Can my sister’s GERD affect pregnancy or the baby’s growth ?

Question

Hello doctor,

I am writing about my sister, who is 33 years old and has been struggling with chronic gastroesophageal reflux disease (GERD) for years. She is now in her first trimester of pregnancy, and the reflux has become much worse. She can barely eat without feeling nauseous or getting heartburn, and she is losing weight quickly. Her usual medications, such as Pantoprazole, were stopped because of concerns during pregnancy. We are all very worried that this could affect her nutrition or the baby’s growth.

What are the safest medications for gastroesophageal reflux disease during pregnancy?
Can untreated GERD affect the baby’s development or the outcome of the pregnancy?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Gastroesophageal reflux disease (GERD) often becomes worse during pregnancy, especially in the first and third trimesters. This happens due to hormonal changes, such as increased Progesterone, which relaxes the lower esophageal sphincter, slows gastric emptying, and puts pressure from the growing uterus on the stomach. Even if your sister had gastroesophageal reflux disease before, it is very common for her symptoms to become more severe now. She may experience strong nausea, heartburn, food aversions, and even weight loss.

Uncontrolled or severe GERD during pregnancy can carry some indirect risks. These include poor nutrition in the mother because she cannot eat properly, weight loss, dehydration, or changes in electrolyte levels. If these problems continue, they may affect the baby’s growth. However, mild to moderate gastroesophageal reflux disease does not directly harm the baby, and with the right and safe treatment, both the mother and baby can stay healthy.

For pregnant women with gastroesophageal reflux disease, several medications are considered both safe and effective, depending on how serious the symptoms are. Antacids, such as Calcium carbonate and Magnesium hydroxide, are usually the first treatment and are safe during pregnancy. However, it is better to avoid those that contain Aluminum or Aspirin. If antacids do not provide enough relief, histamine-2 receptor blockers such as Famotidine are often used and are also considered safe.

If symptoms continue or are more severe, proton pump inhibitors such as Pantoprazole, Omeprazole, or Lansoprazole are generally considered safe. Among these, Pantoprazole is classified as Category B, which means that animal studies show no harm, but data in humans is limited. When symptoms become very serious, especially when there is weight loss or poor food intake, Pantoprazole may be restarted even during pregnancy, but only under a doctor's supervision. Prokinetic agents such as Metoclopramide may also help, especially if nausea and slow stomach emptying are present. However, they should be used carefully because they can cause side effects like drowsiness.

Since your sister's symptoms are getting worse and her nutrition is a concern, her doctor may consider restarting Pantoprazole to protect both her health and the baby’s well-being. To prevent reflux symptoms, it is helpful to

1. Eat small, frequent meals.

2. Stay upright for 30 to 60 minutes after eating.

3. Avoid trigger foods such as spicy, acidic, and fried foods and caffeine; and chocolate.

4. Raise the head of the bed.

5. Avoid eating two to three hours before lying down.

6. Try bland starches or ginger to help with nausea.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.