From the Guidelines
Gastroesophageal reflux disease (GERD) during pregnancy should be managed with lifestyle modifications as the initial step, including dietary changes and avoidance of trigger foods, with medications such as antacids, H2-receptor antagonists, or proton pump inhibitors added as necessary, under the guidance of a healthcare provider. The management of GERD in pregnancy is crucial due to its high frequency, ranging from 30% to 90%, and its impact on maternal comfort and nutrition 1.
Lifestyle Modifications
Lifestyle modifications are the first line of treatment for GERD in pregnancy. These include eating smaller, more frequent meals, avoiding lying down for 2-3 hours after eating, elevating the head of the bed by 6-8 inches, and avoiding trigger foods such as spicy, fatty, or acidic items 1. The Motherisk Pregnancy Unique Quantification of Emesis score can be used to quantify the severity of nausea and vomiting, which often accompany GERD symptoms 1.
Medication Management
For mild symptoms, antacids containing calcium carbonate or aluminum hydroxide can be used 1. If symptoms persist, H2-receptor antagonists like ranitidine or famotidine may be added 1. In severe cases, proton pump inhibitors like omeprazole may be considered, especially in the second or third trimester, under close supervision 1. It's essential to note that while medications can provide relief, they should be used judiciously and under medical guidance to minimize potential risks to the fetus.
Pathophysiology and Complications
GERD in pregnancy is attributed to hormonal changes, particularly the increase in progesterone levels, which causes relaxation of the lower esophageal sphincter, facilitating gastroesophageal reflux 1. Additionally, the growing uterus can exert mechanical pressure, contributing to the symptoms. Untreated GERD can lead to complications such as esophagitis, emphasizing the importance of appropriate management during pregnancy 1.
Conclusion is not needed as per the guidelines, so the answer will be ended here.
From the FDA Drug Label
• are pregnant or plan to become pregnant. It is not known if omeprazole delayed-release capsules will harm your unborn baby • for up to 4 weeks to treat heartburn and other symptoms that happen with gastroesophageal reflux disease (GERD).
Omeprazole can be used to treat GERD in pregnancy, but the safety of omeprazole delayed-release capsules in pregnant women has not been established, and it should only be used if the benefits outweigh the risks 2.
From the Research
GERD in Pregnancy: Symptoms and Treatment
- Approximately two thirds of pregnant patients develop heartburn, with the origin being multifactorial, but the predominant factor is a decrease in LES pressure caused by female sex hormones, especially progesterone 3.
- Serious reflux complications during pregnancy are rare, and therefore EGD and other diagnostic tests are infrequently needed 3.
- Symptomatic GERD during pregnancy should be managed with a step-up algorithm beginning with lifestyle modifications and dietary changes 3, 4, 5, 6.
Treatment Options
- Antacids or sucralfate are considered the first-line medical therapy for GERD in pregnancy 3, 4, 7, 6.
- If symptoms persist, H2RAs should be used, with ranitidine being preferred due to its documented efficacy and safety profile in pregnancy 3, 7, 6.
- Proton-pump inhibitors are 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 3, 6.
- Calcium-containing antacids are the preferred choice of antacids 4.
- Sucralfate can be introduced if symptoms persist with antacids, followed by histamine-2 receptor antagonist 4.
- Inadequate control while on histamine-2 receptor antagonist and antacid may mandate a step-up to proton pump inhibitors along with antacids as rescue medication for breakthrough GERD 4.
Management and Recommendations
- The treatment goal is to alleviate heartburn and regurgitation without jeopardizing the pregnancy or its outcome 4.
- Management of heartburn in pregnant and breastfeeding women involves lifestyle modifications, dietary modifications, non-pharmaceutical remedies, and pharmaceutical drugs 5.
- Recommended treatment algorithm in pregnant and breastfeeding women have been developed, with a focus on a "step-up" methodology with progressive intensification of treatment 5, 6.
- Medical providers must discuss risks and benefits of these medicines with the patient in detail, especially when considering the use of H2RAs or PPIs 6.