Conditions / Pregnancy GERD

Gestational GERD

Affects an estimated 40–85% of pregnant women

Overview

GERD during pregnancy has two causes: (1) Progesterone causes smooth muscle relaxation including the LES, (2) The growing uterus physically compresses the stomach upward as pregnancy progresses. Symptoms peak in third trimester. Most cases fully resolve after delivery.

How it's diagnosed

Clinical diagnosis based on symptoms during pregnancy. Endoscopy avoided unless strictly necessary.

Triggers

  • Same dietary triggers
  • Third trimester body positioning
  • Large meals
  • Spicy and fatty foods
  • Pressure on abdomen

Symptoms

  • Heartburn (often severe in 3rd trimester)
  • Regurgitation
  • Nausea (combined with morning sickness)
  • Difficulty sleeping comfortably

Complications if untreated

Immediate relief

  • Calcium carbonate antacids (Tums) — safe in pregnancy
  • Small sips of milk
  • Ginger tea
  • Semi-upright position

Long-term management

  • Small frequent meals (6× daily)
  • Elevate head of bed
  • Sleep on left side
  • H2 blockers (famotidine) — discuss with OB
  • PPIs only if severe — discuss with OB

Diet

GERD-safe diet with extra attention to iron-rich non-triggering foods: lentils, spinach, tofu. Avoid iron supplements on empty stomach.

When to see a doctor

Antacids and most H2 blockers are safe. Discuss all medications with OB. PPIs generally avoided first trimester unless necessary.

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