What Is Heartburn in Pregnancy?

Heartburn is a burning pain behind your breastbone. It happens because of acid reflux, which occurs when stomach acid moves from your stomach up to your esophagus. Heartburn is often a sign of underlying conditions like gastroesophageal reflux disease (GERD).

Heartburn in pregnancy is usually caused by hormonal changes or the growth of the fetus. It affects 17% to 45% of pregnant women. It’s normal to experience it, although with the right diet and lifestyle, you can prevent heartburn during pregnancy. 

Episodes of heartburn are not predictable, but they occur most commonly during the third trimester. When they do happen, you can manage your symptoms with natural remedies and over-the-counter (OTC) medications.

Symptoms of Heartburn in Pregnancy

Besides the burning sensation that normally comes with heartburn, you may also experience:

• Feeling bloated or full
• Burping frequently
• Feeling sick
• Bringing up food

Causes

Heartburn in pregnant women has more to do with hormones than the food you eat, which is a common cause of heartburn in general.

Rising Progesterone Levels

The major hormone responsible for heartburn in pregnant people is progesterone, which is also known as the “pregnancy hormone.” It prepares your womb for implantation in early pregnancy and supports your growing baby, but that’s not all it does.

Progesterone is also a muscle relaxant—it relaxes the muscle that separates your stomach acid from your esophagus, called the esophageal sphincter. This muscle normally opens to allow food to pass, then closes so acid doesn’t travel back up your esophagus. But if it doesn’t close properly, the acid can move into your esophagus and cause heartburn.

With the high level of progesterone production during pregnancy, this muscle is not as efficient, consequently allowing stomach acid to move into your chest and throat. 

Growing Uterus

Your baby is carried in your uterus during pregnancy. As your baby grows, your uterus begins to become larger and compete for space with other surrounding organs like your stomach.

The pressure that your uterus exerts on your stomach forces stomach acids to be pushed into the esophagus and chest region. This is why women in their third trimester experience frequent heartburn—because their babies and uterus are largest at this time.

Changing Hormone Levels

Your hormone levels change throughout your pregnancy, and they affect how you tolerate and digest food. These hormones often slow down your digestive system, so food moves more slowly. This can result in bloating and heartburn.

Treatments

There are a number of ways to alleviate heartburn during pregnancy. The following natural remedies may help:

• Eat yogurt or drink some milk
• Stir a tablespoon of honey into warm milk and drink it

OTC heartburn relievers, such as Tums or Maalox, may offer relief, but they may not be appropriate for individuals who are pregnant. Some may contain high sodium levels, which can cause you to retain water. They may also contain aluminum, which isn’t safe to consume during pregnancy. Talk to your doctor to see which antacid they recommend during pregnancy.

In severe cases, your doctor may prescribe H2 blockers such as Tagamet or Prilosec. You may receive a higher dosage of these drugs depending on the severity of your heartburn and your general health.

Prevention

Making certain dietary and lifestyle changes can help prevent heartburn during pregnancy.

Avoid Spicy and Acidic Food

Hot and spicy meals increase your stomach acid more than other foods. Stay away from food with high amounts of acid like oranges, onions, coffee, garlic, and soda. You should also avoid fatty or fried meals.

Sit in an Upright Position While Eating

It’s advisable to sit straight up when eating, so the food you eat won’t backtrack and come back up. 

Don’t Lie Down Immediately After Meals

Since gravity helps in digestion and emptying of the stomach, it is advisable that you wait four to five hours after your last meal before lying down. 

Eat Small Meals Regularly

Food doesn’t digest as well or move as quickly during pregnancy, so eating large meals or overeating in general can also increase the risk for heartburn.

Use a Pillow to Sleep

Another way to reduce acid reflux is to raise your head several inches while sleeping. You can do this by using pillows under your head and shoulders or raising your bed frame with a wedge.

Wear Comfortable Night Clothes

Avoid wearing any garment that will apply pressure to your abdominal region while you sleep. Opt to wear stretchy pants and loose tops.

Don’t Drink Fluids During Meals

If you drink fluids during meals, you may make your stomach too full and increase the risk of heartburn. Wait to drink fluids until after your meals. 

Avoid Smoking 

Certain chemicals, like nicotine in cigarettes, relax the lower esophageal sphincter. This allows the acids and other undigested foods to push upward and inflame your chest region.

Avoid Alcohol

Alcohol can also relax the lower esophageal sphincter muscle. More importantly, alcohol can cause health problems for your developing baby. 

Summary

Heartburn in pregnancy is common, especially in the third trimester. You can make some changes to avoid it, such as not eating spicy or fried food and sleeping with your head elevated. Some antacids are not safe for pregnant people, so check with your doctor before taking any medications for your heartburn.

A Word From Verywell

Heartburn in pregnancy usually subsides once you give birth. If you have experienced heartburn before your pregnancy, you may be more likely to experience it during pregnancy.

Generally, eating healthily and maintaining good lifestyle habits will help you during your pregnancy. If these measures don’t provide enough relief, talk to your doctor about heartburn medications that are safe to use during pregnancy.