Episode two takes the upper-GI symptom that rides on the same pregnancy physiology as hyperemesis. GERD dominates because progesterone loosens the lower esophageal sphincter while estrogen strengthens the gastric mucosal barrier, so ulcers stay uncommon. The management is a stepwise sequence built on local-then-systemic safety logic, and the reasoning is that the rules fall out of mechanism rather than memorization. The one hard contraindication anchors the section: misoprostol is off the table because the same prostaglandin effect that heals ulcers induces labor.

Topics covered

Why heartburn dominates in pregnancy
Lifestyle and mechanical first measures
Local-acting antacids and alginates
Sucralfate as a non-absorbed add-on
Famotidine as the preferred H2 blocker
Proton pump inhibitors and the omeprazole detail
Misoprostol contraindication
Endoscopy for alarm features

Key decisions

Calcium carbonate is the preferred antacid because it neutralizes acid without aluminum or sodium bicarbonate, and aluminum-only antacids and sodium bicarbonate are avoided for fetal aluminum and maternal alkalosis concerns.
Famotidine is the preferred H2 blocker on class-specific safety, while ranitidine is withdrawn for NDMA and cimetidine is avoided for antiandrogenic and P450 effects.
The PPI panel was largely category B, and omeprazole is the one historical category-C detail even though it carries the longest pregnancy track record.
Misoprostol is prohibited in pregnancy for reflux or peptic disease because it is a prostaglandin E1 analog that produces uterine contractions.
New dyspepsia in pregnancy is usually GERD, but dyspepsia with iron deficiency anemia or melena warrants endoscopic evaluation regardless of trimester.
H. pylori testing and treatment are deferred to postpartum unless complicated peptic ulcer disease forces the issue, because standard quadruple regimens contain agents problematic in pregnancy.
Endoscopy is reserved for alarm features and timed to the second trimester, with benzodiazepine sedation minimized in the first trimester for cleft lip and palate concerns.

For the full chapter with MCQs, tables, and primary-guideline references, visit www.boardpearls.com.

Questions or feedback: hello@boardpearls.com.

(00:00) - Introduction and the safety-tiered sequence
(00:37) - Why heartburn dominates in pregnancy
(01:06) - Local-acting antacids and alginates
(01:53) - Sucralfate as a non-absorbed add-on
(02:40) - Famotidine as the preferred H2 blocker
(03:24) - PPIs and the omeprazole detail
(04:13) - Misoprostol contraindicated
(05:51) - Endoscopy for alarm features