Signposting evidence-based information on the treatment of heartburn and dyspepsia in pregnancy

Condition management

It is important to complete an individual risk assessment for your patient and to apply the principles of prescribing during pregnancy when looking at the available information and making treatment decisions. Check to see if a risk assessment has already been completed.


NICE CKS Dyspepsia – pregnancy-associated provides an excellent summary of the management of dyspepsia and information on the individual treatments.

You should check if there is local guidance for you to use in your area.

Stepwise recommendations

The guidelines recommend a stepwise approach starting with non-pharmacological measures if appropriate or possible, through the range of pharmacological options:

Non-pharmacological management

  • Small, frequent, bland meals, not late or close to bedtime.
  • Keep a food diary to identify triggers.
  • Raise head of bed by 10–15 cm.
  • Avoid medicines that may cause or worsen symptoms, if appropriate e.g. calcium-channel blockers, NSAIDs and some antidepressants.
  • Stop smoking (if applicable).

Pharmacological management

If symptoms are not controlled adequately by lifestyle changes.

First line – antacids and alginates
  • Combinations of aluminium and magnesium ‘as required’.
  • Calcium-containing products for short-term or occasional use.
  • Not recommended in pregnancy: products containing sodium bicarbonate or magnesium trisilicate.
Second line – acid-suppressants
  • Either ranitidine (off-label in pregnancy) or omeprazole.

It is important to note the advice when to refer or seek specialist advice.

Pregnancy outcome information

UKTIS has pregnancy outcome data and information on H2 receptor antagonists and proton pump inhibitors.

Patient information

Each of the UKTIS summaries has corresponding Best Use of Medicine in Pregnancy (BUMPS) patient information.

NHS Medicines A-Z provides a summary statement on the use in pregnancy of specific heartburn treatments such as antacids, Gaviscon, omeprazole and Pepto-Bismol, and also an overview of indigestion and heartburn in pregnancy.


Support for prescribing decisions in people on interacting medicines, those with swallowing difficulties, renal impairment, or who are pregnant or breastfeeding
SPS protocol templates for the supply and administration of omeprazole for pre planned caesarean section by registered midwives.
SPS PGD template for administering subcutaneous terbutaline sulfate for the reduction of contraction frequency in individuals in labour.
SPS PGD template for the intrapartum administration of benzylpenicillin for prevention of early-onset Group B Streptococcus (GBS) infection in neonates.
Opioid analgesics may be used at any stage of pregnancy at the lowest effective dose for the short-term relief of pain when other analgesics are not effective.
Intramuscular hydroxocobalamin is the preferred treatment choice for management of clinically relevant vitamin B12 deficiency, including during pregnancy.
SPS PGD template for the supply of folic acid 5mg tablets to reduce risk of neural tube defect or compensate for increased folate demand during pregnancy.
SPS PGD template for the supply of aspirin tablets to individuals at risk of pre-eclampsia during pregnancy.
Signposting evidence-based information on the treatment of pain in pregnancy
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