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What hormonal change is most likely contributing to morning and evening acid reflux in a pregnant woman?

  1. Increased estrogen

  2. Increasing progesterone

  3. Decreased gastric acid secretion

  4. Elevated hCG levels

The correct answer is: Increasing progesterone

During pregnancy, the levels of progesterone increase significantly. Progesterone is a hormone that plays various roles in maintaining pregnancy, but one of its effects is smooth muscle relaxation throughout the body, including the gastrointestinal (GI) tract. This relaxation can lead to a decrease in the tone of the lower esophageal sphincter (LES), which normally prevents stomach acid from refluxing into the esophagus. As the LES tone decreases, especially later in pregnancy when the uterus enlarges significantly, there is a greater likelihood of acid reflux. Pregnant women often experience this condition due to the hormonal changes affecting smooth muscle function and the physical pressure from the growing uterus on the stomach. The other choices do not directly contribute to morning and evening acid reflux in the same way. Increased estrogen might have some effects, but it is progesterone's role in relaxing smooth muscles that is most directly linked to the reflux symptoms experienced by pregnant women. Decreased gastric acid secretion is not a typical change seen during pregnancy; rather, gastric acid production may remain stable or even increase. Elevated hCG levels are primarily associated with early pregnancy changes and do not directly influence acid reflux mechanisms.