Gastroparesis is defined as the presence of symptoms associated with delayed gastric emptying in the absence of mechanical obstruction and is recognised as a potential neuropathic complication of long-standing diabetes mellitus (DM), especially in those with type 1 DM, additional diabetes-related complications and poor glycaemic control.
Gastroparesis is more prevalent in women, particularly in those of childbearing age. The cardinal symptoms of nausea, vomiting, bloating, and early satiety are also common during pregnancy. Therefore, recognising this complication can be challenging. The diagnosis and management of gastroparesis during pregnancy must consider the necessity for investigations and treatments that are safe for the fetus. Clear safety data and optimal management protocols are lacking. Deterioration in diabetic neuropathies and vasculopathy has been associated with both chronic hyperglycaemia and rapid glycaemic improvement. These mechanisms may contribute to alterations in gastric motility and gastroparesis in pregnancy, particularly in vulnerable women with poor glycaemic control at baseline.
We present a 36-year-old pregnant person with severe gastroparesis in pregnancy, occurring on a background of chronic hyperglycaemia and in the setting of rapid glycaemic improvement following the commencement of basal-bolus insulin therapy. She presented at 32 weeks gestation with intractable vomiting, significant weight loss and constipation. The management was complex, with symptoms that did not respond to multiple antiemetics and prokinetic agents. She experienced severe electrolyte imbalances and intrauterine growth restriction. Her treatment required a multi-modal and multidisciplinary approach over a prolonged hospitalisation, including nasojejunal (NJ) feeding, but ultimately contributed to indicated preterm delivery.
Severe gastroparesis can lead to serious fetal and maternal morbidity, such as that described in this case, and at worst, even fetal death. Significant deterioration in maternal psychological well-being may also occur. This case highlights the potential factors that may lead to severe gastroparesis during pregnancy and stresses the importance of maintaining optimal prepregnancy glycaemic control. It also underscores the importance of identifying preexisting gastrointestinal dysmotility and diabetes-related neuropathic complications.
Preconception counselling and a multidisciplinary approach to patients with gastroparesis can improve pregnancy outcomes. The development of consensus guidelines to manage pregnant patients with this complex condition would be valuable, especially for those receiving antenatal care in centres without access to a specialist obstetric medicine service.