Heartburn during pregnancy is common, even for women who have never had heartburn before. There are several causes of heartburn and there are effective remedies that do not require taking medication.
Before discussing heartburn during pregnancy, it is important to discuss why you feel heartburn. Heartburn is the reflux of acidic gastric contents into the lower esophagus.
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What Causes Heartburn During Pregnancy?
During pregnancy, there are two factors that cause or worsen heartburn.
Heartburn occurs when the valve (esophageal sphincter) at the junction of the esophagus and stomach, allows gastric acid to reflux up into the esophagus.
Heartburn during pregnancy has two main causes:
- Hormonal: The progesterone hormone causes relaxation of the esophageal sphincter muscle. When the sphincter (valve) opens, the acid in the stomach can reflux into the esophagus resulting in heartburn.
- Anatomic: Especially during the third trimester, the abdominal pressure caused by the enlarging uterus, pushes stomach acid through the esophageal sphincter.
Causes of heartburn during pregnancy
The combination of these two factors can cause significant heartburn in the later stages of pregnancy.
Other Causes of heartburn during pregnancy:
- Fatty foods, due to increased acid production
- Spicy foods
- Pre-existing medical conditions (diagnosis of GERD and Hiatal Hernia)
- Multiple pregnancies (twins, triplets)
- H. Pylori is a bacteria that has been associated with stomach ulcers. This is mentioned here more for information purposes for individuals who have had stomach ulcers associated acid reflux. This is not a routine test done for heartburn, though it may be of interest to individuals who have had chronic stomach pain/ulcers. (Discuss this with your physician, if you feel you might benefit from this test.)
Since the hormonal and anatomic causes of heartburn during pregnancy cannot be avoided, the best approach to managing heartburn is prevention.
Preventing the cause of esophageal sphincter relaxation and reflux from increased abdominal pressure can help decrease heartburn during pregnancy.
This will decrease the amount of medication necessary to deal with heartburn during pregnancy.
Reducing the relaxation of the esophageal sphincter is managed by avoiding foods that are known to relax the sphincter (even for those who are not pregnant).
In addition to the foods listed below, there may be other foods that cause your heartburn. Deciding what to eat may come down to what you tolerate.
The following list of foods and beverages to avoid is based on what is known to affect the strength of the esophageal sphincter:
- Citrus Fruit
How To Relieve Heartburn During Pregnancy?
1. Don’t eat late at night.
Eating late at night can cause heartburn and indigestion. If you have to eat, it is better to focus on eating complex carbs and proteins and avoid fatty or spicy foods.
You can also reduce your chances of heartburn at night by consuming only liquids within 3 hours of bedtime.
2. Instead of lying flat, elevate your head/upper body.
Place a pillow or two under your shoulders to elevate your head and upper body. You can also add blocks under the head of your bed if you do not like sleeping on more than one pillow.
Many women feel a pregnancy pillow is a luxury item they don’t need. That could not be further from the truth. A pregnancy pillow can help reduce acid reflux so you can get more sleep.
Getting more sleep during pregnancy is associated with lower stress levels. Lower stress levels can decrease acid production and reduce acid reflux.
Consider getting a pregnancy pillow, they really are a must-have pregnancy item.
3. Eat smaller meals throughout the day.
Gastric emptying is also slowed by the progesterone hormone. Eating a large meal will stay in your stomach longer and allow more time for acid reflux to occur.
Try to eat 5 or 6 small meals a day. Do not overload your stomach when you eat. Avoid greasy, fatty, and fried foods whenever possible.
This is the same advice we give if you are fighting morning sickness. Eating small meals reduces your chances of reflux and nausea during pregnancy.
4. Avoid carbonated beverages
If you have heartburn during pregnancy you may also want to avoid carbonated beverages or any food and drink that causes increased abdominal distention due to gas.
Some other foods that may cause you to have gas and bloating are broccoli, beans, and onions.
