How to treat heartburn during pregnancy

Pregnancy can be full of sweet moments: the excitement of seeing a tiny heartbeat on ultrasound, the first little flutter kicks in your belly, and yes, even that third trimester waddle. What is not sweet, however, is the sour stomach and indigestion that pregnancy can bring.

Gastroesophageal reflux disease (GERD) is a digestive disease that occurs when the ring of muscle between the esophagus and stomach opens or loosens and allows stomach acid to leak into the esophagus. The most common symptoms of GERD are heartburn—a burning feeling in the chest behind the breastbone—and regurgitation, the sensation of fluid or food coming up into the chest. Though nearly everyone will experience heartburn from time to time, GERD is defined as having symptoms two or more times per week, or when the esophagus is damaged from reflux. Treatments often include dietary and lifestyle changes and acid-reducing medications.

According to the American College of Gastroenterology, GERD is quite common. It is thought that up to 20% of the U.S. population has it at one time or another, though this rate may be much higher in those who are elderly, obese, or pregnant.

GERD during pregnancy

Pregnancy heartburn is so common that it is almost a rite of passage, says Sheryl Ross, MD, an OB-GYN at Providence Saint John’s Health Center. About a quarter of pregnant women develop GERD during the first trimester of pregnancy, and incidence increases as pregnancy progresses, according to Austin Garza, MD, a gastroenterologist at Associates in Gastroenterology in Colorado Springs.

Why is GERD common during pregnancy?

GERD is practically a hallmark of pregnancy because changing hormone levels can affect the smooth muscles of the digestive tract. The hormone progesterone, produced in large amounts by the placenta, is a smooth muscle relaxant, according to Heather Johnson, MD, an OB-GYN at Reiter, Hill and Johnson of Advantia Health in the Washington, D.C. area. The relaxation of muscles in the digestive system also causes the lower esophageal sphincter (LES) muscles to relax. This allows stomach acid to more easily make its way into the esophagus. This, combined with the increasing size of the uterus in the second and third trimesters, pushes the stomach upward and intensifies uncomfortable symptoms. “Hence, symptoms tend to worsen as the pregnancy progresses,” Dr. Johnson notes. 

What does GERD feel like during pregnancy?

“GERD can wear many hats” and feel different in each individual, says Dr. Garza. Some may experience an intense burning sensation in the chest and throat, while for others it is a sharp pain just below and slightly to the left of the sternum. Some will have a sour taste or frequent regurgitation or burping. Often, symptoms are worse after meals, and this may make eating challenging, notes Dr. Ross.

Because the symptoms can be wide-ranging and different for each person, it is important to know what symptoms are concerning. Rarely, GERD can cause severe esophageal irritation that leads to pain or difficulty with swallowing, or even bleeding. “Passing dark or black stool would be concerning for the development of bleeding and should prompt an immediate discussion with your physician/obstetrician,” says Dr. Garza. He also cautions that GERD does not typically cause shortness of breath, pain with breathing, nor chest pain with exertion. Any of these symptoms could be signs of a more worrisome complication of pregnancy, especially the development of a blood clot, and would indicate that medical advice is necessary.

Can acid reflux during pregnancy hurt my unborn baby?

Dr. Johnson assures that simple reflux on its own is not harmful to fetuses. It is only when there is a drastic effect on nutritional input that GERD during pregnancy could become a problem. If symptoms are preventing you from eating the recommended number of calories, it is important to contact your healthcare provider immediately.

Natural remedies for pregnancy heartburn

Diet and lifestyle modifications are the primary treatments for GERD during pregnancy. Try the following steps to manage acid reflux during pregnancy: 

1. Eat frequent, small meals instead of large meals.
2. Wait three hours after eating before lying down.
3. Limit weight gain to the recommended amount for your pregnancy, according to the Centers for Disease Control and Prevention (CDC).
4. Elevate the head of your bed about 8 inches. This can be done with a wedge pillow or blocks under the headboard posts.
5. Avoid bending over or stooping as much as possible, especially on a full stomach.
6. Avoid foods that relax the lower esophageal sphincter, such as caffeine, alcohol, chocolate, and fatty foods.
7. Avoid spicy foods and instead eat bland foods, like yogurt, to help with GERD. Just make sure to consume low- or nonfat dairy to avoid triggering symptoms.
8. Try chewing gum. It can stimulate the salivary glands and clear acid buildup in the esophagus.

What can I eat that won’t give me heartburn while pregnant?

The good news is you can eat a lot of things that won’t cause heartburn symptoms while pregnant. The important question really is, says Dr. Johnson, what should you not eat if you have GERD? There is actually a relatively short list of foods to avoid, including alcohol, chocolate, citrus juices, tomato-based products, peppermint, coffee, and fatty foods.

Does water help with acid reflux during pregnancy?

Water can be a bit of a mixed bag when it comes to affecting GERD symptoms in pregnancy. Dr. Johnson notes that some women find that drinking water after a meal helps. It is thought that it may reduce the level of acidity in the stomach. However, Dr. Ross suggests saving the water for non-meal times, as drinking large amounts while eating may fill up the stomach and increase the risk of acid reflux and heartburn. 

Because stomach volume is reduced due to the growing uterus, consuming too much water can provoke GERD symptoms. Any extra water you drink can overwhelm the lower esophageal sphincter, causing uncomfortable symptoms. In other words, drink water in moderation, preferably after or between meals, to avoid provoking symptoms. 

Medications to treat GERD during pregnancy

Beyond the dietary and lifestyle measures listed above, safe antacids are the next step in treating GERD during pregnancy. The first-line medications that are safe to use during pregnancy include:

• Tums (calcium carbonate)
• Maalox (aluminum hydroxide/magnesium hydroxide suspension)
• Mylanta (aluminum hydroxide/magnesium hydroxide/simethicone)
• Rolaids (calcium carbonate)

Dr. Ross explains that these medications help coat the esophagus, minimizing the burning sensation. They also help neutralize stomach acid. These medications should be taken 30 minutes before each meal and before bedtime for optimal results, or they can simply be taken on an as-needed basis.

If you find that you are taking large and frequent doses of the above medications to treat your GERD symptoms, you may need an acid reducing medication, such as the following treatments are also safe during pregnancy:

• Pepcid (famotidine)
• Tagamet (cimetidine)
• Zantac (famotidine) *Though ranitidine was previously recalled, Zantac is back on the market with the same active ingredient as Pepcid.

These are considered second-line medications. Antacids work more quickly and are less expensive. Many women with mild symptoms won’t need to try Pepcid or Tagamet.

According to Dr. Garza, it is best to avoid sodium bicarbonate or aspirin containing antacids  (such as baking soda and Alka Seltzer products) during pregnancy. For severe reflux cases requiring care beyond the safer medications listed above, it is best to talk with your healthcare professional. He or she may prescribe proton pump inhibitors if the medications above don’t work. These popular medications, like Prilosec (omeprazole) and Nexium (esomeprazole), are also generally considered to be safe during pregnancy.

While symptoms of acid reflux can be quite uncomfortable and disruptive during pregnancy, there is no reason to suffer. With the remedies and medications above, GERD symptoms are often quite manageable. If you are having trouble managing them on your own, talk to your doctor. There are so many joyful moments in pregnancy. Don’t let GERD sour your experience.