That being said, it would not be wise to perform an endoscopy during pregnancy to simply evaluate acid reflux or heartburn. The primary indications for endoscopy in pregnancy are significant or continued GI bleeding, severe or refractory nausea and vomiting or abdominal pain, and difficult or painful swallowing. General principles guiding endoscopy in pregnancy are to always have a strong indication, especially in high-risk pregnancies; to defer endoscopy to the second trimester whenever possible; to use the lowest effective dose of sedative medications and to use FDA category A or B drugs if possible.
[Note: Category A drugs have undergone "adequate, well-controlled studies in pregnant women have not shown an increased risk of fetal abnormalities," according to the FDA. Category B drugs: "animal studies have revealed no evidence of harm to the fetus, however, there are no adequate and well-controlled studies in pregnant women OR animal studies have shown an adverse effect, but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus.]
