What is Helicobacter pylori?
Helicobacter pylori is a corkscrew-shaped bacterial species that can infect the upper portions of the human gastrointestinal (GI) tract, which can cause disease. Specifically H. pylori infection causes ulcers in the stomach (gastric ulcer) and the beginning portion of the small intestine (duodenal ulcer).
How common is H. pylori infection during pregnancy?
H. pylori has infected an estimated 50 percent of the human population. Geography, ethnicity and socioeconomic status all affect the chances of being infected. Developing countries have much higher rates of occurrence compared with developed countries, most infections begin in childhood, and risk is highest in those areas with poor hygiene practices. In European countries, Australia, and Japan, H. pylori infects about 20-30 percent of pregnant women, while particularly high rates of infection are seen in some countries (up to 80 percent or more have been reported in Egypt and Gambia, and Turkey has reported rates ranging from 50-70 percent). Not everybody who is infected experiences symptoms, but it is possible that pregnancy increases ones susceptibility to becoming infected in the first place.
How is H. pylori infection diagnosed?
Doctors can diagnose an H. pylori infection through a variety of tests. You can supply stool samples, which can be tested for the presence of antibodies against H. pylori. You can take whats called a urea breath test, in which you swallow a substance called urea, which is labeled with carbon-14, or carbon-13. If H. pylori is in your stomach, the urea will be converted to carbon dioxide containing the special carbon atom, which can be detected through whats called scintillation if its carbon-14, or through mass spectrometry if its carbon-13. Finally, there is a procedure called an endoscopy, in which a tube is inserted through your throat to your upper GI tract and biopsies are taken of the lining of your stomach and small intestine. These tests can be performed if there is a suspicion that you may have been exposed to H. pylori from an infected person or contaminated water or food. They also can be performed if you have symptoms of an ulcer; abdominal pain that is worse when your stomach is empty, nausea, loss of appetite, weight loss, bloating, and frequent belching.
Does an H. pylori infection cause problems during pregnancy?
Most ulcers in the stomach and duodenum are the result of H. pylori infection. In addition to being painful, such ulcers can lead to perforations in the wall of the GI tract, and bleeding, and in the long-term can lead to cancer. Additionally, there may be an association between H. pylori and a rare pregnancy complication called hyperemesis gravidarum (HG), which features extreme nausea and vomiting, much worse than the usual nausea and vomiting of pregnancy.
Does H. pylori infection during pregnancy cause problems for the baby?
There is some concern that H. pylori infection may increase a developing babys risk of insufficient growth, congenital malformations, and even death, although these concerns have not been confirmed with studies.
What to consider about taking medications when you are pregnant:
- The risks to yourself and your baby if you do not treat the H. pylori
- The risks and benefits of each medication you use when you are pregnant
- The risks and benefits of each medication you use when you are breastfeeding
What should I know about using medication to treat H. pylori infections during pregnancy?
H. pylori infection is treated with a combination of drugs that is usually called triple therapy (if three drugs are used), though sometimes four drugs are used, in which case it is called quadruple therapy. These medications include a proton pump inhibitor, which reduces acid production in the stomach. They also include one or two antibiotics, such as clarithromycin or metronidazole, and a bismuth-containing drug, such as bismuth biskalcitrate. Although there has been some concern that clarithromycin might increase the risk of spontaneous abortion (miscarriage) early in pregnancy, it is generally considered relatively safe as is metronidazole. Most proton pump inhibitors are considered pregnancy safe, as are certain bismuth drugs.
Who should NOT stop taking medication for an H. pylori infection during pregnancy?
If you have H. pylori, you should complete the full course of your medication treatment in order to eradicate the infection.
What should I know about choosing a medication for my H. pylori infection during pregnancy?
You may find Pregistrys expert reports about the individual medications to treat H. pylori infections here and here. Additional information can also be found in the sources listed at the end of this report.
What should I know about taking a medication for my H. pylori infection when I am breastfeeding?
Proton pump inhibitors appear to be safe during breastfeeding, as are most bismuth drugs, and clarithromycin, metronidazole, and most of the other antibiotics that often are used against H. pylori.
What alternative therapies besides medications can I use to treat my H. pylori infection during pregnancy?
Medications are needed to eradicate the infection and to help the stomach lining to heal.
What can I do for myself and my baby when I have an H. pylori infection during pregnancy?
Complete the entire course of your medication regimen as directed and get plenty of rest.
Resources for H. pylori infection in pregnancy:
For more information about H. pylori during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or read the following articles:
- Mayo Clinic: Helicobacter pylori (H. pylori) infection
- US Center for Disease Control and Prevention: Helicobacter pylori and Peptic Ulcer Disease