- Dietary Changes
Facts you should know about heartburn during pregnancy
- Heartburn (a symptom of gastroesophageal reflux disease or GERD) occurs in one-quarter to one-half of all pregnant women.
- Heartburn usually begins in the first or second trimester of pregnancy and continues throughout the remainder of the pregnancy.
- Heartburn during pregnancy is usually mild and intermittent; it can be severe in some cases.
- Complications of gastroesophageal reflux disease (GERD) such as esophageal bleeding, trouble swallowing, loss of weight, etc. are uncommon.
- Lifestyle changes that can help relieve heartburn during pregnancy are similar to those women who are pregnant, for example,
- Raise the head of the bed
- Lie on the left side at night
- Avoid trigger foods that aggravate heartburn symptoms
- Eat frequent small meals
- Avoid lying down after eating
- Medications that may be safe for pregnant women to relieve heartburn include antacids, alginic acid/antacid combinations, and sucralfate. Antacids may interfere with iron absorption, and iron is important for the growing fetus so pregnant women may need iron supplementation.
- Magnesium-containing antacids could slow labor if taken just prior to labor.
- There are several types of medications used to relieve heartburn in women who are not pregnant, but it is not known how safe some of these medications are for the developing fetus.
- Types of medications that treat heartburn during pregnancy, for example:
- H2 antagonists:
- cimetidine (Tagamet)
- ranitidine (Zantac 360)
- famotidine (Pepcid)
- Proton pump inhibitors (PPIs), for example:
What causes heartburn during pregnancy?
The cause of heartburn (also called gastroesophageal reflux disease, or GERD) during pregnancy is more complicated than in the non-pregnant state. The basic cause of heartburn - reflux of acid from the stomach into the esophagus - is the same. 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 progesterones that are a normal 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 women who are not pregnancy, it also occurs during pregnancy. It is not known if the contraction (motility) of the esophagus above the sphincter, a common contributor to GERD in women who are not pregnant 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.
Which diet and lifestyle changes relieve heartburn during pregnancy?
The management of heartburn (GERD) during pregnancy involves many of the same principles as management in the non-pregnant state. Lifestyle changes may include:
- Raise the head of the bed on 6- to 8-inch blocks. Alternatively, a 6- to 8-inch wedge-shaped foam rubber pad could be used to elevate the upper body. It is important the foam is firm enough to truly elevate the upper body. The wedge should also extend all the way to the waist so the entire chest is elevated.
- Lying on the left side at night may decrease acid reflux just as it does in non-pregnant women 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, pregnant women are prone to heartburn should not lie down.
- After the evening meal, no further liquids should be consumed. The emptier the stomach at bedtime, the less likely there will be reflux of acid.
- Smoking should be discontinued for numerous reasons during pregnancy, including that it aggravates reflux.
- Chewing gum also may be helpful. Chewing gum stimulates the production of saliva, which contains bicarbonate. The saliva and bicarbonate are swallowed, and the bicarbonate neutralizes the acid that has refluxed into the esophagus.
- What Is Avascular Necrosis and How Does It Affect Bones?
- The Arch of the Human Foot Was Key to Upright Walking, Scientists Say
- Worried About Cataracts? Here's What You Need to Know
- FDA Issues Warning About Compounded Versions of Wegovy, Ozempic
- Sick Restaurant Workers Fuel Many Foodborne Illness Outbreaks
- More Health News »
Which heartburn medications are used during pregnancy?
If lifestyle changes are not adequate, treatments with medications that are minimally absorbed into the body (and therefore not a potential threat to the fetus) could be started. Treatments include antacids (for example, Maalox, Mylanta), alginic acid/antacid combination (Gaviscon), and sucralfate (Carafate). The most reasonable first line of treatment is antacids alone, one hour after meals and at bedtime. It may be necessary to alternate magnesium and aluminum-containing antacids to avoid diarrhea or constipation. If antacids alone are not effective, then they should be continued and alginic acid/antacid may be added. Antacids and alginic acid/antacid should be taken after meals and at bedtime, more frequently if necessary, as advised by your doctor.
Sucralfate acts by coating and protecting the lining of the esophagus and stomach and is more effective in an acidic environment. Thus, if sucralfate is being used, it should be taken one-half hour before or after doses of antacids or alginic acid/antacid for maximal effect. A small study in pregnant women showed sucralfate is successful in relieving heartburn and studies in animals have not shown adverse effects of sucralfate on the fetus.
Are heartburn drugs safe to take during pregnancy?
