Heartburn in pregnancy
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Template:Infobox medical condition
Heartburn in pregnancy is a common physiological symptom of burning in the esophagus or throat during pregnancy.[1][2] There may also be associated regurgitation.[3] It does not appear to affect pregnancy outcomes; however, it affects quality of life during pregnancy.[3] Complications may include inflammation of the esophagus, cough, or asthma.[1][3] In those who are affected, it usually starts near the end of the first trimester or in the second trimester, becomes more frequent by the time of the third trimester, and resolves on its own soon after delivery.[2][4]
Risk factors may include fatty or spicy food.[3] The underlying mechanism involves the size of the baby as well as hormone changes.[5] This results in stomach acid entering the esophagus.[1] Diagnosis is generally based on symptoms; though it may rarely be supported by upper endoscopy.[1][3] Esophagitis, on the other hand, is uncommon and usually occurs in those who had the disease before the pregnancy.[2] The diagnosis of gastroesophageal reflux disease (GERD) can be considered if heartburn is troublesome or has complications.[6] If a person had the disease before the pregnancy, heartburn can be considered an exacerbation of GERD.[2]
Initial efforts often include eating small frequent meals and avoiding eating before sleeping.[5] Sleeping with the head raised and reducing caffeine may also be tried.[1] Antireflux medications can be potentially teratogenic, so lifestyle modifications may be preferable in mild cases.[2] Medications that may help include antacids, sucralfate, H2 blockers, and proton pump inhibitors.[1][3] Magnesium, aluminum, and calcium-containing antacids appear safe.[3] Heartburn in pregnancy is common, particularly after 12 weeks of gestation.[5] About 17 to 45% of pregnancies are affected at some point.[1]
Treatment
Mild heartburn in pregnancy can be treated by lifestyle modifications.[5] Avoiding eating too much food at a time can help prevent indigestion, so smaller meals several times a day might be preferable during pregnancy than three large meals.[5] Avoiding spicy food, fatty food, and caffeine prevents symptoms from worsening.[5] Chewing gum stimulates saliva production, which can neutralize stomach acid, so chewing gum is also often recommended, but it is not known whether it is effective.[7] Avoiding lying down for some time after eating and sleeping with the head and shoulders elevated can stop stomach acid from going up the esophagus.[5] Drinking alcohol and smoking tobacco can lead to indigestion and can also harm the baby, so cessation is the common advice.[7][5] Also, medications that cause heartburn may be avoided.[7]
Medications are often used when lifestyle changes are not effective.[7] According to the 2015 Cochrane systematic review they seem to be effective in relieving the symptoms, but the review couldn't determine which medication is the best.[7] Another 2015 systematic review found that antacids may be effective,[1] and there is a consensus that they should be used if lifestyle changes did not work.[6] Some other medications are used to treat typical GERD, such as sucralfate and histamine-2 receptor antagonists.[6]
Prognosis
Heartburn in pregnancy can become more severe towards the end of pregnancy, but it usually resolves after delivery.[1] During pregnancy, lifestyle changes may help improve the condition.[1] In some women, heartburn can persist for some time after delivery and may require treatment.[1] In addition, heartburn can be due to an exacerbation of pre-existing gastroesophageal reflux disease.[2] Despite heartburn in pregnancy being thought to be a benign condition, some studies have reported that heartburn during pregnancy may increase the risk of developing gastroesophageal reflux disease in subsequent pregnancies, but the overall number of studies is small.[8]
See also
References
- ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 Vazquez, JC (8 September 2015). "Heartburn in pregnancy.". BMJ Clinical Evidence 2015. PMID 26348641.
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 Template:Cite Q
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 Dunbar, K; Yadlapati, R; Konda, V (1 October 2022). "Heartburn, Nausea, and Vomiting During Pregnancy.". The American Journal of Gastroenterology 117 (10S): 10–15. doi:. PMID 36194028.
- ↑ Template:Cite Q
- ↑ 5.0 5.1 5.2 5.3 5.4 5.5 5.6 5.7 "Indigestion and heartburn in pregnancy" (in en). 3 December 2020. https://www.nhs.uk/pregnancy/common-symptoms/indigestion-and-heartburn/.
- ↑ 6.0 6.1 6.2 Template:Cite Q
- ↑ 7.0 7.1 7.2 7.3 7.4 Template:Cite Q
- ↑ Template:Cite Q