From the Research
Safety of GERD Medications During Pregnancy
The safety of gastroesophageal reflux disease (GERD) medications during pregnancy is a concern due to the potential teratogenicity of these medications.
- Studies have shown that the incidence of GERD is high during pregnancy, with symptoms estimated to occur in 30-50% of pregnancies 1.
- The exact mechanism and pathogenesis of GERD associated with pregnancy is likely multifactorial, involving hormonal and mechanical factors that alter the structure and function of the normal physiological barriers to reflux of gastric contents into the oesophagus 2.
Treatment Strategies
Treatment strategies for patients not responding to conservative therapies include a step-up approach, starting with:
- Lifestyle and dietary modifications, which often respond to mild and infrequent symptoms 1, 2, 3, 4, 5.
- Antacids or sucralfate as first-line on-demand drug therapy 3, 4, 5.
- Histamine H2 receptor antagonists (H2RAs) as a second-line treatment, with ranitidine being a preferred option due to its documented efficacy and safety profile in pregnancy 3, 5.
- Proton pump inhibitors (PPIs) reserved for women with intractable symptoms or complicated reflux disease, with lansoprazole being a preferred option due to its safety profile in animals and case reports of safety in human pregnancies 1, 3, 4, 5.
Risks and Benefits
The use of GERD medications during pregnancy should be discussed with the primary physician, weighing the benefits against the risks, as the potential teratogenicity of these medications is not well known 1, 2, 3, 4, 5.
- Exposure to PPI therapy during pregnancy seems to predispose the fetus to minimal risk, and these medications should not be overly restricted based solely on the pregnancy 1.
- Careful discussion of the risks and benefits of therapy with the patient should precede treatment with any of these medications 2.