SCOTTSDALE, ARIZ. — Gastroesophageal reflux disease may be significantly underreported and undertreated in pregnant women, according to a poster presented at the annual meeting of the Central Association of Obstetricians and Gynecologists.
Dr. Houmam Al-Hakeem and his coinvestigators at Southern Illinois University in Springfield diagnosed the condition in 72 of 111 pregnant women screened with the Gastrointestinal Symptom Rating Scale Questionnaire, a measure validated in published studies.
The poster reported that a 2-week trial of conservative management, described as “the first line of treatment in pregnant women,” failed to improve the cumulative scores of the women who had symptoms of gastroesophageal reflux disease (GERD).
GERD “is very common in pregnancy but at the same time it is very overlooked,” Dr. Al-Hakeem said in an interview. Indeed, heartburn is so common, the researchers posited, that many patients and physicians think it is normal in pregnancy.
Conservative management, as prescribed in the study, consists of lifestyle changes such as not lying down after meals, not eating certain foods, raising the head of a person's bed, and taking antacids. Physicians know this does not work, and prescribe medication as a first-line treatment in GERD patients who are not pregnant, according to Dr. Al-Hakeem, who now practices in San Antonio. “Why are we waiting during pregnancy?” he asked. “Because we are afraid to give medicine.”
He said the investigators have already begun the second phase of the study: a double-blind crossover trial of GERD treatments in a pregnant population. The study will look at fetal outcomes as well as reflux symptoms in patients treated with conservative management, pregnancy category B drugs Zantac and Prevacid, and a placebo. Dr. Al-Hakeem anticipated results would be available in about a year.
The 111 patients in the first phase were described as being in good health in a pregnancy of at least 24 weeks' gestation. Patients with documented history of GERD, esophageal disorders, Zollinger-Ellison syndrome, hiatal hernia, peptic ulcer syndrome, and irritable bowel syndrome were excluded from the study.
Women were defined as GERD positive if they had a score of at least 4 on Gastrointestinal Symptom Rating Scale questions specific to reflux. The investigators found no significant differences in ethnicity, education, tobacco use, or alcohol and drug use between the 72 women deemed to be GERD positive and the 39 women who were not.