American College Of Gastroenterology Offers Tips To Ease The Heartburn Of Pregnancy

Heartburn symptoms are
one of the most commonly reported complaints among pregnant women.
Heartburn usually starts during the first trimester and tends to worsen
during the second and third trimesters.


Studies have shown elevated levels of the hormone progesterone
accompanied by increased intra-abdominal pressures from the enlarging
uterus, may lower esophageal sphincter (LES) pressure in pregnant women
contributing to heartburn symptoms, according to research highlighted in
the newly updated "Pregnancy in Gastrointestinal Disorders" monograph by
the American College of Gastroenterology (ACG).



From the monograph, physician experts from ACG have compiled important
health tips on managing heartburn symptoms, and importantly, identifying
which heartburn medications are safe for use in pregnant women and those,
which should be avoided.



Strategies to Ease Heartburn Symptoms during Pregnancy



According to the ACG, pregnant women can treat and relieve their
heartburn symptoms through lifestyle and dietary changes. The following
tips can help reduce heartburn discomfort:



-- Avoid eating late at night or before retiring to bed. Common
heartburn triggers include greasy or spicy food, chocolate, peppermint,
tomato sauces, caffeine, carbonated drinks, and citrus fruits.



-- Wear loose-fitting clothes. Clothes that fit tightly around your
waist put pressure on your abdomen and the lower esophageal sphincter.



-- Eat smaller meals. Overfilling the stomach can result in acid reflux
and heartburn.



-- Don't lie down after eating. Wait at least 3 hours after eating
before going to bed. When you lie down, it's easier for stomach contents
(including acid) to back up into the esophagus, particularly when you go to
bed with a full stomach.



-- Raise the head of the bed 4 to 6 inches. This can help reduce acid
reflux by decreasing the amount of gastric contents that reach the lower
esophagus.



-- Avoid tobacco and alcohol. Abstinence from alcohol and smoking can
help reduce reflux symptoms and avoid fetal exposure to potentially harmful
substances.



The Do's and Don'ts of Using Heartburn Drugs during Pregnancy



Pregnant women with mild reflux usually do well with simple lifestyle
changes. If lifestyle and dietary changes are not enough, you should
consult your doctor before taking any medication to relieve heartburn
symptoms.



According to ACG President Amy E. Foxx-Orenstein, DO, FACG, "Heartburn
medications to treat acid reflux during pregnancy should be balanced to
alleviate the mother's symptoms of heartburn, while protecting the
developing fetus."



Based on a review of published scientific clinical studies (in animals
and humans) on the safety of heartburn medications during pregnancy,
researchers conclude there are certain drugs that are considered safe for
use in pregnancy and those which should be avoided.
















Antacids are one of the most common over-the-counter medications to
treat heartburn. As with any drug, antacids should be used cautiously
during pregnancy.



Antacids



-- Antacids containing aluminum, calcium, or magnesium are considered
safe and effective in treating the heartburn of pregnancy.



-- Magnesium-containing antacids should be avoided during the last
trimester of pregnancy because it could interfere with uterine contractions
during labor.



-- Avoid antacids containing sodium bicarbonate. Sodium bicarbonate
could cause metabolic alkalosis and increase the potential of fluid
overload in both the fetus and mother.



Histamine-type II (H-2) Receptor Antagonists



While limited data exists in humans on the safety of histamine-type II
(H-2) receptor antagonists, ranitidine (Zantac(R)) is the only H-2
antagonist, which has been studied specifically during pregnancy.



In a double-blind, placebo controlled, triple crossover study,
ranitidine (Zantac(R)) taken once or twice daily in pregnant heartburn
patients not responding to antacids and lifestyle modification, was found
to be more effective than placebo in reducing the symptoms of heartburn and
acid regurgitation. No adverse effects on the fetus were reported. (Larson
JD, et al., "Double-blind placebo-controlled study of ranitidine for
gastroesophageal reflux symptoms during pregnancy." Obstet Gynecol 1997;
90:83-7.)



A study on the safety of cimetidine (Tagamet(R)) and ranitidine
(Zantac(R)) suggests that pregnant women taking these drugs from the first
trimester through their entire pregnancy have delivered normal babies.
(Richter JE., "Gastroesophageal reflux disease during pregnancy.
Gastroenterol Clin N Am 2003; 32:235-61.)



Proton Pump Inhibitors



Proton pump inhibitors should be reserved for pregnant patients with
more severe heartburn symptoms and those not responding to antacids and
lifestyle and dietary changes. Lansoprazole (Prevacid(R)) is the preferred
PPI because of case reports of safety in pregnant women. Limited data
exists about human safety during pregnancy with the newer PPIs.


American College of Gastroenterology

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View drug information on Cimetidine Hydrochloride Oral Solution; Ranitidine Capsules.