I've been diagnosed with stomach ulcers, and I just found out I'm pregnant. Will this do any harm to my unborn child? I have Helicobacter pylori.

T.

Although many digestive problems can occur in the mother during pregnancy, peptic (acid-related) ulcers of the stomach and upper intestine, or duodenum, are rare.

Your question raises several important issues. First, if I were your doctor, I would want to learn much more about your stomach ulcers. Has your diagnosis been confirmed by endoscopy? Is this an active problem? Do you have frequent symptoms? Have you had a complication (such as bleeding, stomach obstruction or perforation) as a result of ulcers? Are you currently on any medications?

You also mention that you have Helicobacter pylori, a type of bacterium that's the most common risk factor for ulcers. H. pylori infection is treated with combinations of antibiotics and medications that block acid production in the stomach. Since you are pregnant, it would be important to know which trimester you are in because medications can have different effects on the fetus at various points in pregnancy.

I would not expect your unborn child to suffer any ill effects directly related to your ulcers, assuming you have had no ulcer complications. If you currently don't have any symptoms, I also would not expect that you would require any specific therapy. But if you have active ulcers with intractable symptoms (pain, nausea or vomiting) or have ulcer complications, then therapy may be necessary.

The most common treatment for ulcers is the use of drugs that block acid production in the stomach, such as cimetidine (Tagamet) or ranitidine (Zantac). These medications are classified as Category B in pregnancy, meaning they are generally presumed safe based on animal studies. They have not formally been tested in human studies. Continuous use of these medications helps heal ulcers and often keeps them from recurring because acid is required for ulcer formation.

We also know that eradication of H. pylori infection can prevent ulcer relapse, even in the absence of acid-blocking therapy. However, the drug cocktails used to combat H. pylori include some medications that are in Category C (uncertain safety in pregnancy) such as clarithromycin (Biaxin) and omeprazole (Prilosec), as well as others that are clearly unsafe, such as tetracycline and metronidazole (Flagyl). So, the risk of damage to the fetus may outweigh any benefit of such treatment, especially in the first trimester. On the other hand, if you've had a recent severe complication due to ulcers, such as severe bleeding requiring hospitalization and blood transfusions, there may be an argument for treating H. pylori early.

You should definitely discuss the details of your ulcers with your obstetrician, who will decide -- possibly after consultation with a gastroenterologist -- whether you should receive ulcer therapy during your pregnancy.