Gastroesophageal Reflux in Pregnancy
Gastroesophageal reflux (GER) occurs in up to 80% or more of pregnant women. It is brought about by relaxation of the sphincter between the esophagus and the stomach, where stomach contents reflux up into the esophagus causing heartburn.
Although there are many causes of GER, it has been said that in pregnancy the decreased esophageal sphincter pressure is due to an increase in maternal hormones, particularly estrogen and progesterone. [1] Other factors that lead to this increased risk in pregnancy include increased intra-abdominal pressure secondary to an enlarged uterus and decreased gastrointestinal transit time.
Some of the signs and symptoms of GER include:[2]
- Acid Regurgitation
- Sour taste in the mouth
- Epigastric pain
- Chest pain
- Early satiety
- Abdominal bloating
- Belching
- Postnasal drip
Life-style modifications
We recommend that pregnant women suffering from reflux avoid excess dietary fat, chocolate, and beverages such as coffee, citrus juices, tomato products and carbonated beverages. A waiting period of 2-3 hours after eating is encouraged before lying down in bed may be helpful. Another useful tip would be to elevate the head of the bed by 4-6 inches. Sleep on your left side.[1]
Medications
Medication used to treat reflux and reflux symptoms include antacids, Histamine 2-receptor antagonists(H2RA), and proton-pump inhibitors. It is recommended that you start with calcium, magnesium, or aluminum hydroxide-containing antacids which include Tums, Maalox, Riopan, and Rolaids. These are considered first-line in the treatment of reflux in pregnancy. They are generally safe to use in pregnancy and are sold over the counter. Avoid sodium-containing antacids. [1]
Histamine-2 receptor antagonists are used if reflux persists and antacids fail to relieve symptoms, and these include: ranitidine, famotidine, and nizatidine.[1] Ranitidine and famotidine has been used in pregnancy for over 30 years with no safety issues.[1]
Finally, proton pump inhibitors can be used when lifestyle modifications the symptoms are not controlled by the H2 blockers (ranitidine, etc.). Although no teratogenic outcomes have resulted from taking this class of medications in pregnancy, proton pump inhibitors have not been extensively studied in pregnancy.[1]
1.Ali RA, Egan LJ. Gastroesophageal reflux disease in pregnancy. Best Pract Res Clin Gastroenterol. 2007;21(5):793-806.
2.http://www.thomsonhc.com/hcs/librarian.MicromedexHealthcare Series. Accessed July 10, 2010.
Maria Milla, MD.
Thomas W. Hale, Ph.D.
InfantRisk Center
