Heartburn and Pregnancy (cont.)

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The cause of GERD during pregnancy is a bit more complicated than in the non-pregnant state. The basic cause--reflux of acid from the stomach into the esophagus--is the same. Similar to the situation with GERD in the non-pregnant state, the lower esophageal sphincter (the muscle at the lower end of the esophagus that normally prevents acid from refluxing) is weak in pregnancy. This probably is an effect of the high levels of estrogens and especially progesterones that are part of pregnancy. This weakness resolves after delivery. It is not known whether unexplained, transient relaxations of the sphincter, a common cause of reflux in the non-pregnant state, also occur in pregnancy. It also is not known if the contraction (motility) of the esophagus above the sphincter--a common contributor to GERD in the non-pregnant state--is impaired in pregnancy and is responsible for delaying the clearance of acid from the esophagus back into the stomach. What makes pregnancy different is the distortion of the organs in the abdomen and the increased abdominal pressure caused by the growing fetus. These changes clearly promote the reflux of acid.

The management of GERD during pregnancy involves many of the same principles as management in of GERD in women who are not pregnant, and the general population that suffers from GERD. Specifically, the so-called "lifestyle" changes should be meticulously followed.

  • The two feet of the head of the bed should be raised on 6 to 8 inch blocks. Alternatively--and perhaps more conveniently--a 6 to 8 inch wedge-shaped foam rubber pad should be used to elevate the upper body. It is important that the foam be firm enough to truly elevate the upper body. The wedge should also extend all the way to the waist so that the entire chest is elevated.
  • Lying on the left side at night may decrease acid reflux just as it does in women who are not pregnant, and other individuals with GERD. (In this position, it is physically more difficult for acid to reflux into the esophagus.) Occasionally, it may be necessary to sleep in a recliner chair at a 45-degree or greater angle.
  • Any specific foods that aggravate heartburn should be avoided (for example, coffee, cola, tea, alcohol, chocolate, fat, citrus juices, etc.)
  • Frequent, small meals should be eaten rather than three large meals, and the last meal of the day should be early in the evening. After meals, women who are with heartburn should not lie down.
  • After the evening meal, no further liquids should be consumed. (The more empty the stomach at bedtime, the less likely there will be reflux of acid.)
  • Smoking, of course, should be discontinued for several reasons, including the fact that it aggravates reflux.
  • Chewing gum also may be helpful. Chewing gum stimulates saliva which contains bicarbonate. The saliva and bicarbonate are swallowed, and the bicarbonate neutralizes the acid that has refluxed into the esophagus.


Heartburn and Pregnancy Resources

Doctor written main article on Heartburn (Reflux)

Medically Reviewed by a Doctor on 12/2/2013