GPAtlas🧭 When to suspect
Suspect gastro-oesophageal reflux disease (GORD) in any pregnant woman describing heartburn (a retrosternal burning sensation), acid regurgitation into the throat or mouth, or epigastric discomfort. It is one of the commonest complaints of pregnancy, affecting up to 80% of women and tending to worsen through the third trimester.
The mechanism is twofold. Progesterone relaxes the lower oesophageal sphincter (LOS) – the muscular valve that normally keeps stomach contents down – while the growing uterus raises intra-abdominal pressure and slows gastric emptying. Symptoms are therefore typically worse after meals, on lying flat, and at night.
The clinical task in primary care is twofold: control the symptoms with a safe, stepped approach, and – the point that matters most – never mistake the epigastric pain of pre-eclampsia for simple indigestion. New upper-abdominal pain in the second half of pregnancy must prompt a blood pressure and urine check before it is labelled reflux.
Source: NICE NG201 · NICE NG133
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