GERD

What is acid reflux and gastroesophageal reflux disease (GERD)?

Acid reflux, more commonly known as heartburn, is the irritation of the esophagus that is caused by the contents of the stomach coming back up (reflux). Normally, there is a sphincter or valve at the lower part of the esophagus that prevents the reflux of stomach contents into the esophagus. However, during pregnancy, this valve frequently does not work properly because pregnancy hormones cause the sphincter to relax, allowing the stomach contents to go back up into the esophagus. Additionally, the growing uterus pushes everything up, which also includes the stomach contents.

Gastroesophageal reflux disease (GERD) is a more severe form of acid reflux. The symptoms tend to be more severe and present more often than symptoms of reflux.

The symptoms of reflux are the same in pregnancy and are felt as a burning sensation that can begin at the bottom of the breast bone and go all the way up to the throat. If it goes up to the throat or mouth, a sour or bitter taste may occur. The symptoms most frequently happen after eating or drinking, but women who have severe symptoms may have them at any time. Less common symptoms of reflux are a chronic cough, wheezing, hoarseness, nausea, problems swallowing, or painful swallowing.

How common is acid reflux and gastroeshophageal reflux disease during pregnancy?

Acid reflux and gastroeshophageal reflux disease are very common during pregnancy and the risk of them happening increases by trimester: during the first trimester, 26.1% of pregnant women report acid reflux or GERD. By the third trimester, as many as 51.2% of pregnant women have symptoms.

How is acid reflux and gastroeshophageal reflux disease during pregnancy diagnosed?

Acid reflux and GERD can be diagnosed by symptoms alone. Rarely, tests are needed to evaluate or confirm the diagnosis of reflux. If tests are needed for more severe cases, then endoscopy (placing a camera with a light into the esophagus and stomach) or esophageal manometry and pH testing (tests if esophagus is functioning normally) can be done safely in pregnancy. An x-ray study, called a “barium radiograph”, cannot be done in pregnancy because of the risks of radiation exposure to the developing baby.

Does acid reflux and gastroeshophageal reflux disease cause problems during pregnancy?

While acid reflux and GERD do not increase the risk of pregnancy complications, they can lead to significant discomfort for pregnant women. In severe cases, the symptoms can limit the amount of eating and/or drinking in order to reduce the severity and frequency of symptoms. For women who experience reflux while lying down, it may negatively affect their ability to sleep well during pregnancy.

Does acid reflux and gastroeshophageal reflux disease during pregnancy cause problems for the baby?

Neither acid reflux nor GERD cause problems for the developing baby.

What to consider about taking medications when you are pregnant or breastfeeding:

You should think about:

• The risks to yourself and your baby if you do not treat the acid reflux or GERD
• The risk of not controlling your acid reflux or GERD if you stop taking your medication or if you switch to a different medication
• The risks and benefits of each medication you use when you are pregnant
• The risks and benefits of each medication you use when you are breastfeeding

What should I know about using medication to treat acid reflux and gastroeshophageal reflux disease during pregnancy?

Since reflux and GERD do not cause poor pregnancy outcomes, treatment is only for symptom improvement and comfort of the mom. Symptoms tend to be present only during pregnancy and improve quickly after delivering the baby. Long-term problems from acid reflux or GERD are not likely to occur if symptoms are only present during the pregnancy, so medical treatment is not absolutely necessary.

It is best to try the lifestyle changes discussed below for acid reflux and GERD symptoms first. If these dont help the symptoms, then over-the-counter antacids or sucralfate should be tried next. If the symptoms are still not getting better, then it is best to discuss your symptoms with your healthcare provider before trying a daily medication. There is a small possibility that the symptoms you are experiencing are not caused by acid reflux or GERD. More severe pain or pain in the upper right side of your belly may be a sign of liver problems, gallbladder problems, or peptic ulcer. Only your healthcare provider can tell the difference, so discussing your symptoms with them is important. 

Who should NOT stop taking medication for acid reflux and gastroeshophageal reflux disease during pregnancy?

