Heartburn, or gastroesophageal reflux disease (GERD), affects between 30% and 80% of pregnant individuals. This burning sensation occurs when stomach acid backs up into the esophagus, often because hormonal changes cause the lower esophageal sphincter muscle to relax. As pregnancy progresses, the growing uterus puts physical pressure on the stomach, which can worsen symptoms, making heartburn most prevalent in the second and third trimesters. Finding relief is often necessary.
Non-Medication Strategies for Heartburn Relief
Before turning to medications, simple adjustments to daily habits offer the safest initial approach to managing pregnancy-related heartburn. Eating smaller portions multiple times a day instead of three large meals helps prevent the stomach from becoming overly full and reduces the likelihood of acid backflow. It is also beneficial to avoid foods known to trigger reflux, such as spicy, acidic, or high-fat items, as these can slow down the digestive process.
Timing meals correctly can also provide significant relief, especially at night when symptoms tend to worsen due to lying flat. Individuals should avoid eating for at least two to three hours before going to bed, allowing the stomach to empty before reclining. Additionally, elevating the head of the bed by six to eight inches, perhaps with blocks or a wedge pillow, uses gravity to help keep stomach acid in its proper place.
Antacid Ingredients Considered Safe During Pregnancy
When lifestyle changes are not enough, certain antacid ingredients are generally recommended as a first-line pharmacological treatment due to their localized action and minimal systemic absorption. Calcium carbonate is widely considered the preferred option and is safe to use as directed on the packaging. This compound neutralizes stomach acid quickly and provides supplemental calcium, which is important for maternal and fetal bone health.
Magnesium hydroxide is another antacid ingredient that can be used, often in combination with calcium or aluminum, and is considered compatible with use during pregnancy. Antacids containing these ingredients work by neutralizing the acid already present in the stomach, providing rapid relief from discomfort. As a precaution, individuals with existing kidney issues should discuss magnesium-containing products with a healthcare provider, as prolonged use may pose a risk.
For maximum effectiveness, antacids should be taken one to three hours after meals and again at bedtime. It is important to adhere to the maximum daily dosage listed on the product label, even for generally safe ingredients like calcium carbonate. Consulting with an obstetrician or midwife before starting any antacid regimen ensures that the dosage and ingredients are appropriate for the individual’s specific health profile.
Antacid Ingredients Requiring Caution or Avoidance
While many antacids are safe, certain ingredients should be avoided or used only under the strict guidance of a healthcare professional. Sodium bicarbonate, or baking soda, is not recommended because it can lead to fluid retention and metabolic alkalosis in both the mother and the fetus. The high sodium content poses an unnecessary risk, especially for those with hypertension or pre-eclampsia, as pregnancy already predisposes individuals to fluid shifts.
Aluminum hydroxide, frequently found in combination antacids, should also be approached with caution. High or prolonged doses may cause constipation, which is a common issue during pregnancy. Although aluminum salts are safe in moderation, they can interfere with the absorption of other necessary medications, such as iron supplements. Separate the intake of aluminum-containing antacids from other medications by several hours to prevent this interaction.
Systemic Medications for Severe Heartburn
For severe, persistent heartburn that does not respond to antacids, stronger medications like H2 blockers (e.g., famotidine) and Proton Pump Inhibitors (PPIs) are sometimes prescribed. These systemic medications reduce the amount of acid the stomach produces. They are generally reserved for third-line treatment under medical supervision. While many are considered safe in pregnancy, they are not intended for self-treatment as a first-line option and require a physician’s review.
When to Consult a Healthcare Provider
Individuals should seek medical advice if lifestyle changes and over-the-counter antacids fail to provide adequate relief. Persistent, severe symptoms requiring daily antacid use or higher than recommended doses indicate the need for a comprehensive medical evaluation. A healthcare provider may then consider prescribing H2 blockers or PPIs for better symptom control.
Consult a doctor immediately if heartburn is accompanied by other concerning symptoms:
- Weight loss.
- Difficulty swallowing.
- Pain that radiates to the back or shoulder.
- Heartburn-type pain located below the ribs, which can signal a serious condition like pre-eclampsia.
- Vomiting blood or having dark, black stools, which could signal bleeding in the digestive tract.