Heartburn in Pregnancy (Management)

GORD during pregnancy should be managed with a step-up algorithm:

  • Lifestyle modifications and dietary changes will help reduce the symptoms of GORD during pregnancy as at any other time.
  • Alginate reflux suppressants have non-systemic mode of action and are not associated with any known significant side effects. They are therefore considered the first line medical therapy in pregnancy and lactation.
  • Antacids are normally suitable to take during pregnancy, but some preparations contain sodium and may be best avoided.
  • H2-receptor antagonists should be reserved for patients with more severe symptoms, and are not generally recommended by the manufacturers, though there are studies that indicate that ranitidine, for example, is effective and suitable to take during pregnancy.[Larson JD, 1997] Nizatidine, however, is not recommended.
  • Proton pump inhibitors have not been extensively tested in pregnant women, and are therefore not recommended. They should be reserved for women who have severe intractable symptoms, and possibly for administration prior to anaesthesia during labour and delivery.[Broussard CN, 1998] H2-RAs and PPIs are not licensed for use in pregnancy.

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