by Dr. Michele Brown OB/GYN
There's no greater surprise for a woman than learning she is pregnant for the first time except for the first time she experiences one of mother nature's unkindest pregnancy symptoms -- Heartburn! Hopefully, this article will quickly help you solve the burning symptoms of heartburn should they arise.
As in most other conditions during pregnancy, behavioral modifications are always attempted initially. Before reaching for a bottle of antacids (which should be used, like all drugs, with caution during pregnancy), try some simple lifestyle changes that often ease heartburn.
Helpful Lifestyle Changes
- Elevate the head of the bed
- Avoid bending, stooping, or position changes that increase the reflux
- Small frequent meals
- Avoid late dinners or snacks within three hours of lying down
- Avoid dietary fat and other spicy esophageal irritants such as citrus juices, tomato products, coffee, chocolate, and peppermint.
The treatment of choice. The antacids neutralize the acid of the stomach juice and thus prevent its caustic effects on the lining of the esophagus. Antacids are best used in liquid form or chewable tablets. Antacids containing calcium, aluminum and magnesium are considered safe, as their absorption into the bloodstream is minimal.
Preparations containing phosphates are less effective than carbonates, hydroxides, or oxides.
Some antacids contain sodium bicarbonate and therefore are high in sodium. Those should be used in moderation as high sodium can contribute to fluid retention and overload in both mother and fetus.
Poor absorption of iron is a side effect of all antacids and can lead to anemia. An increase in iron supplementation may be indicated.
Some preparations combine antacids with other agents for a synergistic effect. Alginic acid (Gaviscon) coats the lining of the esophagus and prevents acid corrosion. It is considered safe in pregnancy. On the other hand, Simethicone, commonly found in some antacids, is best avoided in pregnancy despite its lack of absorption due to limited data on its effect on the fetus.
Excessive doses of antacids can have major side effects. Chronic use of aluminum can have increased deep tendon reflexes and elevated calcium levels. And elevated magnesium can cause diarrhea, decreased muscle tone, and cardiovascular and respiratory depression.
Dosages are generally 1 to 8 tablets chewed in divided dosages 3 to 4 times daily between meals and at bedtime. Liquid forms are 5 to 30 cc depending upon the particular medication used.
Other Heartburn Medications
Sucralfate, (Carafate -- 1 gram three times a day), similar to antacids, is an aluminum salt that inhibits gastric acid, and does not get absorbed. It is considered safe in pregnancy and in breast-feeding women.
GI Stimulant or Prokinetic agents: Metoclopramide is a drug that raises lower esophageal pressure and is also an anti-emetic. It is very effective in controlling heartburn of pregnancy and considered safe in pregnancy. A recent study in The New England Journal of Medicine by Matok concluded that metoclopramide in the first trimester was not associated with increased risks of any major congenital malformations, perinatal death, preterm birth, low birth weight, or low Apgar scores.
H2 Receptor Blockers (Pepsid and Axid, Cimetidine, Famotidine, and Nizatidine): The drugs in this category inhibit gastric acid secretion. These drugs are used in women with severe heartburn. Even though animal studies have not shown any adverse effects of the fetus, very little data is available in humans. These drugs should therefore be avoided in pregnancy if possible.
Proton pump inhibitors (Prilosec, Lansoprazole): Similar to H2 Blockers, these drugs also block gastric acid secretion. These drugs are more effective and have more rapid onset of action in relieving the symptoms of GERD compared to H2 receptor blockers. Two recent articles, one published by The American College of Gastroenterology by Gill in 2009 and another published by New England Journal of Medicine in 2010 by Pasrternick confirmed the safety of the use of Prilosec during pregnancy. Further studies need to be done to determine the safety of use during lactation and also risks with other drugs in this category.
Reflux is common in pregnancy. In most cases the condition responds well to lifestyle changes. More severe cases may require drug therapy. Antacids alone or in combination with alginic acid used after meals or at bedtime provide excellent relief in most cases. In refractory cases, H2 receptor blockers should be considered but used sparingly (once a day rather than twice a day) after dinner. PPI’s as of recent data have now also been proven to be both safe and effective drug therapy.
Once your baby's born the heartburn will be a distant memory. Is it interfering with the quality of your pregnancy even after you've made lifestyle changes? Studies indicate treatment of heartburn will not affect the well being of your growing baby.
Dr. Brown, founder of Beauté de Maman, is a board-certified member of the American College of Obstetrics and Gynecology, a member of the American Medical Association, the Fairfield County Medical Association, Yale Obstetrical and Gynecological Society and the Women's Medical Association of Fairfield County. She is a magna cum laude graduate of Tufts University, completed her medical training at George Washington University Medical Center and completed her internship and residency in obstetrics and gynecology at Yale-New Haven Hospital. Dr. Brown has a busy obstetrical practice in Stamford, Connecticut and, as a clinical attending, actively teaches residents from Stamford Hospital and medical students from Columbia Presbyterian Hospital in New York.
Copyright © Michele Brown. Permission to republish granted to Pregnancy.org, LLC.
Active management of heartburn can improve the pregnant woman’s quality of life.