Acid Reflux Medicine: Safe During Pregnancy?

Acid reflux, or heartburn, is a common issue during pregnancy, affecting up to 80% of pregnant people. While it is generally harmless, it can be uncomfortable and disrupt sleep and eating habits. The condition is caused by hormonal changes that relax the muscles in the oesophagus, allowing stomach fluids to travel upwards, especially after large meals or when lying down. It is also caused by the growing foetus putting pressure on the stomach, which tends to worsen in the second and third trimesters.

What are safe acid reflux medicines during pregnancy?

Heartburn, acid reflux, and gastroesophageal reflux disease (GERD) are common during pregnancy, affecting up to 80% of pregnant people. This is due to hormonal changes that slow digestion and physical changes that put more pressure on the stomach as the fetus grows. While this condition is generally harmless, it can be uncomfortable.

Antacids

Over-the-counter antacids are generally considered safe during pregnancy. These include:

• Tums
• Rolaids
• Mylanta
• Maalox
• Calcium carbonate chewables

Antacids work by neutralising the acid in the stomach and are usually the first choice for treating heartburn in pregnancy. However, it is important to pay attention to the dosage. Pregnant people should not take more than 1,000 milligrams (mg) of elemental calcium per day from antacids and should avoid long-term use of antacids containing magnesium trisilicate.

Sucralfate

If antacids do not provide relief, a doctor may recommend sucralfate, which forms a barrier in the stomach to block stomach acid from travelling up the oesophagus. It is sold under the brand name Carafate in the United States and is considered safe during pregnancy.

Histamine-2 Receptor Agonists (H2RAs)

If sucralfate is not effective, the next medication to try is a histamine-2 receptor agonist. These medications help to lower the amount of acid produced in the stomach. H2RAs include the generic medications cimetidine, famotidine, nizatidine, and ranitidine, as well as brand names like Pepcid, Tagamet, and Zantac. However, it is important to note that ranitidine (Zantac) was removed from the market in 2020 due to concerns about a possible cancer-causing substance.

Proton Pump Inhibitors (PPIs)

Proton pump inhibitors are another option for treating acid reflux. While they are routinely prescribed for non-pregnant individuals, there may be some risks associated with PPI use during pregnancy, including an increased risk of low birth weight, gestational diabetes, and preeclampsia. Therefore, it is important to consult with a doctor to weigh the risks and benefits before taking PPIs during pregnancy. PPIs include:

• Lansoprazole (Prevacid)
• Omeprazole (Prilosec)
• Pantoprazole (Protonix)
• Esomeprazole (Nexium)

Lifestyle and Dietary Changes

In addition to medication, there are several lifestyle and dietary changes that can help manage acid reflux during pregnancy:

• Avoid lying down within 3 hours after eating
• Wear loose-fitting clothing
• Eat small, frequent meals instead of larger meals
• Eat slowly and chew food well
• Limit fluids during meals
• Avoid eating within 2-3 hours before bedtime
• Sleep or rest on your left side
• Elevate the head of your bed
• Avoid trigger foods, such as spicy, acidic, or fried foods

It is always important to speak with your doctor or healthcare provider before taking any medication during pregnancy, including over-the-counter remedies, to ensure the safety of you and your baby.

What foods should be avoided to prevent acid reflux during pregnancy?

During pregnancy, it is important to be cautious about the types of food consumed to prevent acid reflux. Acid reflux, also known as heartburn, is a common occurrence during pregnancy, affecting up to 80% of pregnant people. It is caused by the relaxation of muscles in the esophagus due to hormonal changes, allowing stomach acid to travel up the esophagus. Additionally, the growing fetus increases pressure on the stomach, worsening acid reflux during the second and third trimesters.

To prevent acid reflux, it is recommended to avoid specific foods that are known triggers. These include:

• Spicy foods: Avoid foods with black pepper, onions, or garlic, as they can irritate the stomach lining and relax the lower esophageal sphincter.
• Citrus fruits and juices: The high acidity in citrus fruits can exacerbate acid reflux.
• Tomatoes and tomato-based products: These are highly acidic and can trigger heartburn.
• High-fat foods: Fatty foods take longer to digest, increasing the risk of acid reflux. Greasy foods like burgers and ice cream fall into this category.
• Caffeinated drinks: Both caffeinated and decaffeinated coffee can decrease pressure on the lower esophageal sphincter, leading to acid reflux.
• Carbonated beverages: These can cause stomach irritation and relax the lower esophageal sphincter.
• Chocolate: While delicious, chocolate is best consumed in moderation during pregnancy due to its potential to trigger acid reflux.

It is important to note that everyone has different trigger foods, so it is advisable to keep a food diary to identify specific items that cause acid reflux. Additionally, eating smaller, frequent meals, avoiding lying down after eating, and wearing loose-fitting clothing can also help prevent acid reflux during pregnancy.

