If you’ve ever been pregnant and grimaced as acid burned in your chest and throat, you’re not alone: Research suggests that as many as 80 percent of pregnant women have experienced the symptoms of gestational reflux, or heartburn.

Many women who develop heartburn during pregnancy have never had heartburn before, so it comes as a bit of an unwelcome surprise. Want to better understand why you might develop heartburn when you’re pregnant and what you can do about it? Here’s what you need to know.

When does heartburn in pregnancy start?

Heartburn can and often does start during the first trimester, says Dr. Camille Thélin, MD, MS, a clinical assistant professor and Women’s Digestive Health Program Director, Division of Digestive Diseases and Nutrition, University of South Florida’s Morsani College of Medicine.

That’s when those pregnancy hormones start surging through your body. They seem to decrease the pressure in the valve that separates the stomach from the esophagus. This valve is actually a muscle called the lower esophageal sphincter. Think of it like a door between the esophagus and the stomach, suggests Dr. Thélin. And when the pressure decreases, it doesn’t do its job quite as effectively.

That allows the strong digestive acids in the stomach to creep back up into the esophagus toward your throat. That acid is what causes the burning sensation and possibly a sour taste in the back of your mouth.

However, if you’re one of the lucky ones who make it through the first trimester heartburn-free, don’t get too comfortable just yet: Heartburn can also develop during second or third trimester, too.

Related: Simple Diet Changes That Can Ease Heartburn and GERD

What causes heartburn in pregnancy?

“But whyyyyyy” you may be moaning, as you clutch your throat. Unfortunately, you can’t point to just one cause—experts generally believe that it’s a combination of factors, including those pregnancy hormones that may decrease the pressure of the valve separating your stomach from your esophagus.

But you also have to consider that when you’re pregnant, your body is expanding, most notably in your abdomen. As your baby grows, your uterus grows, too. And as your uterus swells, it pushes against your stomach, causing an increase in intraabdominal pressure—that causes reflux.

How do you treat heartburn during pregnancy?

You do have a few treatment options, fortunately. There are some medications that are considered safe, and there are even a few home remedies that some people find helpful.

You could try eating fresh or dried papaya, which may help to neutralize acid, according to Dr. Yi Qin, MD, a gastroenterologist with the Cleveland Clinic. Or you could sip on some chamomile tea or a glass of milk.

However, it’s always a good idea to talk to your doctor before you try a treatment, even a home remedy. “I would just caution that, during pregnancy, a lot of herbal or home remedies must be used with caution, because they may have negative effects on the baby,” says Dr. Qin. 

What medications can I take for heartburn during pregnancy?

Home remedies may not be enough to do the trick for you. Here are some medications that your doctor might recommend trying—but always be sure to consult your doctor first before trying any of these (or any suggested home remedies, at that!) 

  • Antacids. “If you have mild symptoms, you could consider something as easy as an antacid,” says Dr. Thélin. In fact, ask any random pregnant woman, and chances are that she has a roll of antacids stashed somewhere close by. Over-the-counter antacids with calcium carbonate, like Tums, are inexpensive, easy to get, and can neutralize some of that acid.
  • Alginates. Alginate-based reflux suppressants work by forming an actual physical gel-like barrier at the top of your stomach that blocks the acidic stomach contents. Research suggests that they may provide more long-lasting relief than antacids by themselves, too. Gaviscon is probably the most well-known version on the market.
  • H2 blockers. Histamine-2 receptor antagonists, or H2 blockers, like cimetidine (Tagamet HB) and famotidine (Pepcid, Pepcid AC), are often recommended, too. They work by reducing the acid in your stomach. One familiar name, though, is no longer available; the FDA pulled one popular H2 blocker, ranitidine (Zantac), off the market in 2020.
  • Proton pump inhibitors. These medications decrease the amount of acid produced in the stomach. However, research suggests it’s better to leave these meds to women with more serious symptoms of gastroesophageal reflux disease (GERD) or pregnant women who don’t respond to other treatments or lifestyle changes.

What you want to avoid are antacids that contain sodium bicarbonate. Better known as baking soda, sodium bicarbonate can be found in some antacids like Alka Seltzer, but experts suggest that pregnant women steer clear of them.  “It can lead to a lot of swelling or water retention,” says Dr. Qin.

Another drug that you might also want to avoid during pregnancy is the omeprazole, which is a proton pump inhibitor. In the past, the Food and Drug Administration categorized drugs A to D, with the safer drugs in the A category and the riskiest drugs of all in a separate Category X. Omeprazole was considered a Category C drug, compared with other PPIs that were designated Category B.

Related: You’ve Heard the Term, but What Exactly Is Gerd? Here’s What Experts Say About This Not-So-Fun Condition

Can I prevent heartburn during pregnancy?

You may not be able to entirely prevent heartburn while you’re pregnant. After all, your uterus is going to continue to expand and put pressure on your stomach, and those pregnancy hormones are still present in your body. But you can take a few steps to reduce the likelihood, such as:

  • Avoiding your known triggers. If you’ve discovered that your morning cup of coffee triggers heartburn, it’s time to find a new beverage. And if certain foods, like fried foods and citrus fruits, tend to cause problems, avoid them and eat other foods instead.
  • Propping yourself up at night. Don’t try to sleep flat on your back (this generally isn’t recommended during pregnancy anyway). Put a couple of pillows behind your head, or even a wedge underneath the top of your mattress, so you can keep your head and neck elevated.
  • Not lying down right after eating. Give your body some time to digest before you try to sleep. If you lie down shortly after eating, you may feel the acidic contents of your stomach creeping back up your esophagus.
  • Wearing loose clothing. Tight clothing, like tight, high-waisted pants, can put extra pressure on your stomach. “An analogy is like squeezing a balloon from the bottom up,” says Dr. Qin.
  • Eating slowly. Chew your food slowly and put your fork down after each bite. Overeating can lead to heartburn, but you’re less likely to overeat if you eat slowly.
  • Checking in about your medications. If you were already taking a medication to treat GERD, the chronic form of acid reflux, prior to becoming pregnant, follow your doctor’s orders about continuing to take it.

Related: Foods that Cause Heartburn

When can you expect heartburn during pregnancy to end?

When can you expect the heartburn to go away? If you’re worried that the answer to this question is “never,” do not despair. Unless you had GERD prior to getting pregnant, your heartburn will almost certainly go away after you deliver your baby, says Dr. Qin.

“It doesn’t go away immediately after childbirth, but over time, as the pregnancy hormones go down and as the abdominal pressure decreases,” she says.

Next up: Heartburn help is here—experts share their top tips to get rid of heartburn.

Sources

  • Alimentary Pharmacology and Therapeutics: “Review article: the management of heartburn during pregnancy and lactation”
  • Nature: Efficacy of alginate-based reflux suppressant and magnesium-aluminium antacid gel for treatment of heartburn in pregnancy: a randomized double-blind controlled trial
  • Dr. Camille Thélin, MD, MS, clinical assistant professor and Women’s Digestive Health Program Director, Division of Digestive Diseases and Nutrition, University of South Florida’s Morsani College of Medicine
  • Dr. Yi Qin, MD, gastroenterologist with the Cleveland Clinic



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