Heartburn in pregnancy
Heartburn is a common complaint during pregnancy; the incidence is reported to be between 17% and 45%. Serious complications are rare, although it may be associated with severe nausea and vomiting, and the condition usually resolves soon after delivery.
Focus of the review
The review assesses the efficacy and safety (primarily related to teratogenic adverse effects) of several interventions used to manage heartburn during pregnancy, ranging from lifestyle changes to antacids and acid-suppressing drugs.
Comments on evidence
We found no direct evidence from RCTs regarding the role of lifestyle measures or acid-suppressing agents (H2 receptor antagonists and PPIs) compared with placebo or no treatment in the management of heartburn in pregnancy. One systematic review, which included one relevant RCT, found that antacids may provide effective heartburn relief in pregnancy compared with placebo. Another systematic review, also with one relevant RCT, found no difference between antacid alone and antacid plus acid-suppressing drug in terms of symptoms relief. Overall, the quality of evidence was low.
Search and appraisal summary
The update literature search for this review was carried out from the date of the last search, February 2010, to December 2014. For more information on the electronic databases searched and criteria applied during assessment of studies for potential relevance to the review, please see the Methods section. Searching of electronic databases retrieved 80 studies. After deduplication and removal of conference abstracts, 59 records were screened for inclusion in the review. Appraisal of titles and abstracts led to the exclusion of 58 studies and the further review of one full publication. The full article evaluated did not meet our reporting criteria, and thus no new evidence was added at this update. One systematic review was added to the Comment section.
The National Institute of Health and Care Excellence (NICE) antenatal care guidelines recommend that women who present with symptoms of heartburn in pregnancy should be offered information regarding lifestyle and diet modification. Antacids may be offered to women whose heartburn remains troublesome despite lifestyle and diet modification.
Substantive changes at this update
Acid-suppressing drugs (H2 receptor antagonists and proton pump inhibitors only) No new evidence found. One systematic review added to the Comment section. Categorisation unchanged (unknown effectiveness).
INTRODUCTION: Heartburn is a common complaint during pregnancy; the incidence is reported to be between 17% and 45%. METHODS AND OUTCOMES: We conducted a systematic overview and aimed to answer the following clinical question: What are the effects of interventions to prevent or treat heartburn in pregnancy? We searched Medline, Embase, The Cochrane Library, and other important databases up to December 2014 (BMJ Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). RESULTS: At this update, searching of electronic databases retrieved 80 studies. After deduplication and removal of conference abstracts, 59 records were screened for inclusion in the review. Appraisal of titles and abstracts led to the exclusion of 58 studies and the further review of one full publication. The full article evaluated did not meet our reporting criteria, and thus no new evidence was added at this update. We performed a GRADE evaluation for two PICO combinations. CONCLUSIONS: In this systematic overview, we categorised the efficacy for six interventions, based on information about the effectiveness and safety of acid-suppressing drugs, antacids with or without alginates, raising the head of the bed, reducing caffeine intake, reducing intake of fatty foods, and reducing the size and frequency of meals.