Condition management
It is important to complete an individual risk assessment for your patient and to apply the principles of prescribing during pregnancy when looking at the available information and making treatment decisions. Check to see if a risk assessment has already been completed.
Guidelines
NICE CKS Dyspepsia – pregnancy-associated provides an excellent summary of the management of dyspepsia and information on the individual treatments.
You should check if there is local guidance for you to use in your area.
Stepwise recommendations
The guidelines recommend a stepwise approach starting with non-pharmacological measures if appropriate or possible, through the range of pharmacological options:
Non-pharmacological management
- Small, frequent, bland meals, not late or close to bedtime.
- Keep a food diary to identify triggers.
- Raise head of bed by 10–15 cm.
- Avoid medicines that may cause or worsen symptoms, if appropriate e.g. calcium-channel blockers, NSAIDs and some antidepressants.
- Stop smoking (if applicable).
Pharmacological management
If symptoms are not controlled adequately by lifestyle changes.
First line – antacids and alginates
- Combinations of aluminium and magnesium ‘as required’.
- Calcium-containing products for short-term or occasional use.
- Not recommended in pregnancy: products containing sodium bicarbonate or magnesium trisilicate.
Second line – acid-suppressants
- Either ranitidine (off-label in pregnancy) or omeprazole.
It is important to note the advice when to refer or seek specialist advice.
Pregnancy outcome information
UKTIS has pregnancy outcome data and information on H2 receptor antagonists and proton pump inhibitors.
Patient information
Each of the UKTIS summaries has corresponding Best Use of Medicine in Pregnancy (BUMPS) patient information.
NHS Medicines A-Z provides a summary statement on the use in pregnancy of specific heartburn treatments such as antacids, Gaviscon, omeprazole and Pepto-Bismol, and also an overview of indigestion and heartburn in pregnancy.