- Some antacids, alginic acid/antacid, and sucralfate contain aluminum, and small amounts of aluminum are absorbed into the body. However, the extra aluminum does not accumulate in the body unless there is impairment in the function of the kidneys, which normally excrete the excess aluminum. Absorption of aluminum probably does not present a problem for the fetus unless the mother has kidney impairment.
- Magnesium-containing antacids could slow labor. (Intravenous magnesium has been used therapeutically to slow labor that is progressing too rapidly.) This potential problem only applies to magnesium-containing antacids taken just prior to labor and is not of concern earlier in pregnancy.
- Antacids may interfere with iron absorption, and iron is important for the growing fetus. Pregnant women usually receive supplemental iron and a slight decrease in iron absorption (considering the use of supplements) should not result in a deficiency of iron. Insufficient iron intake or absorption is easily detected in blood tests as iron deficiency anemia.
- If antacids, alginic acid/antacid, and sucralfate are not effective in controlling heartburn, probably the safest absorbed drugs that can be given are the H2 antagonists, such as cimetidine (Tagamet), ranitidine (Zantac 360), and famotidine (Pepcid). Although there are no studies in pregnant women, animal studies have shown no effects on the fetuses of animals. Nizatidine (Axid) should not be used because it has been shown to have adverse effects on animal fetuses, although at much greater doses than those used in humans.
- Proton pump inhibitors are similar to the H2 antagonists with respect to safety. Lansoprazole (Prevacid), rabeprazole (Aciphex), pantoprazole (Protonix), and esomeprazole (Nexium) have been shown to be safe when tested in pregnant animals, but because they are newer, experience with them is less than with the H2 antagonists. They should be used only when H2 antagonists in normal doses fail to control heartburn. Omeprazole (Cimetidine, Zegerid) probably should be avoided since although there are no studies in pregnant women showing problems, it has been shown to have effects on animal fetuses at very high doses in some studies.
- Concerns about the use of H2 antagonists and proton pump inhibitors are greatest during the first trimester when small drug-induced alterations in fetal development can result in major birth defects. Concerns are less during the second trimester and even less during the third trimester when most critical development of the fetus already has taken place. Talk to your doctor before taking any medications to treat heartburn during pregnancy.
- Metoclopramide (Reglan) is used infrequently in treating GERD. Effects on the fetuses of animals have not been demonstrated and it can be used in pregnancy. Because of its neurologic side effects, it should be the drug of last resort.
Subscribe to MedicineNet's Pregnancy & Newborns Newsletter
Health Solutions From Our Sponsors
Roy, P.K., et al. "Gastrointestinal Disease and Pregnancy." Medscape. May 17, 2018. <https://emedicine.medscape.com/article/186225-overview>.
Budak, N. Journal of Food Science. May 2014. <http://onlinelibrary.wiley.com/doi/10.1111/jfds.2014.79.issue-5/issuetoc>.
Costigan, K.A., et al. "Pregnancy folklore revisited: the case of heartburn and hair." Birth. 2006 Dec;33(4):311-4. <http://www.ncbi.nlm.nih.gov/pubmed/17150070>.
Vazquez, J.C. "Heartburn in Pregnancy." BMJ Clin Evid. NIH. 2015; 2015: 1411. Published online BMJ Clin Evid. 2015; 2015: 1411. Published online 2015 Sep 8. <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4562453/>.
Top Heartburn and Pregnancy Related Articles
What Does Chest Pain on the Left Side Above a Female Breast Mean?Chest pain on the left side above a female breast can have a variety of causes. Learn the signs of chest pain on the left side, what may cause it, how doctors diagnose it, and what you can do to treat it.
16 Early Signs & Symptoms of Pregnancy: Could You Be Pregnant?What are the early signs and symptoms of pregnancy? Can you know before your missed period? Read about nausea and vomiting (morning sickness), bloating, tender breasts, and more. Explore first trimester symptoms of pregnancy and learn what week pregnancy symptoms start.
Am I Pregnant QuizWhat are early pregnancy symptoms? In some women, symptoms range from a missed period to feeling lightheaded. Others may experience typical "morning sickness" and food cravings. Could you be pregnant? Take the quiz!
What Is Esophageal pH Monitoring?Esophageal pH monitoring is used to measure the reflux (regurgitation or backwash) of acid from the stomach into the esophagus and to diagnose gastroesophageal reflux disease (GERD). Side effects of the procedure are few but may include mild discomfort in the back of the throat while the catheter is placed, and swallowing.
Fundoplication (Acid Reflux Surgery)Fundoplication is a surgical procedure for treating GERD (gastroesophageal reflux disease). The procedure is to help GERD symptoms including heartburn. Eighty percent of patients with GERD also have a hiatal hernia, and during the fundoplication procedure, the hernial sac may also be surgically fixed. The procedure can be done with laparotomy, thoracotomy, or laparoscopy.
