Review Article: The Management of Heartburn in Pregnancy

J.E. Richter


Aliment Pharmacol Ther. 2005;22(9):749-757. 

In This Article


Heartburn is a normal consequence of pregnancy, occurring in nearly two-thirds of women. The predominant cause is a decrease in LES pressure caused by female sex hormones, especially progesterone. Serious reflux complications (i.e. oesophagitis) during pregnancy are uncommon; therefore upper endoscopy and other diagnostic tests are usually not needed. Symptomatic GERD during pregnancy should be managed with a step-up algorithm beginning with lifestyle modifications and dietary changes (Figure 1). Antacids or sucralfate are considered the first-line medical therapy. If symptoms persist, any of the H2RAs can be used. Proton-pump inhibitors are reserved for women with intractable symptoms or complicated reflux disease. All but omeprazole are FDA category B drugs during pregnancy. Most drugs are excreted in breast milk. Of the systemic agents, only the H2RAs, with the exception of nizatidine, are safe to use during lactation.

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