80% of pregnant women have GERD symptoms and it is common in the third trimester. The severity can be listed by the increasing level of severity in a spectrum. At one end are the patients with very mild symptoms and as you move along the spectrum the symptoms worsen until you reach the other end where symptoms are extremely severe.

Often patients who have severe GERD in pregnancy have GERD symptoms before falling pregnant. At the severe end of the spectrum, patients can suffer significantly. Some may even need to be hospitalised.

There are occasions when the obstetrician cannot manage GERD symptoms effectively and for the well being of the patient and the foetus a referral  is made to the gastro-enterologist.

Here are a few Indications for referral.

Sometimes vomiting can be so severe that the patient loses weight. In pregnancy, regular weight gain is expected. Not gaining weight is not necessarily a problem but losing weight rings alarm bells for the Obstetrician. Certainly weight should not drop below the weight before the pregnancy.

Severe GERD may lead to mal-nutrition in pregnancy. A pregnant woman is eating for two. Mal-nutrition is not only harmful to her but there is serious risk to vital foetal development and growth.

Sometimes acid reflux symptoms get worse during the night and the sufferer ends up with little sleep or none at all. Adequate rest is an important part of a healthy pregnancy. When this is a problem, the Gastro-enterologist input is needed.

There are other conditions that warrants urgent referral. Difficulty swallowing is one. It suggests a possible stricture. Haematemesis is vomiting up of blood. When this happens in GERD patients, it points to bleeding from ulcerated lesions of esophagitis.

Dr. Phil Hariram.