Gastroesophageal reflux disease during pregnancy

Incidence and epidemiology

Heartburn is estimated to occur in 30% to 50% of pregnancies, with the incidence approaching 80% in some populations [1] . Uncommonly, it represents an exacerbation of preexisting disease. Usually, symptomatic gastroesophageal reflux disease (GERD) begins during pregnancy and ceases soon after delivery [2] . Marchand [3] found that most women first experience reflux symptoms after 5 months of gestation; however, Castro [4] suggested that many women report the onset of symptoms only when they become very troublesome, long after the symptoms actually began. After detailed interviews of 60 patients, he noted that 52% first experienced heartburn in the first trimester of pregnancy, 24% in the second trimester, and 9% in the third trimester. Heartburn was more frequent and more severe in the latter months of gestation. Almost all the women had experienced heartburn during previous pregnancies that had improved rapidly after delivery. In a study of 607 pregnant women by Marrero and colleagues [5] , the prevalence and severity of heartburn also progressively increased during pregnancy; 22% complained of heartburn in the first trimester, 39% in the second trimester, and 72% in the third trimester.

Treatment during pregnancy

The challenge of treatment during pregnancy is the potential teratogenicity of common antireflux medications. For mild symptoms, lifestyle and dietary modifications may be all that are required. These modifications include avoiding eating late at night or before retiring to bed, raising the head of the bed by 6 inches, and avoiding foods and medications that cause heartburn. Abstinence from drinking alcohol and smoking tobacco is encouraged to reduce reflux symptoms and to avoid fetal exposure to these harmful substances.

Gastroenterology Clinics
Volume 32 • Number 1 • March 2003
Copyright © 2003 W. B. Saunders Company

Joel E. Richter, MD
E-mail address: richtej@ccf.org
PII S0889-8553(02)00065-1
Center for Swallowing and Esophageal Disorders
Department of Gastroenterology/Hepatology

The Cleveland Clinic Foundation
9500 Euclid Avenue A30
Cleveland, OH 44195, USA

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