Review article: the management of heartburn in pregnancy

Aliment Pharmacol Ther. 2005 Nov 1;22(9):749-57. doi: 10.1111/j.1365-2036.2005.02654.x.


Heartburn is a normal consequence of pregnancy. The predominant aetiology is a decrease in lower oesophageal sphincter pressure caused by female sex hormones, especially progesterone. Serious reflux complications during pregnancy are rare; hence upper endoscopy and other diagnostic tests are infrequently needed. Gastro-oesophageal reflux disease during pregnancy should be managed with a step-up algorithm beginning with lifestyle modifications and dietary changes. Antacids or sucralfate are considered the first-line drug therapy. If symptoms persist, any of the histamine2-receptor antagonists can be used. Proton pump inhibitors are reserved for women with intractable symptoms or complicated reflux disease. All but omeprazole are FDA category B drugs during pregnancy. Most drugs are excreted in breast milk. Of systemic agents, only the histamine2-receptor antagonists, with the exception of nizatidine, are safe to use during lactation.

Publication types

  • Review

MeSH terms

  • Antacids / adverse effects
  • Antacids / therapeutic use
  • Anti-Ulcer Agents / adverse effects
  • Anti-Ulcer Agents / therapeutic use
  • Cisapride / adverse effects
  • Cisapride / therapeutic use
  • Female
  • Gastroesophageal Reflux / drug therapy
  • Gastroesophageal Reflux / therapy
  • Gastrointestinal Motility / drug effects
  • Heartburn / drug therapy
  • Heartburn / physiopathology
  • Heartburn / therapy*
  • Histamine H2 Antagonists / adverse effects
  • Histamine H2 Antagonists / therapeutic use
  • Humans
  • Lactation / physiology
  • Metoclopramide / adverse effects
  • Metoclopramide / therapeutic use
  • Pregnancy
  • Pregnancy Complications / drug therapy
  • Pregnancy Complications / physiopathology
  • Pregnancy Complications / therapy*
  • Proton Pump Inhibitors
  • Sucralfate / adverse effects
  • Sucralfate / therapeutic use


  • Antacids
  • Anti-Ulcer Agents
  • Histamine H2 Antagonists
  • Proton Pump Inhibitors
  • Sucralfate
  • Metoclopramide
  • Cisapride