Heartburn In Pregnancy: 47 Reliable Facts To Stay Safe

Heartburn is the main symptom of acid reflux, and during pregnancy, it often occurs.

There are some specific reasons for that, and we’ll disclose them extensively later.

For the moment, let’s point out two important preliminary considerations.

  • Heartburn in pregnancy doesn’t mean that the pregnancy is complicated or that there are added risks
  • In order for pregnant women to treat heartburn, it’s needed to take some precautions because the treatment differs from other people

In other words, pregnant women have to deal with heartburn, and this is a frequent symptom.

On the other hand, this is not due to some complications or side effects of the pregnancy itself.

Of course, this symptom deserves attention, because if improperly treated it may cause some serious issues with the time.

But, if you follow the right guidelines, it’s possible to overcome this problem easily and without any troubles for the whole duration of the pregnancy.

What matters most is to focus the attention on the root causes of this condition.

This means to always consider heartburn for what it really is, a symptom.

That’s why our action has to address the cause, in order for the effect (symptom) to (almost) disappear.

Or, at least, to make it much more bearable for the duration of the pregnancy.

Heartburn In Pregnancy

Heartburn In Pregnancy

According to several studies, heartburn is one of the most common gastrointestinal symptoms in pregnant women, with an incidence in pregnancy that may range from 17% to 45%.

It looks like a burning sensation in chest, throat, and it’s not very different from what’s felt by the majority of people (women or men) who suffer from it.

To be more precise we should say that the burning sensation is located in the upper part of the digestive tract, including the throat.

In a quite high number of cases, heartburn is present with esophagitis. This is an inflammation of the esophagus lining, due to contact with the acid content that comes from the stomach.

This doesn’t happen always but still is quite frequent, likely because the reflux starts in early pregnancy, and most women are not aware of that for a long time.

Heartburn and early pregnancy

There is evidence that shows the prevalence of heartburn can increase from 22% in the first trimester to 39% in the second trimester, to between 60% and 72% in the third trimester.

This means that there is a positive correlation between the age of the pregnancy and the presence of this symptom.

In addition, due to the common symptoms of pregnancy as it is, the correct diagnosis in the first 3 months is harder to be done.

What we’ve considered above is valid in general terms, however, the thing is more complicated than it may seem.

In the video below, some additional info and tips from Dr. Karampudi of Fernandez Hospital (UK).

We also have some evidence that in many pregnant women, heartburn, acid regurgitation, or both began in the first trimester and disappeared during the second trimester.

Not only that: another study found that gastrointestinal symptoms, such as heartburn and nausea, were even more common in the first trimester.

Finally, the same source also found that primigravidae reported more gastrointestinal symptoms than multiparae.

This means that thanks to the symptoms overlap, the early pregnancy is probably much more affected by heartburn than was previously thought.

Heartburn in pregnancy and baby hair

This a much-discussed topic, and we think we have to make things clearer on that.

According to some “folklore” beliefs, there are people who are convinced of the fact that the presence of heartburn during pregnancy is an “index” of some characteristics the newborn will present.

Only to make an example, the hair volume: according to such beliefs, if a woman has heartburn during its pregnancy, the newborn will have more hair than normally expected.

There is some evidence that an association between heartburn severity during pregnancy and newborn hair does really exist.

Weird fact, for sure, however, there’s a possible scientific explanation.

It involves a shared biological mechanism, that depends on the dual role of pregnancy hormones in both the relaxation of the lower esophageal sphincter and the modulation of fetal hair growth.

Causes Of Heartburn During Pregnancy

There is not a single factor able to determine heartburn in pregnant women.

To be precise, we want to use the term “multifactorial”. There are more factors, all equally important, that play a role to cause heartburn in this specific phase of a women’s life.

Let’s see them one by one.

First of all, the likely most important is related to the hormone balance of the woman.

The increased amounts of progesterone (or its metabolites) cause relaxation of smooth muscle, and the final effect is a reduction in gastric tone and motility.

More than this, we have a decrease in lower oesophageal sphincter (LES) pressure. And that’s the “entrance door” for reflux, from the stomach back into the esophagus, with subsequent heartburn.

