Pregnancy and Medicines

Not all medicines are safe to take when you are pregnant. Some medicines can harm your baby. That includes over-the-counter or prescription drugs, herbs, and supplements.

Always speak with your health care provider before you start or stop any medicine. Not using medicine that you need may be more harmful to you and your baby than using the medicine. For example, many pregnant women take prescription medicines for health problems like diabetes, asthma, seizures, and heartburn. The decision about whether or not to take a medicine depends on the risks and benefits. You and your health care provider should make this choice together.

Pregnant women should not take regular vitamins. They may have too much or too little of the vitamins that you need. There are special vitamins for pregnant women. It is important to take 0.4 mg of folic acid every day before you become pregnant through the first part of your pregnancy. Folic acid helps to prevent birth defects of the baby's brain or spine.

Food and Drug Administration

Prenatal Care

Prenatal care is the health care you get while you are pregnant. It includes your checkups and prenatal testing. Prenatal care can help keep you and your baby healthy. It lets your health care provider spot health problems early. Early treatment can cure many problems and prevent others.

Your doctor or midwife will give you a schedule for your prenatal visits. If you are over 35 years old or your pregnancy is high risk because of health problems like diabetes or high blood pressure, your doctor or midwife will probably want to see you more often. You can also expect to see your health care provider more often as your due date gets closer.

Dept. of Health and Human Services Office on Women's Health

Prenatal Testing

Prenatal testing provides information about your baby's health before he or she is born. Some routine tests during pregnancy also check on your health. At your first prenatal visit, your health care provider will test for a number of things, including problems with your blood, signs of infections, and whether you are immune to rubella (German measles) and chickenpox.

Throughout your pregnancy, your health care provider may suggest a number of other tests, too. Some tests are suggested for all women, such as screenings for gestational diabetes, Down syndrome, and HIV. Other tests might be offered based on your:

• Age
• Personal or family medical history
• Ethnic background
• Results of routine tests

There are two types of tests:

• Screening tests are tests that are done to see if you or your baby might have certain problems. They evaluate risk, but do not diagnose problems. If your screening test result is abnormal, it does not mean that there is a problem. It means that more information is needed. Your health care provider can explain what the test results mean and possible next steps. You may need diagnostic testing.
• Diagnostic tests show whether or not you or your baby have a certain problem.

It is your choice whether or not to get the prenatal tests. You and your health care provider can discuss the risks and benefits of the tests, and what kind of information the tests can give you. Then you can decide which ones are right for you.

Dept. of Health and Human Services Office on Women's Health

Reflux in Children

What are reflux (GER) and GERD?

The esophagus is the tube that carries food from your mouth to your stomach. If your child has reflux, his or her stomach contents come back up into the esophagus. Another name for reflux is gastroesophageal reflux (GER).

GERD stands for gastroesophageal reflux disease. It is a more serious and long-lasting type of reflux. If your child has reflux more than twice a week for a few weeks, it could be GERD.

There is a muscle (the lower esophageal sphincter) that acts as a valve between the esophagus and stomach. When your child swallows, this muscle relaxes to let food pass from the esophagus to the stomach. This muscle normally stays closed, so the stomach contents don't flow back into the esophagus.

In children who have reflux and GERD, this muscle becomes weak or relaxes when it shouldn't, and the stomach contents flow back into the esophagus. This can happen because of:

• A hiatal hernia, a condition in which the upper part of your stomach pushes upward into your chest through an opening in your diaphragm
• Increased pressure on the abdomen from being overweight or having obesity
• Medicines, such as certain asthma medicines, antihistamines (which treat allergies), pain relievers, sedatives (which help put people to sleep), and antidepressants
• Smoking or exposure to secondhand smoke
• A previous surgery on the esophagus or upper abdomen
• A severe developmental delay
• Certain neurological conditions, such as cerebral palsy

Many children have occasional reflux. GERD is not as common; up to 25% of children have symptoms of GERD.

Your child might not even notice reflux. But some children taste food or stomach acid at the back of the mouth.

In children, GERD can cause:

• Heartburn, a painful, burning feeling in the middle of the chest. It is more common in older children (12 years and up).
• Bad breath
• Nausea and vomiting
• Problems swallowing or painful swallowing
• Breathing problems
• The wearing away of teeth

In most cases, a doctor diagnoses reflux by reviewing your child's symptoms and medical history. If the symptoms do not get better with lifestyle changes and anti-reflux medicines, your child may need testing to check for GERD or other problems.

Several tests can help a doctor diagnose GERD. Sometimes doctors order more than one test to get a diagnosis. Commonly-used tests include:

• Upper GI series, which looks at the shape of your child's upper GI (gastrointestinal) tract. You child will drink a contrast liquid called barium. For young children, the barium is mixed in with a bottle or other food. The health care professional will take several x-rays of your child to track the barium as it goes through the esophagus and stomach.
• Esophageal pH and impedance monitoring, which measures the amount of acid or liquid in your child's esophagus. A doctor or nurse places a thin flexible tube through your child's nose into the stomach. The end of the tube in the esophagus measures when and how much acid comes back up into the esophagus. The other end of the tube attaches to a monitor that records the measurements. Your child will wear the tube for 24 hours. He or she may need to stay in the hospital during the test.
• Upper gastrointestinal (GI) endoscopy and biopsy, which uses an endoscope, a long, flexible tube with a light and camera at the end of it. The doctor runs the endoscope down your child's esophagus, stomach, and first part of the small intestine. While looking at the pictures from the endoscope, the doctor may also take tissue samples (biopsy).

