GERD and Pregnancy INTRODUCTION AND EPIDEMIOLOGY

INTRODUCTION AND EPIDEMIOLOGY Heartburn, or pyrosis, is usually described as a burning sensation that radiates upward retrosternally from the epigastrium toward the neck. Heartburn is a common symptom that occurs frequently during pregnancy, in any trimester. Although “heartburn” and “gastroesophageal reflux disease (GERD)” have become integrally connected in the medical literature, the two terms have distinct connotations. Heartburn is a symptom that is considered highly sensitive and specific for GERD. GERD, on the other hand, is a disorder of abnormal gastroesophageal reflux and its associated complications, of which heartburn is the most common symptom. In the non-pregnant individual, GERD may present with extraesophageal complaints, including cough, hoarseness, vocal changes, and asthma, but the relationship between these symptoms and GERD has not been adequately evaluated in pregnant patients (1). Because of the close relationship between heartburn and GERD, most studies in this area address pregnancy-related heartburn in the absence of a stringent diagnosis of GERD. In most women who experience heartburn during pregnancy, the symptoms begin during pregnancy, although less commonly the heartburn may represent a manifestation of underlying GERD. Heartburn may begin in any trimester. In a study of 60 pregnant women who experienced heartburn (2), the onset of heartburn was 52% in the first trimester, 40% in the second trimester, and 8% in the third trimester. Marrero, et al (3) confirmed in a larger study that the prevalence of heartburn increased with gestational age. Among 607 pregnant women attending an antenatal clinic, 22% experienced heartburn in the first trimester, 39% in the second, and 72% in the third, while only 14% of these women reported mild heartburn prior to their pregnancy. Severity also increased throughout pregnancy. By logistic regression analysis, significant predictors of heartburn were found to be increasing gestational age, heartburn before pregnancy, and parity. Maternal age was inversely correlated with heartburn. Race, prepregnancy body mass index, and weight gain in pregnancy did not correlate with the onset of heartburn. Despite its frequent occurrence during pregnancy, heartburn usually resolves after delivery (4).