There’s another important condition that predisposes to reflux.

During pregnancy, the LES is displaced into the thoracic cavity, and this is a negative pressure cavity. Being inside a negative pressure cavity, it allows food and gastric acid to pass from the stomach into the esophagus more easily.

Once the acidic content of the stomach is in contact with the esophagus, esophageal inflammation and a sensation of ‘burning’ occur in almost 100% of cases.

There also is a factor that could worsen heartburn. It’s the pressure of the growing uterus on the stomach as the pregnancy progresses.

To complete the list of other potential causes of heartburn for pregnant women, we have:

  • abnormal gastric emptying
  • delayed small bowel transit
  • some medications, such as anti-emetics

Important observation: it’s not always possible to act on the “root causes” because most of them are related to specific modifications of the anatomy and the physiology of the woman.

That’s why we want to focus our attention on the good habits and the correct lifestyle to make heartburn much more bearable.

Acid Reflux In Pregnancy: A Quite Necessary Thing

As we’ve considered in the previous paragraph, hormones play an important role in determining heartburn.

What we want to say now, is that the thing is not so bad as it may look like, at least for the baby.

Not only the increased amount of progesterone but also another hormone, called relaxin, increases.

Their joint action has a relaxing effect that lowers the pressure of LES.

There also is a factor which could worsen heartburn. It’s the pressure of the growing uterus on the stomach as the pregnancy progresses.

But there’s more.

In fact, food sometimes can move more slowly along the gastrointestinal tract, and this may lead to indigestion issues, bloating and gassy feeling. Last, but not least, the heartburn as well.

The point is: this is highly beneficial for the baby, despite the discomfort that the pregnant woman experiences.

This is important because this digestive “slowdown” allows better absorption of nutrients into the bloodstream and, as a direct consequence, through the placenta which feeds the baby.

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Heartburn Symptoms In Pregnancy

This is quite a redundancy, as heartburn itself is a symptom.

However, pregnancy is a so special moment of life, that even this topic deserves more attention.

Many women experience (during pregnancy) both heartburn and indigestion. And heartburn is a symptom of indigestion as well.

Indigestion manifests itself with some symptoms like regurgitation, burping, sense of heaviness. Bloating, a sense of sickness and vomiting may also be present.

As you noticed, there is a subtle distinction between symptoms, so that it’s a good suggestion to take notes of particular foods, drinks or activities that give you indigestion while you are pregnant.

The same applies to heartburn: the idea is to build a “checklist” of triggers to act on proper lifestyle and eating habits to relieve them as soon as possible. And, what matters most, consistently over the whole duration of pregnancy.

This is also important because of another fact.

Heartburn, nausea, and vomiting are common pregnancy symptoms, particularly among women with a history of such symptoms.

These symptoms do not adversely affect the outcome of pregnancy, so a woman should not worry too much about these, even though it’s important she adopts correct lifestyles and eating habits.

However, it has been noted that pregnancy-related heartburn predisposes to early postpartum heartburn.

Other gastrointestinal symptoms in pregnancy

There are at least two additional gastrointestinal symptoms to consider because they are often related to heartburn.

They are:

  • Constipation, and
  • Hemorrhoids

Both of them can be frequent, even though we cannot say that they are always present.

Constipation occurs in 11% to 38% of pregnant women.

For what concerns hemorrhoids, there is not a certain value of prevalence. However, most pregnant women report related symptoms, and the vast majority of them also have constipation and heartburn, all present at the same time.

Severe heartburn during pregnancy

There may two big groups of reasons for heartburn to get worse during pregnancy.

The likely most common are wrong eating habits (spicy or fatty or heavy meals), as well as the consumption of foods that favor the onset of heartburn.

The other one os the wrong treatment, generally a self-made one, as in the case of drinking an excessive quantity of baking soda, among others.

Natural methods work, however, they have to be prepared and administered in the proper way.

A not so common complication for heartburn over the pregnancy period, which however still deserves to know, it may happen when your heartburn symptoms don’t go away with medicine, nor with natural remedies.

