Pregnancy and Heartburn

Chances are good that you’re one of many pregnant people who experience the churning and burning of heartburn or acid indigestion. It typically hits somewhere in the second or third trimester, and it can be miserable. Heartburn doesn’t really mean your heart is burning. But it’s a good description of the discomfort that begins behind the breastbone. It then moves up to the neck and throat. Officially, heartburn is known as gastroesophageal reflux, when acidic stomach juices or food and fluids back up into the esophagus. This is a hollow muscular tube between your mouth and your stomach.

Why does it happen in pregnancy?

Many people who have heartburn during pregnancy have never had problems before. Unfortunately, if you had heartburn before becoming pregnant, you’re more likely to have symptoms while you are pregnant. Although the exact reasons aren’t clear, most experts believe that pregnancy hormones, particularly progesterone, play a role. Hormones cause relaxation of the esophageal sphincter. This is a tight circular band of muscle at the top of the stomach. This allows partly digested food and stomach acids to backflow, or reflux, into the esophagus. In addition, progesterone also slows the digestive process. This keeps food in the stomach longer. The pregnancy itself—the upward pressure of the growing uterus—also may play a role.

What makes it worse?

Most spicy, greasy, fatty foods known for causing heartburn are also likely to cause problems for pregnant people. 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. Eating right before bedtime can cause problems, too. Smoking makes heartburn worse and is another reason to quit, especially while pregnant.

What makes it better?

For most people, things that help reduce acid production or prevent reflux are helpful in preventing the discomfort of heartburn. Here are tips that may help:

  • Don't eat classic spicy foods, as well as those with lots of fat or grease. Many people advise not having citrus and chocolate, as well.

  • Eat multiple, small meals spread during the day, much like grazing, instead of 3 big meals.

  • Try raising the head of your bed by several inches. And wait a while after eating before going to bed or lying down.

Some people find that it’s better to drink fluids between meals, rather than with a meal. This can increase the amount of contents in the stomach.

If your symptoms don't improve after the above advised diet and lifestyle changes are in place, talk with your healthcare provider about over-the-counter medicines. Antacids are available as chewable tablets and liquids. They work by coating the lining of the esophagus and stomach and neutralizing stomach acid. Heartburn medicines called H2-blockers work by reducing the amount of acid made by your stomach. Although most of these are considered safe in pregnancy, as with all medicines, stay away from these in the first trimester.

When will it end?

Heartburn symptoms are often mild and manageable. Tell your healthcare provider if your heartburn is severe, if you spit up blood, or have dark-colored bowel movements. This is a sign of blood in your digestive tract. Fortunately, heartburn often ends with the birth of your baby and your body goes back to its nonpregnant state.

Online Medical Reviewer: Donna Freeborn PhD CNM FNP
Online Medical Reviewer: Heather M Trevino BSN RNC
Online Medical Reviewer: Irina Burd MD PhD
Date Last Reviewed: 2/1/2023
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