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?) is the only H-2 antagonist, which has been studied specifically during pregnancy.
In a double-blind, placebo controlled, triple crossover study, ranitidine (Zantac?) 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?) and ranitidine (Zantac?) 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?) 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.
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