We are talking about a serious case of refractory and persistent heartburn, with heavier symptoms, it’s not a common condition.

When it happens, we strongly suggest going to your doctor because it may be a sign of something more serious, such as pre-eclampsia. Below a great draw from Medcomic that exactly explains what is and why is so serious.

We’re not here to talk about it, because it’s not a digestive condition, but it’s important to consider that, in general, a pregnant woman who’s developing this serious condition presents high blood pressure and problems with her kidneys. And also liver, blood, and brain are affected.

An important note: because of dangers that this condition can bring to the woman and to the baby as well, it’s extremely important that pregnant women inform the doctor in the case their heartburn doesn’t improve with does not improve with any of the treatments that have been used.

Heartburn and vomiting during third trimester

Heartburn is a symptom of reflux and it has been found that gastroesophageal reflux disease (GERD) tends to decrease over the course of pregnancy.

We want to report an extract from the results obtained by a specific study on the frequency of heartburn for pregnant women. It presents some interesting findings, such as the decrease in the incidence of GERD over three trimesters. Another quite surprising fact is that weight gain did not increase the prevalence of the disease.

As we can expect, spicy foods are a strong risk factor, while green veggies are a protective one.

83.4% of women experienced either heartburn or regurgitation during pregnancy. GER was commoner in primigravidae (69.3%) and 50% remained symptomatic until term. Regurgitation was more common than heartburn and was often associated with nausea/vomiting.

Women with an antenatal history of GERD had 3.79 times the odds of developing symptoms in the third trimester.

So, while the first trimester is characterized by the presence of another symptom that’s also related to reflux in many cases, things may worsen with time.

There was no difference in weight gain in those with and without GER. Spicy food significantly increased the risk of heartburn and green vegetables were protective.

Further analysis showed that during the third trimester, heartburn and especially nausea and vomiting may appear occasionally and are not present for longer periods.

This is valid for women who have not a specific history of heartburn and reflux before pregnancy.

Interestingly, it seems that older women are more likely to present heartburn, while younger have more troubles with nausea and vomiting.

Heartburn Remedies For Pregnancy

When it comes to treating heartburn during pregnancy, we have to make an important premise.

Despite what you can find on the web, at our days still there are limited data suggesting that heartburn in pregnancy could be completely relieved by pharmaceutical treatment.

This means that the best option for treatment is working on foods, lifestyle, and everyday habits.

Drugs may work, in some cases, but we can’t say in advance if this will be your case, or not.

Great attention is needed because, according to s small but interesting study, there is a correlation between medications a pregnant woman takes and a possible case of asthma in the newborn.

One more reason to give much more importance to lifestyle and eating habits, when it comes to relieving heartburn in these cases.

With more details, the following are among the best things to do.

Quit smoking
Tobacco smoking is always bad, much worse if a woman is pregnant. It worsens heartburn and all related symptoms. no more words are needed.
Control your weight
Weight gain during pregnancy has to be gradual. The recommended range is within 25 to 35 lbs. More weight can worsen heartburn, because of the added pressure on the digestive tract.
Wear the right clothes
Tight clothing is bad for heartburn, because it constricts the tummy, with increased chances of feeling heartburn.
Six small meals
You must avoid the digestive overload. Eating six meals a day helps you for heartburn but also for bloating symptoms.
Eating time does matter
It’s important that you eat take your last big meal at least two hours before bedtime. By doing so, the stomach will start the digestion process before lying down for the night.
Don't drink while eating
You have to drink in between your meals, not during them. If you drink and eat at the same time, this can distend the stomach, with subsequent heartburn.
Eat slow
Chewing is important, so the more you chew, the less your stomach will have to work. In addition, by chewing more you can avoid the risk of ingesting air, another added factor to heartburn and reflux.
Eat in the right position
Make sure to stay upright while eating. Once finished, you should stay in that position for at least two hours more. This helps the digestion and hinders the reflux. While sleeping, your head should be elevated to reduce the chances of reflux.
Avoid stress
This is one of the most relevant factors for heartburn, and not only during pregnancy. Try to avoid it at best. You can find help in prenatal yoga, meditation, visualization, biofeedback, and so on.
Drink well
It’s important that you drink something that does not trigger heartburn. You can consider almond milk, coconut water, some herbal teas (fennel, ginger), and also mineral water, or alkaline water, if available.
Eat foods that contain probiotics
They are, among others, sauerkraut, kimchi, kefir, and tempeh. They have a highly beneficial effect on digestion. In addition, you should also consume green veggies, such as broccoli and beans, as well as whole-grain bread and oatmeal.
Eat low-acid fruits
Among them, you can find high benefits from bananas, melons, and similar fruits.

