If you are pregnant, the chances are good that at some stage of your pregnancy, you will experience one or more digestive-related discomforts, including indigestion, heartburn, gas, or constipation. Heartburn during pregnancy is very common.
What are the reasons for digestive changes in pregnancy? One of the chief culprits behind heartburn and other digestive problems is the hormone progesterone.
Progesterone decreases your muscle tone and can relax the muscles of the stomach to slow the emptying time.
Believe it or not, your stomach also gets pushed up so much during the last trimester that it sits much higher than normal, and food contents can be pushed up into your esophagus.
When this happens, the valve allows food particles or stomach acid to sit in your esophagus. This can cause heartburn and indigestion.
Progesterone also wreaks havoc in your lower intestines. It relaxes the smooth muscles of your intestines, which slows their ability to contract well.
Waste from your digestive tract will tend to remain there longer, more water is absorbed, and then the waste becomes harder to pass.
There are several causes of heartburn during pregnancy and there are effective remedies that do not require taking medication.
What is Heartburn?
Heartburn is the reflux of acidic gastric contents into the lower esophagus.
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 management of heartburn during pregnancy is by practicing prevention.
Reducting esophageal sphincter relaxation and decreasing intrabdominal pressure.
- Reducing the relaxation of the esophageal sphincter can be accomplished by avoiding foods that are known to relax the sphincter:
- Citrus Fruit
2. Decreasing intrabdominal pressure during pregnancy is easier said than done. Here are some suggestions:
- Don’t lie flat during pregnancy, especially after eating.
- Avoid lifting heavy objects or any activity that will strain your abdominal muscles. This increases the pressure in your abdomen and will cause gastric contents to reflux up into your esophagus.
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 carbohydrates and proteins and avoiding 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.
Due to a simple lack of space in your stomach, as you progress into your third trimester, your stomach will be compressed and not be able to hold as much.
Coupled with the slower emptying time and progesterone effects mentioned above, eating a large meal might not only cause you painful indigestion, it may not even stay down!
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 extremely important. Staying well-hydrated will help prevent abdominal cramping and 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).
Fluids are essential, not just for you and your digestive tract, but also for the baby.
The recommended daily intake of fluid is 1500-2000 ml of fluid or the equivalent of 6-8 glasses a day of fluids.
This could include water, juice, and or other drinks.
Broths and soups are also good options.
Be careful not to drink too many caffeinated drinks or diet drinks that contain artificial sweeteners.
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.
11. Add Fiber to Your Diet
Adding fiber-rich foods is an essential part of treating and avoiding heartburn. The recommended amount of fiber in an adult diet is 25-35 grams per day.
If you are pregnant, you might benefit from adding another 15% (or 3-5 grams) per day.
Foods that are rich in fiber include whole grains, popcorn, and raw vegetables. Fiber supplements can also be added to your diet but be sure that they do not contain laxative chemicals.
A regular exercise routine can be very helpful in preventing heartburn after meals.
Activities such as walking, swimming, and cycling can help speed up gastric emptying.
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.
When is medication 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 heartburn during pregnancy (even over-the-counter medications), call your doctor. This is a frequent question during pregnancy.
The office nurse can talk to you about your concerns and what to do next. When you call, there are certain questions you will be asked.
These questions are to try and determine 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. You may be asked to take an antacid while you are on the phone.
This can help diagnose the problem if your symptoms start to resolve. Based on your medical history, your symptoms, and the severity of your symptoms, you may be asked to go to the office for an evaluation.
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