Combining gas/bloating with the later stages of pregnancy can cause significant acid reflux.
5. Eat meals slowly.
Avoid eating your food fast. This can lead to heartburn, indigestion and cause you to overload your stomach.
Eat meals slowly. Relax and sip water between bites. Avoid drinking a big glass of fluids all at once.
Do the best you can to eat slowly. Granted, most of us moms eat 90% of our meals standing up and shoveling it in as fast as possible! Because that’s real life. Just do what you can!
6. Drink fluids throughout the day.
Drinking enough fluids during pregnancy is critically important. Staying well-hydrated is so important and can help prevent heartburn.
If you can’t tolerate plain water, you can try infusing your water with fruit or drink juice (watch the sugar content and be sure it is pasteurized), broths, and soups.
7. Wear loose fitting clothing
Wearing tight clothing can increase the pressure on your abdomen and increase your chances of having reflux.
Wear loose comfortable clothing that you can move around in freely.
8. Avoid fatty meals.
Fatty or deep fried foods take a long time to digest and they can increase your chances of heartburn and indigestion.
If your bump is craving fried foods eat them earlier in the day, avoid fried or fatty foods at night. Eating them at night is very likely to cause heartburn during pregnancy.
9. Avoid your personal trigger foods
This is probably the best piece of advice we can give you. Avoid your personal heartburn triggers. You know what sets off your heartburn alarms best!
Maybe it is garlic or Mexican food or coffee. Whatever those foods are, they are best to avoid while you are pregnant.
10. Take a walk after you eat.
Walking after a meal has so many benefits. Walking after a meal helps with digestion and can lower your blood sugar.
You want to avoid lying down for a few hours after you eat. Taking a walk can help you fight that after-meal fatigue that often sets in after we eat.
Can I take medication to relieve heartburn?
If you have heartburn during pregnancy, it is not likely that preventive measures alone will completely get rid of your heartburn. In this situation, the need for medications may be necessary.
You want to talk with your prenatal provider about any medications you plan to take for heartburn during pregnancy. There are a number of options.
Those that are considered acceptable to take still have limitations in terms of how much you can take and which ones are best based on how many weeks pregnant you are.
If medication is necessary for heartburn during pregnancy:
The first step is to try over-the-counter medications (not recommend Maalox or Mylanta due to aluminum content).
The second step is prescription medications. OTC and prescription medications should be taken under the supervision of your prenatal care provider.
In all instances, it is best to avoid medications during early fetal development (first trimester, especially in the first 8 weeks). If mediation is needed very early in your pregnancy, discuss which medications to take with your provider based on your medical history.
- Rolaids: calcium carbonate/magnesium hydroxide, considered safe during pregnancy; take no more than 12 in a 24 hour period
- Tagamet, Pepcid, Zantac: are safe during pregnancy; Category B
- Nexium: Works by reducing acid production in the stomach and is a Category B medication.
*Category B Medications: Either animal-reproduction studies have not demonstrated a fetal risk but there are no controlled studies in pregnant women or animal-reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the first trimester (and there is no evidence of a risk in later trimesters). Drugs in Pregnancy and Lactation Briggs et.al. 4th edition
When Should I call my doctor?
Before taking any medication for what you think may be heartburn (even over-the-counter medications), you will want to call your doctor. This is a common concern during pregnancy and the office nurses can talk to you about your concerns and what to do next. When you call, there are certain questions you will be asked to try and discern the cause and severity of your symptoms.
- Do you have a history of heartburn, GERD, reflux esophagitis, gastritis, hiatal hernia? If not, do you have a heart condition that causes chest pain?
- What have you eaten recently? What were you doing when the pain started? Where you lying down or standing up?
- Are the symptoms getting worse or better?
Based on this information and how many weeks pregnant, a decision will be made as to what you should do. If you are instructed to take an antacid, this may help diagnose the problem, as your symptoms should subside. Based on your medical history, symptoms, and severity, you may be asked to go to the office for an evaluation.
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