GERD and Pregnancy

While GERD is often associated with middle-aged or older people, there's actually one demographic group that experiences the illness in even greater numbers than these two groups.

Nearly 80 percent of mothers-to-be experience mild to severe GERD symptoms at some point of their pregnancy, caused mainly by hormonal and physical changes related to the growing fetus inside them.  Treating GERD in pregnant women can be tricky, because some of the dietary and lifestyle changes that are recommended for other GERD patients simply aren't advisable for pregnant women, and because some of the medications recommended for other patients may be dangerous for the fetus.

GERD, or gastroesophageal reflux disease is caused when a weakness or malfunction of the lower esophageal sphincter allows stomach acid to reflux into the esophagus, irritating the lining of the esophagus and causing severe discomfort and symptoms such as heartburn, difficulty swallowing, nausea and vomiting.

During pregnancy the hormones progesterone and estrogen are produced in much larger quantities than normal. These hormones have a number of functions, one of which is to relax the muscles of the uterus enough to allow it to stretch to accommodate the growing fetus. However, the uterus is not the only part of the body which is relaxed by the uptick in hormone production. The increase in progesterone and estrogen can also relax the muscles in the GI tract, making bowel movements more frequent. They also relax the muscles of the esophagus, making it easier for the lower esophageal sphincter to open, resulting in acid reflux.

Also, during pregnancy, the uterus can push the stomach upward, putting pressure on the esophagus, also causing a weakening of the lower esophageal sphincter, thus contributing to GERD symptoms. In some severe cases, the pressure can cause a hiatal hernia which can contribute to GERD.

GERD can be a serious problem for some pregnant women, resulting in hospitalization to treat the very painful symptoms of this illness. GERD can also be extremely dangerous to the unborn child, because if it causes the mother excessive vomiting or weight loss, the resulting loss of nutrients to the developing child can be detrimental to his or her growth.

Folks who have GERD prior to pregnancy will most likely see their symptoms worsen during pregnancy. Treating pregnant women with GERD can be a challenge for doctors, because they must factor in the effect of any potential treatment to the developing child.

For example, many of the medications used to treat GERD in other patients cannot be used, or must be used in reduced doses because of the potential for harmful effects on the developing fetus. In some cases, overuse of antacids can inhibit iron absorption by the fetus, but dietary supplements containing iron that the mother can take will mitigate this effect.

Hopefully, if medication is needed to treat GERD in a pregnant patient, antacids alone will be adequate because there are few, if any, potentially negative effects for the fetus. Some of the small risks involved with using antacids are slower labor because of the magnesium component of many antacids.

Sometimes antacids aren't enough, however and more aggressive treatments must be explored. H2 antagonists, which reduce the production of acid in the stomach, are considered the next-safest drug after antacids. Studies on pregnant animals have shown no negative side effects of H2 antagonists on pregnant animals. Some common H2 antagonists include Tagamet, Zantac and Pepcid. The H2 antagonist Axid should not be used, because some negative effects have been observed in pregnant animal subjects.

If H2 inhibitors don't solve the problem, the next class of drugs are proton-pump inhibitors, which also work to reduce stomach acid production. Doctors are a little more wary of these drugs than H2 antagonists, because they're newer and less research has been done with these drugs regarding pregnant patients. Some common proton-pump inhibitors include Prevacid, Aciphex and Protonix and Nexium.

Doctors are the most wary of using medication during the first trimester of pregnancy, because at this time the fetus is the most susceptible to major abnormalities caused by drug interactions. The risk is markedly less during the second and third trimesters.

Lifestyle modification and dietary changes are also part of the normal course of treatment for GERD, but because weight gain is important to the development of the fetus, pregnant women can not make all of the dietary changes suggested to other patients. Pregnant women can change the types of foods they eat however, consuming less foods likely to result in the overproduction of stomach acid. Other common therapies for GERD such as changing sleep position and refraining from eating close to bed time can also be safely undertaken by pregnant women.

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