Gastroesophageal reflux disease and pregnancy: recommendations for safe treatment

Gastroesophageal reflux disease (GERD) is common during pregnancy, affecting up to 80% of pregnant women. Treatment aims to relieve symptoms and not harm the fetus. Our objective is to provide guidance on the safe treatment of GERD in pregnancy. An electronic search of the English-language literature was performed in MEDLINE, PubMed, and Cochrane, to identify randomized controlled trials, observational studies, management recommendations, and reviews of GERD and its treatment during pregnancy. The search period was defined from 1992 to 2024. Treatment during pregnancy should be gradual, starting with lifestyle changes. If symptoms are severe, calcium-containing antacids or alginates should be started as the first pharmacological measure (grade A recommendation). If symptoms persist, sucralfate may be introduced (grade C recommendation), followed by a histamine-2 receptor antagonist (grade B recommendation). Proton pump inhibitors are reserved for women with intractable symptoms or complicated GERD; all are Food and Drug Administration category B drugs except omeprazole, which is category C (grade C recommendation). There are drugs that are contraindicated during pregnancy, and others that have not been thoroughly studied in this situation.