Gastric Reflux and its Treatment in Early Pregnancy
Women who suffer from ‘heart burn’ or gastric reflux are almost guaranteed to experience exacerbation of symptoms during early pregnancy. Many more, previously asymptomatic pregnant women will have their first experience with gastric reflux during pregnancy. The ‘heart burn’, bloating, abdominal discomfort or even severe upper abdominal pain can range from mild discomfort to a condition which severely affects the day to day functions. Symptoms associated with gastric reflux are pretty much independent of the so called morning sickness which affects at least one third of pregnant women. However, reflux can further augment the suffering from the nausea and vomiting in early pregnancy.
The discomfort and ‘burning’ sensation in the upper abdomen are due to highly acidic gastric secretions flowing upwards to the esophagus and causing a low grade inflammation or at least irritation to the inner lining or mucosa of the esophagus. There are multiple reasons for the more frequent suffering during pregnancy. Foremost is a generalized slowing of all digestive tract functions secondary to the high progesterone environment. Later in pregnancy the effect of pressure and crowding inside the abdomen further slows the passage of semi digested food along the small and large bowel. Sometimes the reflux is explained by the presence of a hiatal hernia. A hiatal hernia occurs when a portion of the stomach protrudes into the area of the esophagus through a larger than natural opening in the diaphragm, which separates the abdominal and chest cavities. Often the most severe symptoms of reflux are at night, but one may suffer throughout the day.
There are three main measures which can reduce or alleviate gastric reflux:
1. Life style adjustments are very important. Maybe the most important is to eat relatively frequent small portion meals. Do not eat until you feel full, stop before you would otherwise in your non-pregnant state. Never eat within 3 hours of bedtime! Do not load your stomach with high protein content, as protein requires the most gastric acid for digestion. Stay away from protein shakes. If your discomfort is worst at night, prop yourself up with a couple of large pillows, and if that is not helpful try to elevate the head of the bed at least 5 inches so that if a small hernia exists, it will slip back into the abdominal cavity. Avoid the foods which irritate you most: it could be coffee, tea, orange juice or spicy, pickled or fatty food. Everybody is different in that regard. Listen to your body, it knows the best and this goes for your cravings too. A small portion of ice cream or frozen yogurt never hurt anybody.
2. Antacids are the second line of defense. They come in many shapes, brands and flavors. All are over the counter and all are safe during pregnancy. Again, listen to your body and chew on Tums, Rolaids or Gaviscon, drink your Maalox, Mylanta or Pepto Bismol. See for yourself which is the fastest to relieve your symptoms and lasts the longest. Some of the antacids, like Tums and Rolaids are Calcium based, which is particularly good for your bone health. Please follow manufacturer’s instructions because even a good thing may be too much if indiscriminately taken.
3. Proton Pump Inhibitors, the most effective medical treatment for reflux were the privilege of the non-pregnant. While animal studies usually did not show any detrimental effects on their newborn, human safety data was simply not sufficient. The main brand name Proton Pump Inhibitors are Nexium, Prilosec, Prevacid and Protonix. Recent large study (Gastroenterology, 2009) did not show a significant increase in birth defects in 1530 pregnant women who took Proton Pump Inhibitors during pregnancy. The results of this study were published in December 2010 in the New England Journal of Medicine, the most prestigious publication in medicine. The study showed that out of 841,000 live births, 3651 women were exposed to Proton Pump Inhibitors during the first trimester. The risk of birth defects was not different in these women compared to women who were not exposed to PPI’s. The bottom line is simple and straightforward: For acid reflux in pregnancy, first try lifestyle adjustments, and if they do not help – resort to antacid medications. If you are still suffering despite the above measures, contact your OB/GYN physician and talk with him/her about Proton Pump Inhibitors.
(Disclaimer; The above is not intended as medical advice. Please check with your medical practitioner the safety and advisability of taking any of the listed medications.)