Pregnancy induces significant hormonal, anatomical, and physiological changes that affect gastrointestinal motility and functional adaptations. During this period, common symptoms include nausea, constipation, vomiting, dyspepsia, and gastroesophageal reflux. Less frequent symptoms include peptic ulcer disease, diarrhea, gallstone disease, inflammatory bowel disorders, hemorrhoids, and acute surgical conditions such as appendicitis and pancreatitis. Diagnostic evaluation should be carefully tailored, with selective use of laboratory and imaging studies, while endoscopic procedures are reserved for strict indications, preferably performed in the second trimester with appropriate precautions. Management primarily focuses on lifestyle and dietary modifications, with pharmacologic agents employed only when necessary and in accordance with trimester-specific safety profiles. In cases refractory to conservative measures, interventional or surgical approaches may be considered following multidisciplinary decision-making. The maternal gut microbiota and microbiome have been the focus of growing interest in recent years, particularly during pregnancy. This chapter reviews the physiology of the gastrointestinal system in pregnancy, common disorders, diagnostic strategies, and therapeutic approaches, with a particular emphasis on maternal–fetal safety.