II. Evaluation

  1. Avoid diagnostic testing in pregnancy

III. Management: First Line Agents

  1. General Measures
    1. See Gastroesophageal Reflux
    2. See Gastritis
    3. Drink 8 glasses (8 ounces) non-caffeinated fluid daily
    4. Decrease provocative foods
      1. Decrease or eliminate Caffeine, chocolate, spicy foods
      2. Avoid milk products toward end of day
      3. Avoid fatty foods
    5. Tobacco Cessation
    6. No eating food 2-3 hours before bedtime
    7. Elevate head of bed to 30 degrees
  2. First: Antacids (may interfere with iron absorption)
    1. Avoid Antacids that contain Salicylates
    2. Aluminum hydroxide - Magnesium Hydroxide (Maalox)
    3. Calcium Carbonate (Tums)
  3. Next: Gastric mucosa protection or skip to H2 Blocker
    1. Sucralfate 1 gram PO tid (not effective in GERD)
  4. Next: H2 Blocking Agents (Avoid Axid or Nizatidine)
    1. Cimetidine (Tagamet) 400 mg orally twice daily or at bedtime
    2. Famotidine (Pepcid)
    3. Ranitidine (Zantac) 150 mg orally twice daily
      1. Less known about Ranitidine in pregnancy

IV. Management: Refractory cases

  1. Metoclopramide (Reglan)
  2. Avoid Proton Pump Inhibitors (e.g. Prilosec) unless approved by a primary maternity care provider
    1. Class C Medication
    2. Unknown longterm safety

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