Helicobacter Pylori: What It Means in Pregnancy

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Helicobacter pylori (H. pylori) are bacteria that can cause a stomach or upper intestinal ulcer (peptic ulcer). These bacteria live in the stomachs of over half of all Americans. In most cases, the infection starts in childhood. The word “infection” is a bit misleading because H. pylori rarely causes symptoms or an ulcer. In most people it is an asymptomatic, long-term infection that people never know they have.

Since many women are living with H. pylori, many women will have it during pregnancy. What does that mean for your pregnancy and your baby? There has been a fair amount of research to answer that question. The results are not yet clear. There may be some risk, but probably not enough to worry about. H. pylori was not discovered or linked to ulcer disease until the 1980s. Not surprisingly, there are still a lot of unanswered questions.

H. Pylori Basics:

H. pylori infection is probably spread from person to person through saliva. It can also be spread through stool. In countries with poor sanitation, infection may spread through contaminated drinking water. Once the bacteria are in your stomach, they change the inner lining of the stomach, making the stomach and upper intestine less resistant to stomach acid. Over time, usually in later adult years, a peptic ulcer can form. There is some evidence that having this infection also increases your risk for stomach cancer.

Only about 10 percent of people with H. pylori develop an ulcer. H. pylori can also cause stomach symptoms without causing an ulcer. Researchers are not sure why H. pylori causes symptoms in some people and others are asymptomatic, but symptoms to watch out for include:

  • Heartburn
  • Stomach pain that is worse on an empty stomach
  • Nausea, loss of appetite, and weight loss
  • Burping and bloating
  • Stomach bleeding

Stomach bleeding is usually a sign of a bleeding ulcer. You may vomit up blood or coffee ground material, or you may see bloody or dark and tarry stool. These signs always need an emergency evaluation.

If you have signs or symptoms of H. Pylori, diagnosis can include a blood test, breath test, stool test, or a stomach biopsy. Treatment is a combination of medication to reduce stomach acid and two antibiotics all given together.

H. Pylori and Pregnancy:

There is not any strong research showing that being pregnant increases your risk of developing H. pylori symptoms. In fact, peptic ulcer disease in pregnancy is very rare. This may be because stomach acid secretions decrease during pregnancy. Having an asymptomatic H. pylori infection during pregnancy could have some risks:

  • Hyperemesis Gravidarum (HG). Several studies have found a link between severe morning sickness (HG) and H. pylori. Other studies failed to find the link. Right now, the evidence suggests that being positive for H. pylori may increase your risk for HG.
  • Iron Deficiency Anemia (IDA). Pregnancy already puts you at higher risk for IDA because you need more iron. Some studies show that being H. pylori positive may add to the IDA risk, probably because H. pylori can decrease your stomachs ability to absorb iron.
  • High Blood Pressure of Pregnancy (Pre-Eclampsia). Some studies found about a 20 percent higher risk of pre-eclampsia in pregnant women positive for H. pylori. The cause may be increased inflammation from the infection that affects blood vessels.
  • Fetal Growth Restriction (FGR). FGR means having a lighter or smaller than average baby. One study found about a 7 percent higher risk for FGR in women with H. pylori. The cause could be a higher rate of anemia in these women.
  • Other Studies. Researchers have also looked for links between H. pylori and miscarriage, birth defects, and bleeding disorders. These links have not been established.

One thing that seems to be true is that there is little risk of passing an H. pylori infection to your baby during pregnancy or breastfeeding. In fact, most of the evidence shows that if you have been infected with H. pylori, you are more likely to pass your baby antibodies against H. pylori, reducing your baby’s risk.

Should H. Pylori Be Treated During Pregnancy?

If you have symptoms of H. pylori, the infection can be diagnosed with a blood test and a stool test. The blood test will tell if you have antibodies to the bacteria and the stool test will tell if you have an active infection. Neither the breath test or the stomach biopsy is recommended during pregnancy. The breath test involves some radiation exposure and the biopsy requires anesthesia.

Generally speaking, because the risk of H. pylori infection to your pregnancy is low, treatment is delayed until after pregnancy and breast feeding. If you have severe symptoms, such as evidence of a bleeding ulcer, treatment may be recommended. In that case, the safest medications are an H2-receptopr blocker such as Pepcid or Zantac, along with two low-risk antibiotics.

Bottom line on H. pylori and pregnancy is that it should not be a big worry. It is good to know about, and you should let your doctor know if you have the symptoms. Unless you have a peptic ulcer, you will probably not need treatment. The chances of peptic ulcer during pregnancy are less than 0.005 percent, not enough to lose sleep over.

Christopher Iliades
Dr. Chris Iliades is a medical doctor with 20 years of experience in clinical medicine and clinical research. Chris has been a full time medical writer and journalist since 2004. His byline appears in over 1,000 articles online including EverydayHealth, The Clinical Advisor, and Healthgrades. He has also written for print media including Cruising World Magazine, MD News, and The Johns Hopkins Children's Center Magazine. Chris lives with his wife and close to his three children and four grandchildren in the Boston area.

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