Since most women will first get acid reflux or GERD in pregnancy, the medications that are recommended to treat the symptoms are usually safe for pregnancy. However, any time a medication is not essential, it is best to try and avoid taking it during the first 13 weeks of the pregnancy. This is the time of pregnancy that the highest risk for a medication to cause a birth defect exists. After the 13th week, medications can be used more safely in pregnancy.

What should I know about choosing a medication for my acid reflux and gastroeshophageal reflux disease during pregnancy?

Over-the-counter antacids are the first type of medication that should be tried for acid reflux or GERD in pregnancy. These work by neutralizing stomach acids and must be taken either when symptoms first start, at mealtimes, or before bed.

The antacid, calcium carbonate (Tums) is not known to cause birth defects and can be used in pregnacy to treat acid reflux and as a calcium supplement. Daily recommended doses for calcium are 1,000 to 2,000 mg per day, which should not be exceeded. If large amounts of calcium carbonate are needed to control acid reflux symptoms, other medications should be tried instead.

Antacids that have aluminum or magnesium may also be used to treat symptoms safely during pregnancy. These include medications like Maalox Advanced (avoid Maalox Total Relief) or Mylanta. Large doses of magnesium containing antacids should be avoided because they may cause diarrhea. Antacids containing sodium bicarbonate (Alka Seltzer) or magnesium trisilicate (Gaviscon) should be avoided in pregnancy. Not enough information is available for bismuth subsalicylates, so this is also avoided in pregnancy.

Alginates like sucralfate (Carafate) work by creating a protective coating over the walls of the stomach and are safe for use during pregnancy. These tend to be more efficacious for reflux symptoms than antacids.

More severe symptoms of acid reflux or GERD may require a daily medication regimen. H2- receptor blockers, which decrease the production of acid, are usually tried first. They include medications such as ranitidine (Zantac), cimetidine (Tagamet), famotidine (Pepcid), and nizatidine (Axid). All but cimetidine are safe for use during pregnancy. There is a small chance that, if cimetidine is taken during pregnancy, it can affect how the sex organs develop in baby boys, referred to as “feminization.” For this reason, it is avoided during pregnancy.

The last group of medications include omeprazole (Prilosec), lansoprazole (Prevacid), and pantoprazole (Protonix), which block the production of acid. These medications dont work immediately to control symptoms but instead need to be taken daily to improve symptoms. These are newer medications with less safety information available but they do appear to be safe for use in pregnancy.

You may find Pregistrys expert reports about the medications to treat aci
d reflux or GERD here. Additional information can also be found in the sources listed at the end of this report.

What should I know about taking a medication for my acid reflux and gastroeshophageal reflux disease when I am breastfeeding?

Most women who have acid reflux or GERD during pregnancy will have symptom improvement relatively quickly after delivery, so medication may not be needed while breastfeeding. If antacids are needed during breastfeeding, most are considered safe for use while nursing. Sodium bicarbonate is considered safe if used occasionally, but regular use is not recommended.

What alternative therapies besides medications can I use to treat my acid reflux and gastroeshophageal reflux disease during pregnancy?

Some simple lifestyle changes may help many women improve their acid reflux and GERD symptoms during pregnancy and should be tried before taking medication. These changes include:

• Elevating the head of the bed
• Eating small, frequent meals more slowly
• Quitting smoking and drinking alcohol (if not already done)
• Avoiding any foods or drinks that trigger symptoms
• Avoiding lying down after eating
• Avoiding tight fitting clothing

What can I do for myself and my baby when I have acid reflux and gastroeshophageal reflux disease during pregnancy?

It is important to remember that acid reflux and GERD do not cause problems for the baby or the pregnancy. While common during pregnancy, the symptoms dont tend to last for long after delivery and generally will not cause any long-term health problems. Ideally, lifestyle changes and over-the-counter antacids or alginates should be used first to control symptoms. If symptoms dont improve with these treatments then talk with your health care provider before trying daily medications.

Resources for acid reflux and gastroeshophageal reflux disease during pregnancy:

For more information about acid reflux and gastroeshophageal reflux disease during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or contact the following organizations:

• American Gastroenterological Association
• American College of Obstetricians and Gynecologists
• American College of Gastroenterology