Sometimes reflux and GERD in children can be treated with lifestyle changes:

• Losing weight, if needed
• Eating smaller meals
• Avoiding high-fat foods
• Wearing loose-fitting clothing around the abdomen
• Staying upright for 3 hours after meals and not reclining and slouching when sitting
• Sleeping at a slight angle. Raise the head of your child's bed 6 to 8 inches by safely putting blocks under the bedposts.

If changes at home do not help enough, the doctor may recommend medicines to treat GERD. The medicines work by lowering the amount of acid in your child's stomach.

Some medicines for GERD in children are over-the-counter, and some are prescription medicines. They include:

• Over-the-counter antacids
• H2 blockers, which decrease acid production
• Proton pump inhibitors (PPIs), which lower the amount of acid the stomach makes
• Prokinetics, which help the stomach empty faster

If these don't help and your child still has severe symptoms, then surgery might be an option. A pediatric gastroenterologist, a doctor who treats children who have digestive diseases, would do the surgery.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Reflux in Infants

What are reflux and GERD?

The esophagus is the tube that carries food from your mouth to your stomach. If your baby has reflux, his or her stomach contents come back up into the esophagus. Another name for reflux is gastroesophageal reflux (GER).

GERD stands for gastroesophageal reflux disease. It is a more serious and long-lasting type of reflux. Babies may have GERD if their symptoms prevent them from feeding or if the reflux lasts more than 12 to 14 months.

There is a muscle (the lower esophageal sphincter) that acts as a valve between the esophagus and stomach. When your baby swallows, this muscle relaxes to let food pass from the esophagus to the stomach. This muscle normally stays closed, so the stomach contents don't flow back into the esophagus.

In babies who have reflux, the lower esophageal sphincter muscle is not fully developed and lets the stomach contents back up the esophagus. This causes your baby to spit up (regurgitate). Once his or her sphincter muscle fully develops, your baby should no longer spit up.

In babies who have GERD, the sphincter muscle becomes weak or relaxes when it shouldn't.

Reflux is very common in babies. About half of all babies spit up many times a day in the first 3 months of their lives. They usually stop spitting up between the ages of 12 and 14 months.

GERD is also common in younger infants. Many 4-month-olds have it. But by their first birthday, only 10% of babies still have GERD.

In babies, the main symptom of reflux and GERD is spitting up. GERD may also cause symptoms such as:

• Arching of the back, often during or right after eating
• Colic - crying that lasts for more than 3 hours a day with no medical cause
• Coughing
• Gagging or trouble swallowing
• Irritability, especially after eating
• Poor eating or refusing to eat
• Poor weight gain, or weight loss
• Wheezing or trouble breathing
• Forceful or frequent vomiting

In most cases, a doctor diagnoses reflux by reviewing your baby's symptoms and medical history. If the symptoms do not get better with feeding changes and anti-reflux medicines, your baby may need testing.

Several tests can help a doctor diagnose GERD. Sometimes doctors order more than one test to get a diagnosis. Common tests include:

• Upper GI series, which looks at the shape of your baby's upper GI (gastrointestinal) tract. Your baby will drink or eat a contrast liquid called barium. The barium is mixed in with a bottle or other food. The health care professional will take several x-rays of your baby to track the barium as it goes through the esophagus and stomach.
• Esophageal pH and impedance monitoring, which measures the amount of acid or liquid in your baby's esophagus. A doctor or nurse places a thin flexible tube through your baby's nose into the stomach. The end of the tube in the esophagus measures when and how much acid comes up into the esophagus. The other end of the tube attaches to a monitor that records the measurements. Your baby will wear this for 24 hours, most likely in the hospital.
• Upper gastrointestinal (GI) endoscopy and biopsy, which uses an endoscope, a long, flexible tube with a light and camera at the end of it. The doctor runs the endoscope down your baby's esophagus, stomach, and first part of the small intestine. While looking at the pictures from the endoscope, the doctor may also take tissue samples (biopsy).

Feeding changes may help your baby's reflux and GERD:

• Add rice cereal to your baby's bottle of formula or breastmilk. Check with the doctor about how much to add. If the mixture is too thick, you can change the nipple size or cut a little "x" in the nipple to make the opening larger.
• Burp your baby after every 1 to 2 ounces of formula. If you breastfeed, burp your baby after nursing from each breast.
• Avoid overfeeding; give your baby the amount of formula or breast milk recommended.
• Hold your baby upright for 30 minutes after feedings.
• If you use formula and your doctor thinks that your baby may be sensitive to milk protein, your doctor may suggest switching to a different type of formula. Do not change formulas without talking to the doctor.

If feeding changes do not help enough, the doctor may recommend medicines to treat GERD. The medicines work by lowering the amount of acid in your baby's stomach. The doctor will only suggest medicine if your baby still has regular GERD symptoms and:

• You already tried some feeding changes
• Your baby has problems sleeping or feeding
• Your baby does not grow properly

The doctor will often prescribe a medicine on a trial basis and will explain any possible complications. You shouldn't give your baby any medicines unless the doctor tells you to.

Medicines for GERD in babies include:

• H2 blockers, which decrease acid production
• Proton pump inhibitors (PPIs), which lower the amount of acid the stomach makes

If these don't help and your baby still has severe symptoms, then surgery might be an option. Pediatric gastroenterologists only use surgery to treat GERD in babies in rare cases. They may suggest surgery when babies have severe breathing problems or have a physical problem that causes GERD symptoms.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases