Is Maalox Safe for Pregnant Women?
Yes, Maalox (aluminum hydroxide/magnesium hydroxide) is safe for use during pregnancy and represents a first-line treatment option for heartburn in pregnant women. 1, 2
Treatment Algorithm for Heartburn in Pregnancy
First-Line Therapy: Antacids (Including Maalox)
- Antacids, alginates, and sucralfate are the recommended first-line therapeutic agents for heartburn in pregnancy. 2
- Maalox specifically contains aluminum and magnesium hydroxide, which falls into the antacid category that has been extensively studied and deemed safe. 1
- Pregnant women who received pharmaceutical antacid treatment (including aluminum/magnesium hydroxide combinations) experienced complete heartburn relief significantly more often than those receiving placebo (RR 1.85,95% CI 1.36 to 2.50), with moderate-quality evidence supporting this benefit. 3
Safety Profile
- Antacids are categorized as "low risk" medications during pregnancy and should never be avoided. 4
- There was no significant difference in side effect rates between antacid treatment groups and placebo groups in pregnant women (RR 0.63,95% CI 0.21 to 1.89). 3
- The mechanism of action involves acid neutralization and potentially stimulation of endogenous prostaglandin synthesis, without causing histological or ultrastructural lesions to gastric mucosa. 5
Step-Up Approach When Maalox Is Insufficient
Second-Line: H2 Receptor Antagonists
- If symptoms persist despite antacid use, H2 receptor antagonists (H2RAs) can be added, with the exception of nizatidine (which shows fetal teratogenicity in animal studies). 2
Third-Line: Proton Pump Inhibitors
- PPIs are reserved for women with intractable symptoms or complicated GERD. 2
- All PPIs are FDA category B drugs except omeprazole (category C). 2
- This escalation should only occur after antacids and H2RAs have proven inadequate. 1, 2
Important Clinical Considerations
Dosing and Administration
- Use the lowest effective dose necessary to control symptoms. 4
- Maalox can be used throughout all trimesters of pregnancy. 1
Common Pitfall to Avoid
- Do not skip antacids and jump directly to PPIs or H2RAs. The evidence supports a stepwise approach beginning with antacids like Maalox, which have the most favorable safety profile and proven efficacy. 2
Breastfeeding Compatibility
- Antacids are compatible with breastfeeding, allowing continuation postpartum if needed. 1