Gastroesophageal reflux disease (GERD) during pregnancy

Most pregnant women have symptoms of gastroesophageal reflux disease (GERD), especially heartburn, at some point during pregnancy. These symptoms may begin at any time during a pregnancy and often may become worse as the pregnancy progresses. Heartburn is common during pregnancy because hormones cause the digestive system to slow down. The muscles that push food down the esophagus also move more slowly during pregnancy. In addition, as the uterus grows, it pushes on the stomach and sometimes forces stomach acid up into the esophagus.

Although these symptoms are common during pregnancy, they rarely cause complications, such as inflammation of the esophagus (esophagitis), or harm the fetus. Most of the time, symptoms of heartburn improve after the baby is born.

Treatment for pregnant women with GERD is similar to treatment for nonpregnant women who have GERD, focusing first on lifestyle changes and nonprescription medications. For example, pregnant women will be encouraged to:

• Avoid lying down right after eating.
• Avoid eating certain foods that may make heartburn worse, including chocolate, onions, peppermint, citrus or tomato products, or spicy foods.
• Elevate the head of the bed 6in.to 8in.. Do this by putting blocks underneath your bed frame or placing a foam wedge under the head of your mattress. This will help prevent stomach acid from flowing into your esophagus when you are sleeping. Using extra pillows does not work.
• Use nonprescription antacids such as Rolaids or Maalox for relief of heartburn symptoms. Antacids that contain sodium bicarbonate should not be taken by pregnant women because they can lead to fluid retention. Antacids that contain calcium carbonate (such as Tums) are okay to take.

Along with making lifestyle changes and taking nonprescription medications, some health professionals may recommend the prescription drug sucralfate for treating GERD symptoms during pregnancy. Although they are generally safe during pregnancy, don't use the following prescription and nonprescription medications without first discussing them with your health professional:

• Acid reducers, such as cimetidine (for example, Tagamet) or ranitidine (for example, Zantac)
• Proton pump inhibitors, such as omeprazole (for example, Prilosec) or lansoprazole (for example, Prevacid)