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Gastroesophageal Reflux (GERD)

Last Update: 16 Jan 2025

Welcome to our Fact Sheet on gastroesophageal reflux (GERD) commonly known as acid reflux, during pregnancy. The information is based on current research and may be updated as new scientific knowledge emerges. It’s important to remember that the content shared here does not replace personalized advice from healthcare professionals.

1. What Is Gastroesophageal Reflux and How Can You Recognize the Symptoms?

Gastroesophageal Reflux (GERD) is often called acid reflux or heartburn. It happens when stomach contents (like food, liquids, and stomach acid), flow back into the esophagustooltip. Certain food and drinks, lifestyle habits (like eating right before bed) can trigger or worsen acid reflux. While occasional acid reflux is normal, GERD is when this happens often (like after every meal), leading to uncomfortable symptoms or health problems. 

The main symptom of GERD is a burning feeling when stomach contents or acid move back into the esophagus. Other symptoms can include coughing, hoarseness (a raspy voice), chest discomfort or throat irritation, trouble sleeping, nausea, burping, pain or bloating in the upper abdomen, and sometimes even vomiting. 

GERD is one of the most common digestive issues during pregnancy, affecting nearly 1 out of 2 pregnant persons in the third trimester tooltip. During pregnancy, higher levels of hormones like estrogen and progesterone can relax the muscle between the stomach and esophagus, making it easier for acid to move back up. As the baby grows, it puts pressure on the stomach, which can make GERD symptoms, like heartburn, more common.  

Most people notice GERD symptoms in the first or second trimester, with heartburn becoming more frequent and intense during the last few months of pregnancy. 

2. Why Is It Important to Treat GERD During Pregnancy?

Treating GERD during pregnancy is essential to prevent discomfort and avoid other complications. Like with any medical condition, it’s important to talk to your healthcare team to assess the benefits and potential risks for your situation. This ensures you and your baby receive the best care possible.  

Understanding Risks in Pregnancy 

Research helps us estimate the risks linked to common pregnancy-related conditions. Miscarriages, congenital malformations tooltip, premature birth, and other complications can happen in any pregnancy for many reasons. These are called background risks. Here we compare this background risk with the risks associated with the untreated condition.

So far, no link has been found between GERD and pregnancy outcomes such as miscarriage or malformations. However, untreated GERD can cause issues for the pregnant person including poor sleep, difficulty eating, leading to reduced nutrition, and general discomfort. In rare and severe cases, untreated GERD may lead to more serious health issues, such as ulcers and esophagitis (inflammation of the esophagus).  

Table 1 below provides a summary of the potential impacts of untreated GERD during pregnancy compared to the background risks. Keep in mind that these risks can be influenced by factors like the pregnant person’s age, genetics, ethnicity, lifestyle, and other medical conditions.  

By understanding these risks and working with your healthcare provider, you can manage GERD effectively for a healthier and more comfortable pregnancy. 

Table 1: Potential impacts of untreated GERD during pregnancy.

For who? What? What does research say?
For the pregnant person

Fertility

No studies have examined whether GERD affects the ability to get pregnant.

Miscarriages

No studies examined if GERD increases the risk of miscarriage above the background risk.

Sleep Disruption

GERD, especially heartburn, often worsens at night, disrupting sleep and impacting health and well-being.

Anxiety and Stress 

Ongoing discomfort can increase stress and anxiety, affecting mental and physical health. 

Esophageal Damage 

Chronic GERD may cause inflammation (esophagitis) or ulcers in the esophagus, leading to pain and complications. 

For the unborn child

Premature birth

Some studies found a slightly increased risk of preterm birth (before 37 weeks) (Han, 2024).

Congenital malformations 

No studies examined if there is a link between GERD and malformations. 

For future child/adult

Brain development

No studies have examined potential effects on brain development. 

3. What Can I Do to Manage my GERD Before Medications?

Similarly to nausea and vomiting during pregnancy, the first line of treatment to GERD are lifestyle changes. Here are some steps you can try during pregnancy before using medications: 

  • Eat smaller meals: Instead of three large meals, eat smaller portions more often to avoid overfilling your stomach.  
  • Avoid trigger foods: Some foods can worsen GERD symptoms, such as spicy foods, citrus fruits (e.g. oranges, grapefruits, lemons), tomatoes, chocolate, caffeine, and fatty or fried foods. Try to identify and avoid foods that trigger your symptoms. 
  • Stay upright after eating: Sit up for at least an hour after eating to help keep stomach acid from flowing back up into your esophagus. You can also use extra pillows or a wedge pillow to elevate your upper body at night while sleeping. 
  • Avoid eating before bed: Try to finish meals at least 3 hours before bedtime to give your stomach time to digest. 
  • Sleep on your left side: This position, with your head slightly elevated, can reduce nighttime reflux.  
  • Drink between meals:  Sip fluids in between meals instead of drinking large amounts with meals to avoid overfilling your stomach. 

