Review article: the management of heartburn during pregnancy and lactation

Aliment Pharmacol Ther. 2020 Feb;51(4):421-434. doi: 10.1111/apt.15611. Epub 2020 Jan 17.


Background: Gestational reflux is common, affecting up to 80% of pregnant women. Most symptoms will abate during lactation. During both of these periods, interventions used to relieve symptoms focus on a "step-up" methodology with progressive intensification of treatment. This begins with lifestyle modifications.

Aim: To provide guidance in the treatment of reflux in pregnancy and lactation, as well as briefly summarising the pathogenesis, clinical presentation and diagnostic workup.

Methods: A comprehensive search, using online databases PubMed and MEDLINE, along with relevant manuscripts published in English between 1966 and 2019 was used. All abstracts were screened, potentially relevant articles were researched, and bibliographies were reviewed.

Results: Only a small percentage of relevant drugs are contraindicated for use in pregnancy or while breastfeeding. However, not all drug agents have been extensively evaluated in pregnant women or during the breastfeeding period. Antacids, alginates, and sucralfate are the first-line therapeutic agents. If symptoms persist, any of the H2 RAs can be used except for nizatidine (due to foetal teratogenicity or harm in animal studies). PPIs are reserved for women with intractable symptoms or complicated GERD; all are FDA category B drugs, except for omeprazole, which is a category C drug.

Conclusions: The management of heartburn during pregnancy and lactation begins with lifestyle modifications. In situations where disease severity increases, medical providers must discuss risks and benefits of these medicines with the patient in detail.

Publication types

  • Review

MeSH terms

  • Alginates / therapeutic use
  • Antacids / therapeutic use
  • Breast Feeding* / statistics & numerical data
  • Contraindications, Drug
  • Female
  • Gastroesophageal Reflux / drug therapy
  • Gastroesophageal Reflux / epidemiology
  • Gastroesophageal Reflux / therapy
  • Gastrointestinal Agents* / classification
  • Gastrointestinal Agents* / therapeutic use
  • Heartburn / drug therapy
  • Heartburn / epidemiology
  • Heartburn / therapy*
  • Histamine H2 Antagonists / therapeutic use
  • Humans
  • Lactation / drug effects
  • Lactation / physiology*
  • Omeprazole / therapeutic use
  • Pregnancy
  • Pregnancy Complications / drug therapy
  • Pregnancy Complications / epidemiology
  • Pregnancy Complications / therapy*
  • Proton Pump Inhibitors / therapeutic use
  • Risk Reduction Behavior
  • Sucralfate / therapeutic use


  • Alginates
  • Antacids
  • Gastrointestinal Agents
  • Histamine H2 Antagonists
  • Proton Pump Inhibitors
  • Sucralfate
  • Omeprazole