Finally, also papaya can help, because of its content in papain, an enzyme that improves digestion.

The listed above are the most common recommendations for working on the root causes of heartburn.

However, the list of foods that help people who suffer from heartburn is longer.

How to get rid of heartburn during pregnancy fast

This is a thing to consider.

Heartburn may have a sudden onset. In other words, you can’t predict when heartburn will come, even though you can know what are triggers and promoting factors (you have to know them all for better relief).

So, it’s important to create your “emergency kit” for sudden heartburn.

To this end, you can refer to the following:

  • Oatmeal: this is one of the most helpful heartburn relievers, and it’s also good for many other purposes as well
  • Milk: despite controversies, it may help you (don’t drink too much), however, it’s essential that you know in advance IF milk really does help you, because it may not be helpful depending on a case by case basis; almond milk is the best option, no matter of the situation
  • Herbal Tea: also, in this case, you must know in advance which tea type can be of help before to take it with you for this kind of emergency heartburn kit (consider ginger, fennel, in some cases peppermint and marshmallow root)

By doing so, you increase your chances to counter a sudden heartburn episode, even if the best thing to do is to work on eating habits and lifestyle

Acupuncture for pregnancy

A special mention to acupuncture.

According to some findings, it seems that acupuncture can be of help, however, still there is the need for further investigations about that.

What instead seems very probable, is that acupuncture can help fertility in women with troubles.

We are talking about the unexplained cases of infertility in women.

This means that this treatment may be of help for pregnancy as a whole, both for getting pregnant and keeping pregnancy safer from risks and side effects, just like heartburn.

More studies are needed for sure, however, we want to report that because of this topic will have more and more consideration with the time.

Heartburn chiropractic treatment for pregnant women

Following the acupuncture, we have to shed a light on another alternative treatment option.

It’s about chiropractic treatment. This topic is not widely discussed on the web but deserves attention.

For making things clearer, we decided to report the exact words you can find inside the study about chiropractic management of pregnancy-related heartburn.

Findings of the initial examination were thoracic intersegmental dysfunction and pain upon palpation of the diaphragm, with hypertonicity noted. Therapy localization was positive for reflexes associated with the esophagus and lower esophageal sphincter, suggesting spasms. Emotional components also were identified in association with the symptoms.

The patient was treated by adjusting the thoracic spine, manually releasing the diaphragm spasms, and releasing the esophageal spasm with an activator (a small hand-held instrument that creates a percussive force).

The patient was symptom-free and did not use any medication after the fifth treatment. She was followed throughout the remainder of her pregnancy and was asymptomatic and required no further treatment.

This case study presents a great success.

We can’t say that chiropractic management can work always and forever, by the way, it’s important to consider it in some cases because it showed effectiveness.

What matters most is that the treated woman, followed up for possible evolutions of the disease, was symptoms-free and, even more important, did not require any further treatment (neither pharmacological nor chiropractic).

Tums during pregnancy

Tums (brand name) is made by calcium carbonate, and it’s widely used to alleviate heartburn in pregnant women.

It works work by neutralizing stomach acid in the body.

However, there are several side effects. That’s why it’s essential talking to a doctor about the specific, individual status of health before starting to use calcium carbonate for heartburn.

People with high levels of calcium in their urine, low levels of phosphate in the blood, or kidney stones should not take calcium carbonate.

One of the most serious effects is pancreatitis induced by the increase in calcium content.

This is due to excessive calcium carbonate ingestion but, fortunately, it can resolve after delivery of the fetus, fluid resuscitation, and return of calcium level to normal.

