GERD Symptom Improvement During Pregnancy
Heartburn during pregnancy is common in the latter part of pregnancy and resolves after delivery in the vast majority of women. 1
Natural History and Timeline of GERD in Pregnancy
The course of GERD symptoms during pregnancy follows a predictable pattern that differs markedly from symptom improvement:
Symptom Progression Pattern
GERD symptoms typically worsen, not improve, during pregnancy, with prevalence increasing from 26.1% in the first trimester to 36.1% in the second trimester and 51.2% in the third trimester. 2
The frequency of GERD symptoms in pregnant women ranges from 30-90%, with approximately two-thirds of all pregnancies affected and around 25% of pregnant women experiencing daily heartburn. 1, 3
Symptomatic GERD usually presents in the first trimester and progresses throughout pregnancy, reaching maximum severity during the third trimester. 3, 4
Post-Delivery Resolution
Heartburn during pregnancy resolves soon after delivery in most cases, though little is known about late sequelae or influence on subsequent pregnancies. 1, 5
The resolution occurs because the underlying pathophysiology—decreased lower esophageal sphincter pressure caused by progesterone and increased intra-abdominal pressure from the gravid uterus—reverses after delivery. 1, 5
Pathophysiologic Basis for Symptom Worsening
The progression rather than improvement of GERD symptoms during pregnancy is explained by:
Progesterone causes relaxation of the lower esophageal sphincter, facilitating gastroesophageal reflux throughout pregnancy with increasing hormonal levels. 1
Progesterone also has an inhibitory effect on gastrointestinal and small bowel motility, leading to delayed gastric emptying that worsens as pregnancy advances. 1
Mechanical factors including increased intra-abdominal pressure from the enlarging uterus contribute to symptom progression, particularly in the third trimester. 5, 6
Clinical Implications
Pregnant women should be counseled that GERD symptoms are expected to worsen during pregnancy, not improve, with reassurance that resolution typically occurs after delivery. 1, 5
The prevalence of GERD symptoms in pregnant women (51.2% by third trimester) is substantially higher than in non-pregnant controls (9.3%), emphasizing the pregnancy-specific nature of this condition. 2
Despite high symptom burden, serious reflux complications during pregnancy remain rare, and most cases can be managed conservatively with lifestyle modifications and antacids. 5, 3
Common Pitfall to Avoid
Do not assume GERD symptoms will spontaneously improve during pregnancy as they do in some other conditions—the hormonal and mechanical changes of pregnancy consistently worsen reflux symptoms until delivery occurs and these factors resolve. 2, 4