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Pregnancy and Childbirth: The answers

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Heartburn and Peptic ulcers medicines in pregnancy


If a pregnant woman is experiencing heartburn, which is not uncommon; the initial advice should be conservative management. This should take the form of small frequenGaviscon is safe in pregnancy especially after the first trimestert meals, preferably rich in carbohydrates. The expectant mother should also avoid lying flat or prolonged stooping. She may also try to lie in a propped-up position at night. If all these do not work, then medication may have to be tried.


There is lingering concern about safety of antacids (such as magnesium- or aluminium-based preparations) in early pregnancy (the first 8 to 10 weeks). This is based on reports of occasional congenital defects in the past which have not been fully disproved. In this phase of pregnancy, therefore, they are best avoided. Other antacids such as Tums® have Calcium carbonate as the active ingredient.


There is certainly no risk to the fetus from these antacids in the second or third trimester of the pregnancy and, when required, they can be taken with peace of mind.


Common brand names of  antacids include Gaviscon®, Tums®, Peptac®, Rennie®, MTums (calcium carbonate) is safe but not always effective in pregnancyaalox®, and Mucogel®.




Treatment for peptic ulcers in pregnancy

The general rule is that peptic ulcers tend to improve in preg­nancy. It is exceptionally unusual for peptic ulcers to start or be diagnosed for the first time during pregnancy.


For somebody who has been on specific treatment for the ulcers, the medication is likely to be one of the drugs known as H2receptor antagonists. These work by inhibiting the secretion of acid in the stomach.


The most common are Cimetidine (Tagamet®) and Ranitidine (Zantac®). Other similar drugs include Nizatidine (Axid®) and Famotidine (Pepcid®).


There is a lot of data regarding safety of these drugs in pregnancy and for Ranitidine (Zantac) in particular, a mass of data collected shows no evidence of association with birth defects (teratogenicity) and therefore, if required, it can be used in pregnancy.


Ranitidine given in labour or just before a cesarean section

This kind of use is also considered perfectly safe and has been used for many years on hundreds of thousands of women about to give birth. No ill-effect on the baby has ever been reported.


Other ulcer-healing drugs in pregnancy

In some countries, Sucralfate (Antepsin®) is considered ideal for use in pregnancy, since it is not absorbed from the stomach.


Omeprazole (Losec®) is another useful drug. It belongs to a group of drugs called Proton pump inhibitors. Their safety in pregnancy cannot be guaranteed and therefore the advice is to avoid unless necessary. In practice, it is used fairly widely.  

Other Proton pump inhibitors include Esomeprazole (Nexium®), Lansoprazole (Zoton®), Pantoprazole (Protium®) etc.

Carbenoxolone was used for gastric ulcers in the past but is no longer licensed for this in many countries including the UK. It is still used in the form of a mouthwash for mild oral lesions. It is not used in pregnancy.

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