyperemesis gravidarum: challenges and opportunities. Front Med (Lausanne). 2022;8:809270.
• Demirel F, Turkay Ü. The effect of inflammatory markers in the hemogram parameters of pregnant women with thyroid disease on obstetric and neonatal outcomes. Duzce Med J. 2023;25(3):231-5.
• Alqudah M, Al-Shboul O, Al Dwairi A, Al-U´Datt DG, Alqudah A. Progesterone inhibitory role on gastrointestinal motility. Physiol Res. 2022;71(2):193-8.
• Coquoz A, Regli D, Stute P. Impact of progesterone on the gastrointestinal tract: a comprehensive literature review. Climacteric. 2022;25(4):337-61.
• Xiao ZL, Pricolo V, Biancani P, Behar J. Role of progesterone signaling in the regulation of G-protein levels in female chronic constipation. Gastroenterology. 2005;128(3):667-75.
• Peña-Rosas JP, De-Regil LM, Garcia-Casal MN, Dowswell T. Daily oral iron supplementation during pregnancy. Cochrane Database Syst Rev. 2015;2015(7):CD004736.
• Lee NM, Saha S. Nausea and vomiting of pregnancy. Gastroenterol Clin North Am. 2011;40(2):309-34, vii.
• Biaggi A, Conroy S, Pawlby S, Pariante CM. Identifying the women at risk of antenatal anxiety and depression: A systematic review. J Affect Disord. 2016;191:62-77.
• Nik Mazlan NAA, Mohamed Sidek AS, Zakaria AD, Zakaria Z, Yahya MM, Wan Zain WZ, et al. Proportion of colonic diverticulosis and its associated factors among patients underwent colonoscopy. Duzce Med J. 2024;26(1):9-14.
• Kulich KR, Madisch A, Pacini F, Piqué JM, Regula J, Van Rensburg CJ, et al. Reliability and validity of the Gastrointestinal Symptom Rating Scale (GSRS) and Quality of Life in Reflux and Dyspepsia (QOLRAD) questionnaire in dyspepsia: a six-country study. Health Qual Life Outcomes. 2008;6:12.
• Turan N, Aşt TA, Kaya N. Reliability and validity of the Turkish version of the gastrointestinal symptom rating scale. Gastroenterol Nurs. 2017;40(1):47-55.
• Zielinski R, Searing K, Deibel M. Gastrointestinal distress in pregnancy: prevalence, assessment, and treatment of 5 common minor discomforts. J Perinat Neonatal Nurs. 2015;29(1):23-31.
• Naumann CR, Zelig C, Napolitano PG, Ko CW. Nausea, vomiting, and heartburn in pregnancy: a prospective look at risk, treatment, and outcome. J Matern Fetal Neonatal Med. 2012;25(8):1488-93.
• Zhang H, Wu S, Feng J, Liu Z. Risk factors of prolonged nausea and vomiting during pregnancy. Risk Manag Healthc Policy. 2020;13:2645-54.
• Daher R, Yazbeck T, Jaoude JB, Abboud B. Consequences of dysthyroidism on the digestive tract and viscera. World J Gastroenterol. 2009;15(23):2834-8.
• Xu GM, Hu MX, Li SY, Ran X, Zhang H, Ding XF. Thyroid disorders and gastrointestinal dysmotility: an old association. Front Physiol. 2024;15:1389113.
• Altuwaijri M. Evidence-based treatment recommendations for gastroesophageal reflux disease during pregnancy: A review. Medicine (Baltimore). 2022;101(35):e30487.
• Sucu ST, Karaman E, Kose C, Sucu S, Keskin HL. Is postpartum depression related to total weight gain during pregnancy and maternal anemia?. Rev Assoc Med Bras (1992). 2024;70(2):e20230908.
• Jacobson BC, Somers SC, Fuchs CS, Kelly CP, Camargo CA Jr. Body-mass index and symptoms of gastroesophageal reflux in women. N Engl J Med. 2006;354(22):2340-8.
• Cao H, Huang X, Zhi X, Han C, Li L, Li Y. Association between tea consumption and gastroesophageal reflux disease: A meta-analysis. Medicine (Baltimore). 2019;98(4):e14173.
• Qian J, Chen Q, Ward SM, Duan E, Zhang Y. Impacts of caffeine during pregnancy. Trends Endocrinol Metab. 2020;31(3):218-27.
• Huerta-Franco MR, Vargas-Luna M, Tienda P, Delgadillo-Holtfort I, Balleza-Ordaz M, Flores-Hernandez C. Effects of occupational stress on the gastrointestinal tract. World J Gastrointest Pathophysiol. 2013;4(4):108-18.
• Sugaya N. Work-related problems and the psychosocial characteristics of individuals with irritable bowel syndrome: an updated literature review. Biopsychosoc Med. 2024;18(1):12.