One thing to remember is that calcium carbonate is in FDA Pregnancy Category C, which means it’s not clear whether it could harm an unborn baby.

It passes into breast milk but still is considered safe for feeding.

Finally, we want to remember that there are 195 drugs known to interact with calcium carbonate (4 among them are major drug interactions).

To precisely know what they are, you can click the button below (you’ll be redirected to the full, official list of drugs that interact with calcium carbonate).

Drug Interactions

The 195 drugs that interact with Calcium carbonate
Click Here

 

Bottom line: take Tums only after the suggestion of your physician, or (much better) avoid the need of taking it by working on eating habits and a proper lifestyle).

Safe antacids during pregnancy

The prenatal use of acid-suppressive medications may increase the risk of asthma and allergy in the offspring.

This is a rising public health concern, because of the widespread use of such drugs.

There are some safer alternatives, to be preferred in all cases unless various complications occur.

As we’ve seen before, calcium-based, and magnesium-based antacids could be used, but they should not be the first choice.

On the contrary, they can be of great help in some “advanced treatment needed” cases, particularly for patients with preeclampsia. In these cases, ranitidine can be preferred. Follow this link to learn more about what happened in the United States after the FDA found low levels of N-nitrosodimethylamine (NDMA) in ranitidine.

In cases that do not respond to the treatment, PPIs (Proton Pump Inhibitors), with an exception for omeprazole, could be considered, but after the first trimester.

To stay safe, alginic acid and sucralfate can be used as the first step.

Talking about alginic acid, you can remember Gaviscon. While for sucralfate, you can find here more details.

A very comprehensive study in 2017 showed why alginates are more effective than placebo or antacids for treating GERD symptoms. This means that antacids like Alka Seltzer, Mylanta, Tums, Rolaids, and Maalox are not the first option.

Here below, a beautiful image from the website PepTest to show how alginates work.

Gaviscon and Maalox are probably the most used by the people who suffer from heartburn.

The point is: despite what we’ve seen above, in pregnant women they can have the same effectiveness. That’s why we want to spend a few words on it.

Gaviscon vs Maalox: what’s best for pregnant women?

According to findings, pregnant women with heartburn could take alginate-based reflux suppressant or magnesium-aluminum antacid gel as a treatment, and expect the same result.

We can report the table from the study (a review of more studies) which focuses the attention on 4 relevant parameters.

They are the presence of heartburn after treatment, the general quality of life, maternal satisfaction and maternal side effects.

As we can see, there is no significant difference between the two products tested.

Warning: the timing of this study has been short, which means that long-time effects or rebounds have not been considered. however, this is a good addition to what we’ve discussed above about the comparison between alginate-based products and antacids.

Always about antacids, please remember that products containing aspirin are forbidden. In fact, they can lead to pregnancy loss, heart defects, and bleeding on the brain in premature infants.

Same precautions for antacids that contain magnesium trisilicate, because it’s not proven safe during pregnancy.

Conclusions

Now that we’ve considered the most relevant aspects of heartburn in pregnancy, it’s time to point out the most relevant ones.

There are 47 things to remember, to increase the chances of staying safe during pregnancy.

Below you can find the final, comprehensive list.

Takeaways
#1) Heartburn in pregnancy doesn’t’ mean that the pregnancy is complicated or that there are added risks.

#2) In order for the pregnant women to treat heartburn, it’s needed to take some precautions because the treatment differs from other people.

#3) Heartburn incidence in pregnancy may range from 17% to 45%.

#4) In a high number of cases, there also is esophagitis.

#5) There is a positive correlation between the age of the pregnancy and the presence of this symptom.

#6) A study found that gastrointestinal symptoms, such as heartburn and nausea, can be even more common in the first trimester.

#7) Primigravidae report, in general, more gastrointestinal symptoms than multiparae.

#8) There is some evidence that an association between heartburn severity during pregnancy and newborn hair does really exist.

#9) There is not a single factor able to determine heartburn in pregnant women.

#10) The likely most important factor is related to the hormone balance of the woman.

