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Dyspepsia - pregnancy-associated - Management
What advice should I give to a pregnant woman with dyspepsia?

  • Reassure the woman that dyspepsia symptoms are common in pregnancy and will likely resolve after birth, and that complications are rare.
  • Give written lifestyle and dietary advice as first-line management, especially in the first trimester. Advise the woman to:
    • Adopt healthy eating habits, eat smaller meals more frequently, not eat within 3 hours of going to sleep, and avoid known irritants (e.g. alcohol, coffee, fruit juices, chocolate, and fatty and spicy foods).
    • Prop up the bed head when sleeping (lying flat may increase acid reflux).
    • Avoid medications if appropriate (e.g. sedatives, calcium-channel antagonists, antidepressants, nonsteroidal anti-inflammatory drugs).
    • Stop smoking (if applicable).
  • Advise the woman to return if symptoms are not controlled with lifestyle changes, or if worsening or new symptoms develop.
Clarification / Additional information
  • See the CKS topic on Smoking cessation if the woman is having difficulty stopping smoking.
Basis for recommendation
  • CKS could find no trial evidence of lifestyle modifications for managing dyspepsia in pregnancy. These recommendations are largely based on expert opinion [Madanick and Katz, 2006; Mahadevan and Kane, 2006; Ali and Egan, 2007], and extrapolated from the National Institute for Health and Clinical Excellence guidance Dyspepsia: Management of dyspepsia in adults in primary care [NICE, 2005]:
    • Lifestyle modifications are safe and inexpensive, and encourage individual participation. Although there is no evidence that lifestyle changes help symptoms of dyspepsia in pregnancy, more important general health benefits can be gained [MeReC, 1998; NICE, 2005].
    • Lifestyle modifications are thought to resolve symptoms in up to 25% of non-pregnant people with uncomplicated gastro-oesophageal reflux disease [Madanick and Katz, 2006], but this evidence is based on small and inconclusive epidemiological studies [NICE, 2005].

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