GERD PictureThe stomach contents regurgitate and back up (reflux) into the esophagus The food in the stomach is partially digested by stomach acid and enzymes. See a picture of Gastroesophageal Reflux (GERD) and learn more about the health topic.
GERD QuizWho is at risk for developing GERD? Are you? Take this quiz to learn what GERD is, if you're at risk, and what you can do about it.
Heartburn is a burning sensation experienced from acid reflux (GERD). Symptoms of heartburn include chest pain, burning in the throat, difficulty swallowing, the feeling of food sticking in the throat, and a burning feeling in the chest.
Causes of heartburn include dietary habits, lifestyle habits, and medical causes.
Treatments for heartburn include lifestyle changes, OTC medication,prescription medication, and surgery.
Heartburn Foods SlidesLearn the symptoms of heartburn and which foods cause heartburn or GERD. Discover home remedies and which foods may provide treatment for heartburn relief.
Acid Reflux (Heartburn, GERD): Symptoms & RemediesHeartburn is a symptom of acid reflux that causes chest pain when stomach acid backs up into the esophagus. Heartburn symptoms may mimic chest pain that occurs during a heart attack. Gastroesophageal reflux disease (GERD) may produce other symptoms.
How Soon Before Labor Do You Have Diarrhea?Diarrhea may be a sign that your labor will start within 24-48 hours, but there are other more reliable signs that labor is approaching.
Intestinal Gas and Gas PainIntestinal gas and painful bloating are common. Learn about what causes gas pain and how eliminating certain foods from your diet can help relieve symptoms.
Is It Normal to Have Pain on Your Left Side During Pregnancy? Why and When to WorryLeft side pain and back pain are common symptoms that affect many women during pregnancy. Learn what causes it, how doctors diagnose it, and what you can do to treat left side pain and back pain during pregnancy.
LaryngitisLaryngitis is an inflammation of the voice box (vocal cords). The most common cause of acute laryngitis is an infection, which inflames the vocal cords. Symptoms may vary from the degree of laryngitis and age of the person (laryngitis in infants and children is more commonly caused by croup).
PMS vs. Pregnancy: Differences and SimilaritiesMany women have difficulty figuring out if they are pregnant, have PMS, or are about to start their period. The most common signs and symptoms of early pregnancy, PMS, and the start of your period include mood swings, back pain, increased urination, and tender breasts. These three conditions also share other similar signs and symptoms, but there are unique differences between each. Moreover, there are symptoms that only occur if you are pregnant. Early pregnancy symptoms, PMS, and the start of the menstrual period all have common signs and symptoms like mood swings, back pain, and breast pain. Symptoms and signs between the three conditions that may seem similar, but are slightly different include the following: Pelvic or abdominal cramping before or during your menstrual period is normal; however, the cramping of early pregnancy is mild. If you are pregnant, nausea and vomiting, or morning sickness, is common. They are not common symptoms of PMS. Fatigue is common in both, but PMS usually goes away once your period begins. Food cravings or aversions to certain foods are common in both pregnancy and PMS, but if you are pregnant, the cravings or aversions to foods are more specific and intense. You may have spotting or bleeding if you are pregnant or suffering from PMS. When the embryo inserts itself into the uterus (implantation bleeding), you may mistake it as your menstrual period. However, implantation bleeding is much lighter (not enough to soak a pad or tampon) than the heaving bleeding experienced at the beginning of your period. Signs and symptoms that you may have only if you are pregnant include, implantation cramping and bleeding, a white, milky vaginal discharge, and your areolas or nipples darken. The only way to find out if you are pregnant is with a pregnancy test. Home pregnancy test kits are available without a prescription at pharmacies and most grocery stores. Contact a doctor or other health care professional if you think you may be pregnant.
Pregnancy Myths and Facts QuizBeing pregnant is a delicate time for both mother and baby. Take this pregnancy myths and facts quiz to separate the myths and facts about being pregnant, and learn the truth behind healthy pregnancies!
Early Pregnancy Symptoms: Am I Pregnant?Pregnancy symptoms can vary from woman to woman, and not all women experience the same symptoms. When women do experience pregnancy symptoms they may include symptoms including missed menstrual period, mood changes, headaches, lower back pain, fatigue, nausea, breast tenderness, and heartburn. Signs and symptoms in late pregnancy include leg swelling and shortness of breath. Options for relief of pregnancy symptoms include exercise, diet, and other lifestyle changes.
Pregnant? Don't Eat ThisDo you know which common foods may be risky during pregnancy? Learn which foods to avoid, while pregnant, such as queso dip, lunch meat, coffee and more.