What lifestyle changes can help prevent acid reflux during pregnancy?

Lifestyle changes can help prevent acid reflux during pregnancy. Acid reflux, also called heartburn or indigestion, is common during pregnancy, affecting an estimated 30% to 80% of pregnant people. It is caused by hormonal changes and the growing foetus pressing against the stomach.

Dietary changes

• Eat small, frequent meals throughout the day instead of three large ones. Smaller meals can help reduce the likelihood of acid reflux because there is less food in the stomach to be pushed back up into the oesophagus.
• Eat slowly.
• Avoid fried, spicy, or fatty foods. These foods can trigger heartburn.
• Avoid citrus fruits and juices. Citrus fruits are highly acidic and can irritate the oesophagus, leading to heartburn.
• Avoid carbonated beverages, like soda or pop. Carbonated drinks can increase stomach pressure and promote acid reflux.
• Drink between meals, not during. Drinking while eating can increase the volume of the stomach contents, which can then push against the lower oesophageal sphincter and cause acid reflux.
• Avoid eating within 2-3 hours of going to bed. Lying down soon after eating can increase the risk of acid reflux because gravity is no longer keeping the stomach contents away from the lower oesophageal sphincter.

Body position changes

• Sit up straight when eating. This can help take the pressure off the stomach.
• Wait at least two hours after eating to lie down.
• Wait three hours after eating before going to bed.
• Sleep on your left side. This can help keep stomach acid from coming up while you sleep.
• Raise the head of your bed. By keeping your upper body slightly elevated, you can reduce the risk of acid reflux while sleeping.

Other changes

• Wear loose-fitting clothing. Tight clothes can put additional pressure on the stomach, worsening heartburn.
• Regular exercise can aid digestion and reduce the likelihood of acid reflux. Remember to consult your physician before starting any new exercise regimen during pregnancy.
• Avoid smoking and drinking alcohol. Smoking and drinking alcohol during pregnancy can cause health problems for the foetus and increase the risk of acid reflux.

What are the risks of taking proton pump inhibitors during pregnancy?

Proton pump inhibitors (PPIs) are a type of medication used to treat heartburn, a common symptom of gastroesophageal reflux disease (GERD). While PPIs are routinely prescribed to non-pregnant individuals, there may be some risks associated with their use during pregnancy.

One large study found an increased risk of low birth weight, gestational diabetes, and preeclampsia in pregnant individuals who used PPIs. Another study suggested that there was a higher risk of birth defects in women who took PPIs 1–4 weeks before conception. However, the authors could not confirm these findings when examining the use of over-the-counter PPIs or omeprazole, a specific type of PPI.

Despite these potential risks, healthcare providers may still prescribe PPIs to pregnant individuals if the benefits outweigh the risks. This decision should be made in consultation with a doctor, who can help weigh the risks and benefits of PPI therapy during pregnancy.

It is important to note that other treatment options for GERD during pregnancy include antacids, H2-receptor antagonists such as famotidine or ranitidine, and prokinetic agents like metoclopramide. Lifestyle modifications, such as eating smaller meals and avoiding late-night snacks, are also recommended for pregnant individuals with GERD.

What are the risks of untreated acid reflux during pregnancy?

Acid reflux, or heartburn, is a common occurrence during pregnancy, affecting up to 80% of pregnancies. It is caused by hormonal changes and the growing foetus pressing against the stomach. While it is usually not a serious condition, there are risks associated with leaving it untreated.

One of the primary risks of untreated acid reflux during pregnancy is the potential impact on the mother's quality of life. Heartburn can be extremely uncomfortable and disruptive, affecting sleep and eating habits. It can also be associated with nausea and vomiting, which can further impact the mother's health and well-being.

Additionally, untreated acid reflux can lead to more serious complications. In some cases, it can be a sign of preeclampsia, a potentially life-threatening condition for both the mother and the foetus. Preeclampsia is characterised by high blood pressure and organ dysfunction, and it can lead to severe illness, early labour, and low birth weight. Therefore, it is crucial to monitor and manage acid reflux symptoms during pregnancy to reduce the risk of potential complications.

Furthermore, untreated acid reflux can increase the severity of nausea and vomiting during pregnancy, which can have negative consequences for the mother's health and quality of life. In some cases, it may also lead to difficulties with swallowing, a persistent cough, swollen glands, or pain and swelling in the stomach. These symptoms can indicate more serious underlying issues that require medical attention.

While acid reflux during pregnancy is typically managed through lifestyle and dietary changes, as well as over-the-counter or prescription medications, it is always advisable to consult a healthcare professional for personalised advice and treatment options.

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