Almost 85 percent of all pregnant women suffer from acid reflux or heartburn, according to the HarvardScience website. Also referred to as GER for gastroesophageal reflux, acid reflux is uncomfortable but usually harmless. While lifestyle modifications help many women manage these heartburn symptoms, others with more severe symptoms may require medication. It is important to understand the safety implications of the medication options available to treat acid reflux during pregnancy.
Antacids
Antacids made from calcium carbonate, magnesium hydroxide or magnesium oxide are a common first line of defense for women in their first and second trimesters, according to BabyCenter.com. Antacids come in liquid or chewable tablet form and work to neutralize stomach acids.
Pregnant women should stay clear of antacids that contain aluminum, which can be constipating and in large doses even toxic. Avoid antacids that contain aspirin as well, including the renowned Alka-Seltzer. Keep in mind that aspirin sometimes goes by the terms salicylate or acetylsalicylic acid.
Women in their third trimester should refrain from antacids tablets containing sodium bicarbonate or baking soda, which can cause water retention. The American College of Gastroenterology suggests women in their third trimester avoid antacids with magnesium because they can interfere with uterine contractions during labor.
Antacid-Asthma Link
Children whose mothers take antacids during pregnancy had a 50 percent higher incidence of asthma than those children not exposed in utero, according to a study conducted by Boston Children's Hospital researchers Elizabeth Hait, Edda Fiebiger and Eleonora Dehlink. Published in the December 2008 edition of "Clinical & Experimental Allergy" and summarized on the HarvardScience website, the study concluded that in the 1 percent of children exposed to antacids in utero, more than 5 percent required allergy medications or suffered from allergies. Of these, asthma was the most commonly reported allergy-related condition.
The team further recognized that the allergy risk only increased in those children with non-allergic parents. There was no additional risk noted for those whose mothers already suffered from allergies, and who took antacids during pregnancy.
H-2 Blockers
When lifestyle modifications and antacids fail to curb the symptoms of acid reflux during pregnancy, doctors may prescribe H-2 blockers like cimetidine or ranitidine, known as Tagamet and Zantac, respectively. H-2 blockers neutralize acid by targeting the histamine H-2 receptors located in the mucous membrane layer of the stomach. According to the Mayo Clinic, H-2 blockers may not work as quickly as antacids but provide longer symptom relief.
The Journal of Family Practice website notes that the U.S. Food and Drug Administration (FDA) classifies H-2 blockers under pregnancy category "B." This means they have not demonstrated any safety risks.
Proton Pump Inhibitors
When symptoms become severe to the point that vomiting occurs or there is insufficient weight gain, some doctors will resort to proton pump inhibitors like omeprazole or lansoprazole, known as Prilosec and Prevacid. These block the production of acid altogether. According to the Journal of Family Practice, proton pump inhibitors are more effective than antacids and H-2 blockers for acid reflux. Unfortunately, studies examining their safety with human pregnancy are limited. Proton pump inhibitors are in FDA pregnancy category "C" based on the results of animal studies. This means their potential benefit should outweigh potential risks in order to subscribe.
Medication Alternatives
The American College of Gastroenterology lists lifestyle and diet modifications as the first step in pregnancy-related acid reflux symptom management. Before using medications, try skipping fried, fatty, and spicy foods that can exacerbate heartburn, as well as caffeinated and carbonated beverages. Pregnant women should avoid lying down shortly after eating, and should sleep with their head elevated to help gravity keep acid down. Several small meals eaten slowly, along with warm liquids, can also help curb heartburn.
References
- American College of Gastroenterology: Heartburn Or Gastroesophageal Reflux Disease (GERD)
- HarvardScience: Antacid medication in pregnancy may increase childhood asthma
- BabyCenter: Which heartburn medicines are safe during pregnancy?
- Mayo Clinic: GERD Treatments and Drugs
- Highland GERD Institute: Pregnancy and Gerd / Acid Reflux