These changes often help with mild symptoms. If your GERD is severe or doesn’t improve, talk to your healthcare team to find the best treatment options for you and your baby.  

4. Medications Prescribed for Treating GERD

If lifestyle changes aren’t enough to manage GERD symptoms, several types of medications can help. Before starting any medications during pregnancy, it’s best​​ to talk with your healthcare professional including nurse, doctor, or pharmacist to make sure it’s safe for both you and your baby.  

GERD medications fall into three main categories:  

  • Antacids These over-the-counter medications provide fast and temporary relief by quickly neutralizing stomach acid. They are generally considered safe to use during pregnancy when taken as directed. However, some antacids may affect absorption of certain minerals; therefore, it is important to check with your healthcare provider before use.  

  • H2-receptor antagonists These prescribed medication are often used for managing nighttime symptoms or preventing reflux after meals. They reduce stomach acid production, especially at night, by blocking signals that trigger acid release.  
  • Proton Pump Inhibitors (PPIs) PPIs are strong acid blockers used to treat more symptomatic GERD.  They reduce acid production to help relieve symptoms and allow the esophagus to heal.   

Table 2 below lists common GERD medications, including their generic and brand names. Not all of them are considered safe during pregnancy. For example, some antacids may contain other medical ingredients that are best avoided. This is why it’s important to consult your healthcare provider before taking a medication during pregnancy. For more details on a specific medication, refer to its fact sheet. 

Table 2. Some Medications Prescribed for GERD in Canada

Medication Types Medication Names Brand names

Antacids

Calcium Carbonate 

e.g. Tums®, Rolaids®

Aluminum Hydroxide/Magnesium Hydroxide 

e.g. Gaviscon®

H2-receptor antagonists

Ranitidine

e.g. Zantac®

Famotidine

e.g. Pepcid®

Omeprazole 

e.g. Losec®

Esomeprazole 

e.g. Nexium®

Dexlansoprazole 

e.g. Dexilant®

Lansoprazole 

e.g. Prevacid®

Pantoprazole 

e.g. Pantoloc®

Rabeprazole 

e.g. Pariet®

The choice of treatment 

The first option is usually antacids. If symptoms continue, they might be combined with H2 receptor antagonists. Proton pump inhibitors (PPIs) may be added as an option for more persistent GERD symptoms.  

Each medication has its benefits and disadvantages, and your healthcare team (pharmacist, nurse, doctor, midwife) is best equipped to guide you in making an informed decision adapted to your specific needs. 

5. Will I Be Able to Breastfeed/ chestfeed?

People with GERD can usually breastfeed/ chestfeed if they want to. GERD itself doesn’t affect milk production or the baby’s ability to nurse. However, if you’re taking medications for GERD, it’s important to talk to a healthcare provider. Many GERD treatments are compatible with breastfeeding/ chestfeeding, but a doctor can help choose the best options for both the mother’s health and the baby’s safety.  

If you have any questions, don’t hesitate to talk to your healthcare team, including a lactation consultant. They can explain the benefits and possible risks associated with your situation. They’re here to help. Together, you can make an informed decision for you and your baby.

Key Takeaways

  • Gastroesophageal reflux (GERD) also referred as heartburn or acid reflux is a condition where the food and acidity of the stomach flows back in the esophagus. 
  • GERD is one of the most common conditions during pregnancy (around 1 out of 2 pregnant ​persons​​​) especially during the last trimester due to hormones and baby’s growth pushing on the stomach.  
  • The main issues around GERD during pregnancy is the impact on the quality of life for the pregnant person including difficulties to sleep, and discomfort. 
  • Some lifestyle changes such as small meals, avoiding triggering food, and having the upper body more elevated can help reduce GERD and occasional acid reflux.  
  • If lifestyle changes are not enough, medications can be taken to reduce symptoms including antacid (e.g. Tums®), and proton-pumps inhibitor (PPIs) medications like omeprazole (Losec®) et esomeprazole (Nexium®).  
  • Always consult your healthcare team (doctor, nurse, midwife, or pharmacist) before making any changes in your medication intake.  

