First-line management for pregnant women with GERD?

• A. PPI
• B. H2 Receptor Antagonists
• C. Antacids
• D. Lifestyle changes

Answer: (D)

Managing GERD in pregnancy aims to relieve symptoms while keeping fetal exposure to medications low. Reflux is more common in pregnancy because progesterone relaxes the lower esophageal sphincter and the growing uterus increases abdominal pressure. The safest and most effective first step is lifestyle changes that reduce reflux triggers and how often it happens. This includes eating smaller, more frequent meals; avoiding late meals and foods that trigger reflux (fatty or spicy foods, chocolate, caffeine, carbonated drinks); not lying down for a few hours after eating; elevating the head of the bed; wearing loose clothing; and staying active as advised. These changes have no risk to the fetus and can often control mild symptoms. If symptoms persist, medications can be added under medical supervision, with antacids for occasional relief and, if needed, H2 blockers or PPIs used when appropriate.