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Treating Acid Reflux in Pregnancy: Understanding options

Digestion, Women's Health | July 5, 2014 | Author: The Super Pharmacist

reflux, pregnancy, ppi, antacid, zantac

Treating Acid Reflux in Pregnancy: Understanding options

The stomach controls the initial stages of digestion. The cells of its inner lining produce hydrochloric acid (HCl) to break down food passing into it from the oesophagus. This acid may travel back up this tube toward the mouth, which is associated with oesophageal inflammation. This is known as acid reflux or gastro-oesophageal reflux disorder.

Acid reflux often occurs in pregnant women. This may be due to increased mechanical pressure on the stomach caused by increasing uterine size, or by hormonal changes during pregnancy. Peristalsis may also be depressed during pregnancy.

The risk of developing acid reflux may be influenced by some disorders or behaviour patterns a woman may have experienced prior to pregnancy. Conditions that increase the probability of acid reflux may include histal hernia, diabetes, obesity and asthma.

Acid reflux may be addressed by pharmacological options or behavioural modifications.

What is acid reflux in pregnancy?

The stomach is an important organ in which the first stages of food digestion occur. Digestion is aided by the production of an acid, mainly composed of hydrochloric acid (HCl), released by cells in the inner lining of the stomach. This is a strong acid, but the walls of the digestive system are resistant to it, and it is neutralised to a degree by food and its breakdown products in the stomach ('chyme'). However, sometimes stomach acid may find its way out of the stomach toward the throat, via the tube that connects the mouth to the stomach (the oesophagus). This is known as gastro-oesophageal reflux disorder, or acid reflux. This often manifests as irritation or discomfort in the upper chest as the oesophagus is inflamed by an upward surge of stomach acid. This is the basis of another common term for the disorder: 'heartburn'.

Acid reflux may occur in up to two-thirds of women during pregnancy. This may be due to the effect of certain hormones that are abundant during this stage. These may slow digestion, which may cause a 'back-up' of stomach acid.

The Growing Baby

What is acid reflux in pregnancy?As the fetus grows, and the uterus concurrently expands, there may be increased physical pressure or displacement acting on nearby organs, including the stomach. This may also increase the risk of acid reflux. In addition, the movement of the muscles of the oesophagus that allow for swallowing (i.e. moving food from the mouth into the stomach, also known as peristalsis) may slow down during pregnancy.

Acid reflux is often mild, unless the oesophagus is exposed to a high volume or concentration of HCl. It can be distracting and discomfiting, however, especially if it happens regularly over a period of several months.

Risk Factors for acid reflux in pregnancy

The risk of developing acid reflux may be influenced by some pre-existing conditions a pregnant woman may have. These include:

  • Diabetes
  • Asthma
  • Obesity
  • Scleroderma
  • Histal hernia (a bulging of the stomach toward the diaphragm)

A history of smoking or heavy alcohol intake is also associated with an increased risk of acid reflux development. Regular intake of certain foods may also affect the risk of acid reflux. 

How toTreat Acid Reflux in Pregnancy

Acid reflux may be treated by over-the-counter products called antacids, which contain molecules that can neutralise HCl and thus reduce oesophageal inflammation. Pregnant women may take calcium carbonate-based antacids to neutralise acid reflux. H2 antagonists and proton pump inhibitors reduce the production of stomach acid. These are safe to take during pregnancy.

Pharmacological Options 

It is recommended that pregnant women avoid taking any medications unless considered absolutely necessary.

The following is a list of treatments that may be recommended:

Antacids

Acid reflux may be treated by over-the-counter products called antacids, which contain molecules that can neutralise HCl and thus reduce oesophageal inflammation. Antacids that contain calcium carbonate are preferable during pregnancy. These include:

  • Tums
  • Metamucil
  • Gastogel
  • Gaviscon

Warning - Pregnant women should not take antacids that contain sodium bicarbonate, such as Alka-Seltzer, as these will cause excessive water retention. 

H2 antagonists

H2 antagonists inhibit the production of HCl by stomach lining cells, and thus may relieve the effects of acid reflux. These are a class of drugs that are mostly safe to take during pregnancy. H2 antagonists include:

  • Cimetidine (Tagamet)
  • Ranitidine (Zantac)

Of these, cimetidine is more often associated with side-effects. These may include dizziness, disorientation, headache, rash, constipation or diarrhoea. H2 antagonists have a more long-term effect compared to antacids.

Proton-pump-inhibitors (PPI)

Another class of drugs that may be considered for acid reflux during pregnancy are the proton pump inhibitors. These inhibit the formation of HCl in the stomach. Proton pump inhibitors include:

  • Esomeprazole (Nexium)
  • Lansoprazole (Zoton)
  • Omeprazole (Losec, Acimax)
  • Pantoprazole (Somac)
  • Rabeprazole (Pariet)

Proton pump inhibitors may cause skin reactions, such as itching or rash. They may also be associated with other side-effects such as flatulence and constipation.

Sucralfate

Sucralfate, which reacts with HCl to form a more neutral, viscous substance, is also a common therapy for acid reflux during pregnancy.

Behavioural Modifications 

There are also many lifestyle changes or measures one can take to reduce acid reflux while pregnant. These may centre on taking the reduced capacity or efficiency of the stomach into account.

Reducing the amount of food taken in during each meal by eating four or five smaller meals per day, rather than three larger ones.

Avoid lying down for two or three hours after eating to reduce the risk of acid reflux.

If reflux attacks occur at night, try raising the head of the bed by about 15cm, so as to relieve the pressure on the stomach while sleeping.

Food may contribute to acid reflux

The intake of certain foods or food types may increase the probability of acid reflux, as they may be more acidic themselves, or promote the formation of stomach acid. These foods include

  • Citrus fruits
  • Tomatoes
  • Spicy or chilli-rich foods
  • Coffee
  • Polyunsaturated fatty acids
  • Chocolate

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