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Evidence summaries

Interventions for Heartburn in Pregnancy

Antacid, ranitidine, alginate acid, and sucralfateappear to be effective for heartburn in pregnancy. Level of evidence: "B"

A Cochrane review [Abstract] 1 included 3 studies with a total of 286 subjects. A calcium based antacid plus ranitidine relieved heartburn better than antacid alone (mean difference (MD) at one week -0.31, 95% CI -1.89 to 1.27; MD at two weeks -2.13, 95% CI -4.37 to 0.11; 1 trial, n=30). In another study magnesium and aluminium based antacid with simethicone relieved symptoms better than placebo (RR 1.41, 95% CI 1.18 to 1.68; 1trial, n=156).

Another Cochrane review [Abstract] 2 included 4 studies with a total of 358 subjects. More women in the sucralfate group (1g of sucralfate with advice on dietary and lifestyle choices) experienced complete relief of heartburn compared to women who received advice on diet and lifestyle choices (RR 2.41, 95% CI 1.42 to 4.07; 1 trial, n=65).

A double-blinded, RCT 3 included 100 women at less than 36 weeks gestation with heartburn at least twice per week. They were randomized to either alginate-based reflux suppressant or to magnesium-aluminium antacid gel. There was no difference between treatment and control groups in improvement of heartburn frequency (80% vs 88%, p = 0.275), 50% reduction of frequency of heartburn (56% vs 52%, p = 0.688), improvement of heartburn intensity (92% vs 92%, p = 1.000) and 50% reduction of heartburn intensity (68% vs 80% cases, p = 0.075). There were also no significant differences in quality of life, maternal satisfaction, maternal side effects, pregnancy and neonatal outcomes.

Comment: The quality of evidence is downgraded by imprecise results (few patients and wide confidence intervals).

    References

    • Dowswell T, Neilson JP. Interventions for heartburn in pregnancy. Cochrane Database Syst Rev. 2008;(4):Dowswell T, Neilson JP. Interventions for heartburn in pregnancy. Cochrane Database Syst Rev 2008;(4):CD007065. [PubMed]
    • Phupong V, Hanprasertpong T. Interventions for heartburn in pregnancy. Cochrane Database Syst Rev 2015;(9):CD011379. [PubMed]
    • Meteerattanapipat P, Phupong V. Efficacy of alginate-based reflux suppressant and magnesium-aluminium antacid gel for treatment of heartburn in pregnancy: a randomized double-blind controlled trial. Sci Rep 2017;7():44830. [PubMed]

Primary/Secondary Keywords