Guarding against GERD

The medical name might seem strange, but few, if any, pregnant women are strangers to heartburn. Almost every woman experiences heartburn and nausea during the course of her pregnancy. In more than 50 percent of the cases, the problem is severe enough to cause discomfort. In some cases, it is serious enough to warrant a visit to a specialist.

Strangely enough, heartburn has nothing to do with the heart and everything to do with the alimentary canal. The medical name of the condition is Gastroesophageal Reflux Disease (GERD), which is a better indication of the actual problem. GERD is acid reflux, caused when stomach acids leak upward from the stomach into the esophagus and past the valves that are meant to keep them down.

Why does this happen? Pregnancy overwhelms a woman’s body with hormones. Each hormone serves a different purpose. Progesterone, for instance, loosens up muscles to better accommodate the growing fetus. The lower esophageal sphincter (LES) is one of the many muscular valves that are loosened in this fashion.

A simultaneous increase in abdominal cavity pressure due to an expanded uterus leads to heartburn. The stomach has less space and the LES is weaker, causing stomach acids to flood back into the esophagus.

The causes of GERD still remain unclear. Many studies have been conducted on possible precipitating factors, including food, the position of the body, eating habits, sleeping habits, and lifestyle.

For some women, banana, coffee, tea, and/or spicy and acidic foods aggravate heartburn and acid reflux. Some medicines such as sedatives, aspirin, and anti-depressants can also cause acid reflux. In other cases, just lying down could increase the incidence of GERD.

Swallowing often becomes extremely painful for those suffering from GERD. This is because of swelling in the lower throat. In some cases, GERD causes vomiting with blood. Acid tends to irritate and inflame the inner lining of the esophagus. This causes swelling of the lower throat and severe discomfort.

Bloody or black stools are another symptom of GERD. If you have a combination of these symptoms, see a specialist immediately, as it is important to manage the problem as early as possible.

The treatment for GERD in pregnant women is very different from that given to others. “We begin with Category A medicines that are certified as safe for mother and fetus. After that, we try category B medicines such as antacids, histomine blockers, and protempone inhibitors (PPI).

The last resort is the Category C medicine, omniprasone,” says Dr Surasak Aekpongpaisit, Liver and Digestive Institute, Samitivej Hospital. He warns that pregnant women should refrain from using over-the-counter medicines without consulting a doctor, who should be informed of the pregnancy so treatment can be managed accordingly.

“Many patients are concerned that tests might be needed to confirm acid reflux. We actually avoid invasive investigations during pregnancy. Only if the patient continues to have trouble swallowing in spite of medicines do we conduct an upper endoscopy in the second trimester.

We use a camera to check the lower throat and esophagus,” he explains. While this procedure is safe in the second trimester, doctors prefer to avoid this in the third trimester to rule out any chance of premature labor.

If lying down seems to trigger GERD, it is best to sleep with the head and back higher than the rest of the body. Additional pillows can be placed under the mattress to raise your head. Using them on top of the mattress is not sufficient. Another alternative would be to raise the head of the bed, so that it is 10-15 centimeters higher than the foot of the bed.

Most often, it is a combination of food and body position that affects the esophageal sphincter. This means that if you lie down immediately after eating a full meal, the likelihood of GERD is higher. Digestion is slow during pregnancy because the muscles push food through slowly.

At night, it slows down further, so give your body adequate time to complete the digestion process. The best way to reduce heartburn is to:

• Eat small meals;
• Avoid foods that could cause an adverse reaction;
• Sit or walk for an hour after dinner;
• Eat your meal three hours before bed time;
• Drink enough water during the day;
• Limit the amount of water you consume while eating;
• Avoid carbonated liquids;
• Avoid tobacco and alcohol;
• Avoid late night snacks; and
• Avoid chocolate and mint.

In most cases, exercise does not aggravate symptoms, but avoid exercising on a full stomach. Avoid exercises that may press your stomach, especially soon after a meal.

One surprising way to manage GERD is with good posture. Slouching tends to put pressure on your stomach, so keeping your back upright will help. Bending forward is also likely to cause acid reflux. Bend your knees, not your back if you have to pick things off the floor.

Sometimes, GERD worsens as the baby grows. The second and third trimester feel worse than the first. If you have a very large baby or if you are carrying more than one fetus, then there is very little space in your stomach and that worsens GERD. However, the good news is that as long as you manage the symptoms for a few months, GERD disappears completely after delivery.

A history of GERD should not scare you. Sometimes, women who had severe heartburn during the first pregnancy have no problems in subsequent pregnancies. However, if you suffered from GERD during a previous pregnancy, take precautions. Eat small meals, wear loose clothes, do not lie down on a full stomach, and only eat food that agrees with you.

GERD has many complicating factors: the level of hormones, the quantity of food, the type of food, the size of the abdominal cavity, even the clothes you wear. We recommend a complete lifestyle modification to manage the symptoms. If your symptoms do not improve, then consult a doctor immediately.