The objective of the study was to measure the effects of interventions for relieving heartburn in pregnancy. The Cochrane Pregnancy and Childbirth Group’s Trials Register (30 June 2015), ClinicalTrials.gov (2 March 2015), Asian & Oceanic Congress of Obstetrics & Gynaecology (AOCOG) conference proceedings (20-23 October 2013, Centara Grand & Bangkok Convention Centre, Bangkok, Thailand), and reference lists of retrieved studies were explored.

"More women in the sucralfate group experienced complete relief of heartburn compared to women who received advice on diet and lifestyle choices"

The randomized controlled trials (RCTs) and quasi-RCTs of interventions for heartburn in pregnancy were compared with another intervention, or placebo, or no intervention. The interventions could include advice on diet, lifestyle modification and medications including antacids, sucralfate, histamine 2-receptor antagonists, promotility drugs and proton pump inhibitors (PPIs).

The main outcomes of the study were:

• The study included nine RCTs involving 725 women and the trials were at mixed risk of bias
• The data was identified only for three comparisons: pharmaceutical treatment versus placebo or no treatment; acupuncture versus no treatment and pharmacological intervention versus advice on dietary and lifestyle changes
• Two trials evaluated any pharmaceutical treatment compared with placebo or no treatment
• One trial examined a treatment rarely used nowadays including intramuscular prostigmine 0.5 mg versus placebo
• One trial assessed the effect of magnesium and aluminium hydroxide in combination with simethicone liquid and tablet compared with placebo
• One trial evaluated acupuncture compared with no treatment but did not report data concerning relief of heartburn
• One study compared 1 g of sucralfate with advice on dietary and lifestyle choices in treating heartburn
• For the primary outcome of this review (relief of heartburn), women who received pharmaceutical treatment reported complete heartburn relief more often than women receiving no treatment or placebo
• More women in the sucralfate group experienced complete relief of heartburn compared to women who received advice on diet and lifestyle choices
• Side effects was the only secondary outcomes of the study; however, there was only one case of side effects in the pharmacological group.

Conclusion

The review of nine small studies (involving data from only four small studies) indicates that there are restricted data signifying heartburn in pregnancy to be completely relieved by pharmaceutical treatment. Three outcomes were measured and allotted a quality rating using the GRADE methods. Evidence from two trials for the outcome of complete relief of heartburn was assessed as of moderate quality, whereas evidence for the outcomes of partial heartburn relief and side effects was rated to be of very low quality. Further RCTs are desired to completely assess the effectiveness of interventions for heartburn in pregnancy. However, treatment with sucralfate provided improved results as compared to other interventions. Moreover, future researches should also address that other medications including histamine 2-receptor antagonists, promotility drugs, proton pump inhibitors, and a raft- forming alginate reflux suppressant are efficient in treatment of heartburn in pregnancy. In addition to this more research is required on acupuncture and other complimentary therapies as treatments for heartburn in pregnancy. Future studies should also evaluate any adverse outcomes, maternal contentment with treatment and pregnant women’s quality of life in relation to the intervention.