Heartburn During Pregnancy: Causes and Treatment

Despite its name, heartburn has nothing to do with your heart. It is a burning sensation in your chest, just behind your breastbone. Heartburn occurs when stomach acid flows back up into your esophagus, a condition known as acid reflux. The esophagus is the tube connecting your throat to your stomach.

Usually, stomach contents are prevented from refluxing by the lower esophageal sphincter (LES), a muscular ring located where your esophagus meets your stomach. Hormonal changes during pregnancy can cause the LES to relax, allowing stomach acid to move up into the esophagus and irritate its lining. The pressure of your growing uterus on your abdomen also increases your risk of acid reflux and, in turn, heartburn.

According to one study, up to 45% of pregnant women experience heartburn. Symptoms include a burning pain in your chest that may radiate to your throat and a sour taste in your mouth. The pain usually worsens after eating heavily, bending over, or lying flat.

Heartburn may start at any pregnancy stage, but symptoms are more common during the second and third trimesters. In this article, you will learn what causes heartburn during pregnancy and tips on how to get rid of heartburns during pregnancy.

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What Causes Heartburn During Pregnancy?

You may experience heartburn during pregnancy due to various reasons, including:

• Pregnancy hormones. The hormones produced during pregnancy, particularly progesterone, cause the relaxation of your lower esophageal sphincter. And this, in turn, allows for stomach acid to flow backward into your esophagus, irritating its lining, causing a burning sensation in your chest.
• Growing uterus. As pregnancy progresses, your uterus expands, placing pressure on your stomach. Consequently, stomach contents are more likely to be pushed up into the esophagus, explaining why heartburn is more common in the third trimester.
• Slowed digestion. Progesterone causes gastrointestinal smooth muscle relaxation, which slows down digestion and causes food to sticks in your stomach longer. As a result, you may experience heartburn, constipation, bloating, and gas.

How to Get Rid of Heartburn During Pregnancy

Lifestyle changes and home remedies may be enough to help relieve and treat heartburn during pregnancy. Here are some helpful tips:

• Eat several small meals instead of three large meals each day as it will help you avoid overeating. You’re more likely to experience acid reflux, and by extension, heartburn if you’re so full.
• Eat slowly and chew your food thoroughly. Taking your time when eating will also prevent you from overeating.
• Drink fluids between meals rather than while eating. Drinking and eating at the same time can cause your stomach to expand, increasing your risk of heartburn.
• Avoid foods that could trigger or worsen your heartburn. These include spicy, fatty, and greasy foods; citrus fruits and juices; chocolate; coffee and other caffeinated drinks; alcohol; carbonated beverages; and tomato products such as tomato soups and ketchup.
• Sit up straight when you eat and don’t lie down or go to bed within 3 hours of eating. Keeping upright utilizes gravity to help keep stomach contents where they belong.
• Elevate the head of your bed to 6-8 inches. Propping your upper body while you sleep will also take advantage of gravity to keep stomach acid from refluxing into your esophagus. You can achieve this by placing blocks beneath the legs under the head end of your bed or using a wedge pillow.
• Stop smoking. When you smoke, the chemicals you inhale cause the LES to relax abnormally. Consequently, stomach acid can easily flow backward, causing acid reflux symptoms like heartburn. Smoking while pregnant can also lead to preterm birth, sudden infant death syndrome (SIDS), and low birth weight, which according to WHO, contributes to 60% to 80% of all neonatal deaths.
• Don’t drink alcohol. Alcohol can also lead to heartburn by causing the LES to relax. Moreover, it can lead to miscarriage, stillbirth, heart defects, and fetal alcohol spectrum disorders (FASDs).
• Wear loose-fitting clothes. Clothing that fits you tightly around your waist squeezes your stomach and lower esophageal sphincter, increasing acid reflux episodes.
• Maintain a healthy weight. Extra pounds can worsen heartburn due to the added pressure on your abdomen. According to the CDC, the recommended weight gain range for women pregnant with one baby is as follows: 28-40 pounds if underweight (BMI less than 18.5), 25-35 pounds if normal weight (BMI 18.5-24.9), 15-25 pounds if overweight (BMI 25.0-29.9), and 11- 20 pounds if obese (BMI greater than or equal to 30.0).
• Chew gum. Doing so stimulates saliva production, which, when swallowed, neutralizes the refluxed acid in your esophagus. Chew on sugarless gum if you prefer not to ingest artificial sugars while pregnant and go for non-minty gum if mint-flavored gum tends to exacerbate heartburn for you.

If lifestyle and diet changes don’t work, over-the-counter medications may help improve your symptoms. These include:

• Antacids, including Tums, Maalox, Mylanta, and Rolaids
• H2 blockers, such as cimetidine (Tagamet) and famotidine (Pepcid)
• Proton pump inhibitors (PPIs), including omeprazole (Prilosec, Rapinex), lansoprazole (Prevacid), rabeprazole (Aciphex), and esomeprazole (Nexium)

However, talk to your doctor or a pharmacist before taking any OTC heartburn medication while pregnant. Your doctor may also prescribe higher doses of the drugs if your heartburn is severe.

Heartburn medications that are unsafe to take during pregnancy

• Ranitidine (Zantac): The FDA in 2020 requested removing of all ranitidine products from the market due to a contaminant called N-Nitrosodimethylamine (NDMA), which is a probable cancer-causing agent.
• Magnesium-containing antacids: these drugs can slow labor and pose a problem when taken later in your pregnancy.
• Antacids containing aspirin: the use of aspirin is generally not recommended during pregnancy as it can harm your baby. Risks include heart defects, bleeding in the brain of premature infants, and pregnancy loss.
• Antacids containing sodium bicarbonate: can increase swelling.

When Will Heartburn During Pregnancy End?

Heartburn will usually end with childbirth. However, since several severe conditions (e.g., angina, HELLP syndrome, and gastroparesis) can mimic heartburn, notify your doctor or midwife of any symptom you experience. In regards to heartburn, tell your doctor if:

• Your heartburn is so severe it disrupts or prevents sleep.
• Heartburn medication worsens your symptoms or causes any side effects.
• You notice other symptoms such as weight loss, abdominal pain, changes in fetal movement (baby movements), et cetera.
• Heartburn continues for several days after you’ve given birth.

Heartburn during pregnancy is common, but symptoms are usually mild and manageable. Lifestyle and diet changes, such as sleeping with your head elevated and avoiding spicy foods, can relieve your symptoms and even prevent heartburn. If these measures prove ineffective, talk to your doctor about medications that are safe for treating heartburn during pregnancy.

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