Which medication is commonly used for severe heartburn in pregnancy?

Hyperemesis gravidarumis severe nausea and vomitingin pregnancy leading to weight loss, electrolyte imbalance, and dehydration. Unlike normal morning sickness, it persists beyond the first trimester and interferes with nutrition. It is associated with elevated human chorionic gonadotropin(hCG) levels and more common in multiple gestation or molar pregnancy. Normal weight gain in pregnancy is 11.5–16 kg for women with BMI 18.5–24.9; weight loss instead of gain is abnormal. Laboratory findings include hypokalemia (<3.5 mEq/L), hyponatremia (<135 mEq/L), ketonuria, and metabolic alkalosis.

Rationale for correct answers

2.Hyperemesis gravidarum is suspected when nausea and vomiting are persistent, cause weight loss, and lead to dehydration or electrolyte disturbances. The presence of weight loss distinguishes it from physiologic morning sickness, making this the correct diagnosis.

Rationale for incorrect answers

1.Gastroesophageal reflux disease in pregnancy presents with heartburn, regurgitation, and epigastric discomfort due to relaxation of the lower esophageal sphincter. It does not cause severe persistent vomiting with weight loss.

3.Irritable bowel syndrome is characterized by abdominal pain, bloating, diarrhea, or constipation. It is not specific to pregnancy and does not present with persistent vomiting or weight loss.

4.Peptic ulcer disease causes epigastric pain, often related to meals, and may present with nausea. However, it does not typically cause severe persistent vomiting with maternal weight loss during pregnancy.

Take home points

• Hyperemesis gravidarum is defined by persistent vomiting with weight loss and electrolyte imbalance.
• Elevated hCG levels and multiple gestations increase risk.
• Differentiation from morning sickness is based on severity, persistence, and complications.
• Management includes hydration, electrolyte replacement, antiemetics, and nutritional support.

Heartburn in pregnancy(pyrosis) results from progesterone-induced relaxationof the lower esophageal sphincter, delayed gastric emptying, and mechanical pressurefrom the enlarging uterus. Gastric acid normally has a pH of 1.5–3.5, and disruption of esophageal sphincter tone allows reflux of this acidic content into the esophagus, producing burning retrosternal pain. Risk factors include large meals, lying supine after eating, fatty/spicy foods, and abdominal compression. Management emphasizes lifestyle and positional modifications.

Rationale for correct answers

1.Eating small, frequent meals prevents gastric overdistension, lowering reflux risk.

2.Avoiding spicy and fatty foods reduces gastric acid stimulation and delays gastric emptying, helping relieve symptoms.

4.Elevating the head of the bed during sleep decreases nocturnal reflux by using gravity to limit acid regurgitation.

5.Avoiding tight clothing around the abdomen reduces intra-abdominal pressure, lowering the chance of reflux.

Rationale for incorrect answers

3.Lying down immediately after eating worsens reflux because gravity no longer prevents acid regurgitation. Patients should wait at least 2–3 hours before lying down.

Take home points

• Heartburn in pregnancy is due to progesterone relaxation of the LES and uterine pressure.
• Small, frequent meals and avoidance of spicy/fatty foods help reduce reflux.
• Elevating the head of the bed prevents nocturnal symptoms.
• Tight abdominal clothing increases reflux risk and should be avoided.