Research Is Great, But It Is Not Perfect

Making informed health decisions also involves considering the current state of scientific knowledge. Here are some considerations, found by our team, on the quantity and qualities of studies available so far on GERD during pregnancy: 

  • Not enough research: There’s little information about how GERD affects pregnancy outcomes or the baby’s long-term health. 
  • Unreliable information: GERD is often self-managed with over-the-counter medications, making it hard to track accurate information on treatments, risks, and effects.  
  • Lack of long-term follow-up: Most studies only look at immediate pregnancy outcomes, with little follow-up on the baby’s development as they grow. 
  • Different treatment approaches: There’s no consensus on the best treatments for GERD during pregnancy, which makes comparing studies and identifying effective options difficult. 
  • Psychological impact: More studies needed on the emotional effects of GERD during pregnancy. 
  • Lack of diversity:  Many studies don’t include diverse populations, which limits the understanding of how GERD affects people from different ethnic and socioeconomic backgrounds.  

These limitations highlight the need for more detailed studies to better understand and manage GERD during pregnancy. 

For more information, you can also consult the following resources: 

References

  1. Altuwaijri, M. “Evidence-Based Treatment Recommendations for Gastroesophageal Reflux Disease during Pregnancy: A Review.” Medicine (Baltimore) 101.35 (2022): e30487. Print. 
  2. Antunes, C., A. Aleem, and S. A. Curtis. “Gastroesophageal Reflux Disease.” Statpearls. Treasure Island (FL)2024. Print. 
  3. Chen, J., and P. Brady. “Gastroesophageal Reflux Disease: Pathophysiology, Diagnosis, and Treatment.” Gastroenterol Nurs 42.1 (2019): 20-28. Print. 
  4. Chiba, N., et al. “Speed of Healing and Symptom Relief in Grade Ii to Iv Gastroesophageal Reflux Disease: A Meta-Analysis.” Gastroenterology 112.6 (1997): 1798-810. Print. 
  5. Collings, K. L., et al. “Clinical Effectiveness of a New Antacid Chewing Gum on Heartburn and Oesophageal Ph Control.” Aliment Pharmacol Ther 16.12 (2002): 2029-35. Print. 
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  9. Habr, F., et al. “Predictors of Gastroesophageal Reflux Symptoms in Pregnant Women Screened for Sleep Disordered Breathing: A Secondary Analysis.” Clin Res Hepatol Gastroenterol 37.1 (2013): 93-9. Print. 
  10. Han X, Wu TQ, Yao R, Liu C, Chen L, Feng X. Gastroesophageal Reflux Disease and Preterm Birth: Univariate and Multivariate Mendelian Randomization. Int J Womens Health. 2024 Aug 13;16:1389-1399. doi: 10.2147/IJWH.S467056. PMID: 39157004; PMCID: PMC11330254. 
  11. Hunt, Richard, et al. “World Gastroenterology Organisation Global Guidelines: Gerd Global Perspective on Gastroesophageal Reflux Disease.” Journal of Clinical Gastroenterology 51.6 (2017): 467-78. Print. 
  12. Kahrilas, P. J. “Esophageal Motor Activity and Acid Clearance.” Gastroenterol Clin North Am 19.3 (1990): 537-50. Print. 
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  14. Kaltenbach, T., S. Crockett, and L. B. Gerson. “Are Lifestyle Measures Effective in Patients with Gastroesophageal Reflux Disease? An Evidence-Based Approach.” Arch Intern Med 166.9 (2006): 965-71. Print. 
  15. Kiserud, T., et al. “Correction: The World Health Organization Fetal Growth Charts: A Multinational Longitudinal Study of Ultrasound Biometric Measurements and Estimated Fetal Weight.” PLoS Med 18.1 (2021): e1003526. Print. 
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Narimene Ait Belkacem
University of Montreal
Émy Roberge
Centre hospitalier universitaire Sainte-Justine
Catherine Lord
Immerscience Inc.
Anick Bérard
Centre hospitalier universitaire Sainte-Justine
Jessica Gorgui
University of Montreal
Isabelle Malhamé
Research Institute of the McGill University Health Centre
Modupe Tunde-Byass
University of Toronto
Patricia Kammegne Djidjou
University de Montreal
Enav Zusman
The University of British Columbia
Sasha Bernatsky
Research Institute of the McGill University Health Centre

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