II. Evaluation
- Avoid diagnostic testing (including endoscopy) in pregnancy
- Gastoesophageal reflux is among the most common causes of Dyspepsia in Pregnancy
III. Management: First Line Agents
- See Helicobacter Pylori
-
General Measures
- See Gastroesophageal Reflux
- See Gastritis
- Drink 8 glasses (8 ounces) non-caffeinated fluid daily
- Decrease provocative foods
- Decrease or eliminate Caffeine, chocolate, spicy foods
- Avoid milk products toward end of day
- Avoid fatty foods
- Tobacco Cessation
- No eating food 2-3 hours before bedtime
- Elevate head of bed to 30 degrees
- First: Antacids (may interfere with iron absorption)
- Avoid Antacids that contain Salicylates, or Sodium Bicarbonate (alka-seltzer, due to alkalosis)
- Aluminum hydroxide - Magnesium Hydroxide (Maalox)
- Calcium Carbonate (Tums)
- Next: Gastric mucosa protection or skip to H2 Blocker
- Sucralfate 1 gram orally three times daily (not effective in GERD)
- Next: H2 Blocking Agents (Avoid Axid or Nizatidine)
- Ranitidine (Zantac) 150 mg orally twice daily
- Preferred H2 Blocker in pregnancy
- Cimetidine (Tagamet) 400 mg orally twice daily or at bedtime
- Famotidine (Pepcid)
- Ranitidine (Zantac) 150 mg orally twice daily
IV. Management: Refractory cases
- Metoclopramide (Reglan)
- Avoid Proton Pump Inhibitors (e.g. Prilosec) unless approved by a primary maternity care provider
- Class C Medication
- Unknown longterm safety (although Omeprazole is considered likely safe)