Interventions for heartburn in pregnancy.

Systematic review of nine small randomized trials in pregnant women with heartburn, conducted in the United Kingdom, United States, Australia, Germany, Italy, and Brazil. The review evaluated medications and acupuncture for relief of heartburn and related maternal outcomes, often against placebo or no treatment, with some trials using active comparators or dietary and lifestyle advice.

Included active interventions were a range of medications and complementary therapy for heartburn in pregnancy, including prostigmine 0.5 mg intramuscular single dose, magnesium and aluminium hydroxide plus simethicone, mucaine with or without oxethazaine, Syn-ergel, algicon suspension 10 mL, magnesium trisilicate mixture 10 mL, sucralfate 1 g three times daily, ranitidine 75 mg daily plus antacids, and acupuncture delivered weekly for 8 weeks (8 to 12 sessions). Comparators included placebo, no treatment, other antacid preparations, or dietary and lifestyle advice depending on the trial.

Overall, evidence was limited and too sparse to identify the best intervention for heartburn in pregnancy. Pharmaceutical treatments may provide complete relief of heartburn compared with placebo or no treatment, but the evidence base was small and much of it could not be pooled because of missing data or inconsistent outcome reporting. In individual active arms, complete relief was reported in 17/50 with prostigmine, 58/83 with magnesium and aluminium hydroxide plus simethicone, and 37/41 with sucralfate; side effects were uncommon in these reported arms (0/50, 5/83, and 1/42, respectively). Acupuncture may improve quality of life domains such as sleep and ability to eat, but supporting data were limited.

No large-scale randomized trials were available, and most included studies were small. Several trials had high attrition, incomplete reporting, or outcome measures that were not usable for primary analyses, which limited pooling and certainty. Evidence for adverse outcomes and quality of life was sparse, and the wide range of interventions and comparators increased heterogeneity and indirectness.