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Gastro-oesophageal reflux and pregnancy: various treatment options

Non-drug measures can often make the symptoms of gastro-oesophageal reflux during pregnancy acceptable to patients. The reference drugs are the same both during and outside pregnancy.

Gastro-oesophageal reflux is when the acid from the stomach rises up the oesophagus into the mouth, causing heartburn. It occurs after meals, when leaning forward, or sometimes when lying down. Very frequent in pregnant women, the symptoms begin in the first trimester and become more intense as the pregnancy progresses. Complications are rare and reflux generally stops after birth.

In cases of enduring, troublesome gastro-oesophageal reflux without complications, non-drug measures should be tried first: avoid copious meals rich in fatty foods, acidic or spicy foods, alcohol, coffee, smoking, physical effort or lying down after a meal, leaning forward, stress, tight clothing. It sometimes helps to lose weight and to raise the head of the bed by 10 to 15 cm.

When these measures are not sufficient, the first-line treatment is a moderate dose of an antacid taken over a short period. A proton-pump inhibitor such as omeprazole, or an H2 receptor antagonist such as ranitidine, is used in the case of troublesome symptoms or of oesophagitis. Studies linked to the use of omeprazole in pregnant women do not show any particular risk of fetal toxicity. The evidence regarding ranitidine is much less robust, but does not show any particular risk either.

Cimetidine and domperidone should be ruled out because they expose the mother, the fetus or the newborn to severe adverse effects.

©Prescrire 1 December 2015

"Gastro-oesophageal reflux during pregnancy" Prescrire Int 2015; 24 (166): 296-299. (Pdf, subscribers only).

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