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Pregnancy-related GERD is best managed using symptom-based diagnosis, lifestyle modification, and stepwise pharmacological therapy, with alginates/antacids first and H2RAs or PPIs reserved for refractory symptoms.
Gastroesophageal reflux disease (GERD) is highly prevalent during pregnancy, yet its evaluation and treatment have lacked uniform, locally relevant guidance. Clinical practice has often depended on Western recommendations that may not align with Indian dietary patterns, medication access, or real-world diagnostic constraints. To address this unmet need, a national panel of Indian gastroenterologists and gynaecologists has developed India-specific, consensus-based recommendations for the diagnosis and management of GERD in pregnancy.
Using a modified Delphi method, a three-member steering committee of gastroenterologists reviewed the literature and identified 65 relevant studies, which informed nine pilot consensus statements. An expert panel of 15 clinicians (9 gastroenterologists and 6 gynaecologists) from across India was then convened. Evidence summaries were shared 1 month in advance, followed by an in-person consensus meeting to discuss and refine the statements.
The revised statements were circulated electronically for voting using a 5-point Likert scale, with consensus predefined as ≥80% agreement. Results were reviewed by the steering committee and finalised during a virtual meeting, after which the manuscript was drafted and approved.
Key Consensus Statements (100% Agreement)
All final recommendations achieved unanimous (100%) agreement, underscoring strong expert alignment:
These consensus recommendations yield a clear, pragmatic framework for tackling GERD in pregnancy. By emphasizing symptom-based diagnosis, avoidance of unnecessary endoscopy, lifestyle interventions, and rational, step-up pharmacological therapy, the guidance supports safe, effective, and context-appropriate care for pregnant women with reflux symptoms.
Journal of Obstetrics and Gynaecology
Expert consensus for the management of gastroesophageal reflux disease in pregnancy: collaborative insights from experts in India
Aniruddha Pratap Singh et al.
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