GERD Overlooked, Undertreated in Pregnant Women


SCOTTSDALE, ARIZ. — Gastroesophageal reflux disease may be underreported and undertreated in pregnant women, according to a poster presented at the annual meeting of the Central Association of Obstetricians and Gynecologists.

Dr. Houmam Al-Hakeem and his coinvestigators at Southern Illinois University in Springfield diagnosed the condition in 72 of 111 pregnant women screened with the Gastrointestinal Symptom Rating Scale Questionnaire, a measure validated in published studies.

The poster reported that a 2-week trial of conservative management, described as “the first line of treatment in pregnant women,” failed to improve the cumulative scores of the women who had symptoms of gastroesophageal reflux disease (GERD).

GERD “is very common in pregnancy but at the same time it is very overlooked,” Dr. Al-Hakeem said in an interview.

Conservative management, as prescribed in the study, includes not lying down after meals, avoiding certain foods, raising the head of the bed, and taking antacids. Physicians know this does not work, and prescribe drugs as a first-line treatment in GERD patients who are not pregnant, according to Dr. Al-Hakeem, who now practices in San Antonio.

“Why are we waiting during pregnancy?” he asked. “Because we are afraid to give medicine.”

He said the investigators have begun the second phase of the study: a double-blind crossover trial of GERD treatments in a pregnant population. The study will look at fetal outcomes and reflux symptoms in patients treated with conservative management, the drugs Zantac and Prevacid, and a placebo. Dr. Al-Hakeem anticipated results would be available in about a year.

The 111 patients in the first phase were in good health in a pregnancy of at least 24 weeks' gestation. Patients with documented history of GERD, esophageal disorders, Zollinger-Ellison syndrome, hiatal hernia, peptic ulcer syndrome, and irritable bowel syndrome were excluded.

The investigators found no significant differences in ethnicity, education, tobacco use, or alcohol and drug use between the 72 women deemed to be GERD positive and the 39 women who were not.

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