During pregnancy it seems like all the rules change. You begin to think about everything that you put into your body but at the same time your body is changing so dramatically that each day seems to bring a new issue, thought or concern. Most women experience heartburn at some point during pregnancy. The reasons for the increased likelihood of heartburn include: hormones relaxing the esophageal sphincter, increased pressure on the stomach from the growing baby and frequently constipation blocking up the plumbing.
Many women will be able to deal with the reflux using preventive measures such as raising the head of the bed, eating smaller more frequent meals, avoiding trigger foods, etc. Occasionally though these measures aren’t enough and the reflux symptoms get to the point where a mother may need to consider medication. Avoiding medications is always the first choice but sometimes they are necessary.
While it’s always important to check in with your doctor and pharmacist before taking a new medication, it’s especially important during pregnancy. Your doctor or midwife may actually have a list of "safe" medications during pregnancy. The FDA assigns medications pregnancy categories. These categories allow doctors a way to think about the need vs. risk for all medications given during pregnancy. Unfortunately, the FDA admits that the categories are a bit confusing and misleading but in general those in the A or B category are considered relatively safe. It’s also important to remember that sometimes medications can actually change categories as research comes out and is validated. Recently there was new research that showed a connection between first trimester usage of proton pump inhibitors and heart defects but this research has not been duplicated yet and needs further scrutiny before the pregnancy category would be changed.
It can be somewhat problematic though if you are seeing multiple doctors during pregnancy. Often times the obstetrician is unfamiliar with some less common medications whereas your primary care doctor or other specialist may not be comfortable prescribing medication while you are pregnant. I actually had one primary care doctor tell me once that he would not see me if I were pregnant or nursing. Problem is that I was going to be pregnant or nursing for about 10 years straight - I found another doctor If you see a specialist you may need to ask her about the medications safety during pregnancy (or nursing) and if she is unsure it’s okay to ask her to call your obstetrician. Don’t ever assume your doctor knows you are pregnant or nursing. It may be written in your chart but it never hurts to bring it up. I was at an urgent care center once and was 8 months pregnant and the doctor didn’t actually realize I was pregnant!
Many of us like to do our own research after we’ve been given prescription just to be on the safe side. I did a quick search of how the different anti-reflux medications are rated and found a great site called Safefetus.com. On this site, you can search for any medication and find out which pregnancy category it has been assigned. For example category B reflux medications include: Pepcid, Zantac, and Prevacid. Pepto Bismol and Prilosec are category C. It’s important to only use these sites to double check things though - your doctor and pharmacist will be able to give you the most up to date and relevant information and they also know why you may need a medication. In other words, why the benefit you get outweighs the risk to the baby. For example, in the unlikely event that you develop a bleeding ulcer during pregnancy which is dangerous for both you and the baby, your doctor may want to put you on a proton pump inhibitor.
Finally, if you are reading this and thinking about becoming pregnant - good for you (and your baby) for thinking about your medications before getting pregnant. Now is a good time to see your doctor to discuss the medications you are taking and whether they pose a risk to your future baby. The first trimester is time when the baby is forming and at the greatest risk for malformations due to medications. But, remember, if you were taking a medication before you knew you were pregnant the risk does not mean your baby will have problems due to the medication you took. It simply means there is increased risk: talk to your doctor about any concerns you may have.