Insights and strategies to effectively manage heartburn in expectant mothers.

A common complaint during pregnancy, heartburn affects up to 80% of expectant mothers¹. Understanding the physiological changes contributing to heartburn, implementing non-pharmacological approaches, and guiding the use of OTC medications are crucial roles for pharmacists in supporting pregnant women. 

UNDERSTANDING THE PHYSIOLOGY: 

During pregnancy, various physiological changes can predispose women to heartburn. Hormonal fluctuations, particularly increased levels of progesterone, contribute to the relaxation of the lower oesophageal sphincter (LES), allowing gastric acid to reflux into the oesophagus^2,3. Additionally, the growing uterus increases intra-abdominal pressure, further promoting reflux symptoms⁴. Understanding these changes is essential for pharmacists to provide appropriate management strategies. 

NON-PHARMACOLOGICAL APPROACHES: 

Non-pharmacological strategies play a significant role in managing heartburn in pregnant women. Pharmacists can advise expectant mothers to adopt dietary modifications, such as avoiding spicy or acidic foods, eating smaller meals more frequently, and avoiding lying down immediately after eating^4,5. Lifestyle changes, including maintaining an upright posture after meals, elevating the head of the bed during sleep, and avoiding tight clothing, can also alleviate symptoms^4,5. Pharmacists should emphasise the importance of these approaches as first-line therapy for mild heartburn. 

OVER-THE-COUNTER MEDICATIONS: 

Over-the-counter medications are commonly used for heartburn relief during pregnancy, but their safety profiles and potential risks must be considered. Antacids, such as calcium carbonate and magnesium hydroxide, can provide rapid relief by neutralising gastric acid. H2-receptor antagonists reduce acid production and are generally considered safe in pregnancy. However, prolonged use of high-dose H2-receptor antagonists may lead to concerns about foetal effects. Proton pump inhibitors (PPIs), such as omeprazole, should be used with caution and reserved for severe cases due to limited safety data in pregnancy.¹ 

COUNSELING TIPS FOR PHARMACISTS: 

Pharmacists play a vital role in counselling pregnant women experiencing heartburn. When recommending over-the-counter medications, pharmacists should ensure proper dosing and administration while highlighting potential adverse effects, such as constipation with antacids that include aluminium hydroxide or aluminium carbonate⁶. It's essential to counsel patients on the appropriate duration of medication use and encourage regular follow-up with healthcare providers. Pharmacists should also educate pregnant women on alarm symptoms, such as persistent or severe heartburn, difficulty swallowing, or unintended weight loss, which warrant immediate medical attention⁶. 

Heartburn in pregnancy presents unique challenges for both patients and healthcare providers. Pharmacists can support pregnant women by understanding the physiological changes contributing to heartburn, advocating non-pharmacological approaches as first-line therapy, and providing informed guidance on the use of over-the-counter medications. By employing these strategies and offering comprehensive counselling, pharmacists can effectively manage heartburn in pregnant women and improve maternal comfort and well-being. 

REFERENCES 

1. Law R, Maltepe C, Bozzo P, Einarson A. Treatment of heartburn and acid reflux associated with nausea and vomiting during pregnancy. Can Fam Physician. 2010 Feb;56(2):143-4. PMID: 20154244; PMCID: PMC2821234. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2821234/#:~:text=Gastroesophageal%20reflux%20disease%20(GERD)%20is,up%20to%2080%25%20of%20pregnancies.&text=It%20is%20likely%20caused%20by,estrogen%20and%20progesterone%20during%20pregnancy. 
2. Willacy H, Tidy C. Physiological Changes In Pregnancy. Patient. April 2022. Available from: https://patient.info/doctor/physiological-changes-in-pregnancy#:~:text=Progesterone%20causes%20relaxation%20of%20the,transit%20time%20is%20consequently%20longer. 
3. Vazquez JC. Heartburn in pregnancy. BMJ Clin Evid. 2015 Sep 8;2015:1411. PMID: 26348641; PMCID: PMC4562453. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4562453/ 
4. Heartburn During Pregnancy. Cleveland Clinic. Available from: https://my.clevelandclinic.org/health/diseases/12011-heartburn-during-pregnancy 
5. How to Prevent and Treat Heartburn During Pregnanc. Penn Medicine Lancaster General Health. 2022. Available from: https://www.lancastergeneralhealth.org/health-hub-home/motherhood/your-pregnancy/how-to-prevent-and-treat-heartburn-during-pregnancy 
6. Wilson D, Colleen M. Causes of Heartburn and Indigestion in Pregnancy. Healthline. 24 July 2018. Available from: https://www.healthline.com/health/gerd/pregnancy