#11) The increased amounts of progesterone (or its metabolites) cause relaxation of smooth muscle, and the final effect is a reduction in gastric tone and motility.

#12) The pressure of the growing uterus on the stomach as the pregnancy progresses is another factor.

#13) Ther are other factors, like abnormal gastric emptying, delayed small bowel transit, and some medications, such as anti-emetics.

For what concerns treatments,

#14) We want to focus our attention on the good habits and the correct lifestyle to make heartburn much more bearable.

#15) Factors that promote heartburn are beneficial to the baby, in fact, this digestive “slowdown” allows better absorption of nutrients into the bloodstream and, as a direct consequence, through the placenta which feeds the baby.

#16) Heartburn often is present with indigestion.

#17) You have to build a “checklist” of triggers to act on proper lifestyle and eating habits to relieve them as soon as possible.

#18) Pregnancy-related heartburn predisposes to early postpartum heartburn.

#19) Constipation and hemorrhoids are also present frequently.

#20) A persistent heartburn, which doesn’t respond to any therapy, could be a sign of pre-eclampsia. you must talk to your doctor in all cases of highly persistent heartburn.

#21) In general terms, we expect a reduction in GERD symptoms over the duration of a pregnancy.

#22) It seems that older women are more likely to present heartburn, while younger have more troubles with nausea and vomiting.

#23) For what concerns treatments, there are limited data suggesting that heartburn in pregnancy could be completely relieved by pharmaceutical treatment.

#24) The best option for treatment is working on foods, lifestyle, and everyday habits.

Among them, we certainly have:

#25) Quit smoking.

#26) Control your weight.

#27) Wear the right clothes.

#28) Eat six small meals during the day.

#29) Take your last big meal at least two hours before bedtime.

#30) Don’t drink while eating.

#31) Eat slow (and chew well).

#32) Stay upright while eating.

#33) Avoid stress.

#34) Drink something that does not trigger heartburn.

#35) Eat foods that contain probiotics.

#36) Eat low-acid fruits.

You can create your “emergency kit” for sudden heartburn. You should consider

#37) Oatmeal.

#38) Milk.

#39) Herbal Teas.

But there’s more you can do, such as:

#40) Acupuncture.

#41) Chiropractic treatment.

About drugs:

#42) You can take Tums, but you must talk to a doctor first (people with high levels of calcium in their urine, low levels of phosphate in the blood, or kidney stones should not take it).

#43) To stay safe, alginic acid and sucralfate can be used as the first step.

#44) Calcium-based, and magnesium-based antacids could be good as the second step, especially if the case is complicated.

#45) In cases that do not respond to the treatment, PPIs (Proton Pump Inhibitors), with an exception for omeprazole, could be considered, but after the first trimester.

#46) Products containing aspirin are forbidden. In fact, they can lead to pregnancy loss.

#47) Same precautions for antacids that contain magnesium trisilicate because it’s not proven safe during pregnancy.

What To Do Next

Natural solutions are the best option to treat heartburn in this specific case.

That’s why we want to suggest what (according to our experience and expertise) currently are the best guides on how to relieve heartburn on the web.

We strongly suggest you check them all, and then pick your favorite.

Each one has its strong points, that’s why we also recommend reading their respective reviews.

For the moment, we want to thank you so much for your time and interest in this topic!

The Proven Holistic 5-Step System


One of the best strategies. Its strength point is the holistic approach, which means that you're going to care about all aspects that may affect your organism, in 5 steps. Also known as "Heartburn No More".

The Three Everyday Ingredients


This strategy works on underestimated aspects, such as food combinations that are much more important than avoiding certain types of foods. Also known as "The Acid Reflux Strategy".

The Double Protocol For Reflux


It targets two conditions at the same time: acid reflux and infection by H. pylori. Quick warning: this book is not suitable for all reflux sufferers. Also known as "Rapid Reflux Relief".

The Reflux Remedy Kit


This is a book + kit that presents some little known and creative natural remedies for heartburn and acid reflux. A good integration. Also known as "Heartburn & Acid Reflux Remedy Report".

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  1. Kerry Lobue
    • Dr.Gray

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