Reflux / Heartburn
What is Reflux?
Heartburn is common in pregnancy (incidence is 17-80%), and can occur in all trimesters, with increasing severity in later pregnancy.
There is increased likelihood of heartburn if the woman has had a previous baby. Elevated levels of progesterone cause the lower oesophageal sphincter to become more relaxed allowing gastric reflux.
Impaired gut motility and gastric emptying, and increased abdominal pressure from the uterus may contribute to heartburn in pregnancy.
Heartburn / reflux can lead to a burning or painful sensation in the upper part of the digestive tract and the throat.
Things to try:
- Eat small frequent meals
- Avoid eating and drinking at the same time to reduce stomach volume
- Avoid gastric irritants (foods & medications causing reflux) e.g. chocolate, coffee, citrus juices, tomato products , alcohol , fizzy drinks, greasy/spicy/acidic foods
- Avoid eating late at night or within 3 hours of going to bed
- Chewing gum stimulates the salivary glands and may neutralise acid
- Cease smoking
Positioning
- Elevate the head of the bed by 10-15cm.
- Lying on the left side has been shown cause less frequent reflux
- Encourage an upright position where possible, avoiding lying down after meals
Pharmacological interventions
Pharmacological interventions may be initiated if adjustments to life-style changes provide a poor response.
Antacids
- Simple antacids are used intermittently however limited data is available on their use in pregnancy.
- Most calcium and magnesium-based antacids are considered safe at usual doses in pregnancy.
- Liquid antacids are more effective than solid antacids.
- Avoid taking the antacid near the time of consuming supplemental iron (gastric acid facilitates the absorption of iron).
- Take antacids at least 1 hour apart from iron and other medications.
- Intermittent use of metoclopramide is safe in pregnancy.
- For severe symptoms, Omeprazole (Nexium) can be prescribed after medical review.
