A persistent cough during pregnancy can be a source of discomfort for expectant mothers. Often, this cough is not from a respiratory infection but a symptom of acid reflux, also known as gastroesophageal reflux disease (GERD). GERD involves stomach acid flowing back into the esophagus, irritating its lining and sometimes manifesting as a persistent cough. This condition is common in pregnancy, affecting many individuals, particularly as pregnancy progresses.
Why Acid Reflux Cough Occurs During Pregnancy
Hormonal shifts play a role in the development of acid reflux during pregnancy. Elevated levels of progesterone, a hormone crucial for maintaining pregnancy, cause smooth muscles throughout the body to relax. This relaxation extends to the lower esophageal sphincter (LES), the muscular valve between the esophagus and stomach. When the LES relaxes excessively, it allows stomach acid to flow back up into the esophagus, leading to reflux.
Physical changes also contribute to increased acid reflux. As the uterus expands to accommodate the growing fetus, it exerts upward pressure on the stomach. This compression can force stomach contents and acid into the esophagus, especially after meals. The combination of hormonal relaxation and physical pressure creates an environment conducive to acid reflux.
The cough arises from two main mechanisms. Stomach acid directly irritates the esophageal lining and potentially the airways if small amounts are inhaled, a process called micro-aspiration. This irritation triggers a protective cough reflex. Reflux events in the esophagus can also indirectly activate cough receptors through nervous reflexes, serving as a protective mechanism for the lungs.
Recognizing the Symptoms
A cough caused by acid reflux has distinct characteristics. It is typically a dry, persistent cough that may worsen at night or after meals. Lying down or bending over can also intensify the coughing episodes. This cough can persist for an extended period, sometimes longer than eight weeks.
The cough commonly appears alongside other acid reflux symptoms. These include heartburn, a burning sensation in the chest, and a sour or bitter taste in the mouth. Other indicators include a sensation of food coming back up, hoarseness, frequent throat clearing, or belching. A persistent cough can be a sign of GERD even without typical heartburn.
Distinguishing an acid reflux cough from others involves observing the absence of typical infection symptoms. Unlike a cold or flu, a reflux cough usually does not involve fever, body aches, or nasal congestion. It also differs from allergy-related coughs by lacking seasonal patterns or other common allergy symptoms.
Managing Acid Reflux Cough Safely
Lifestyle and dietary adjustments are the initial approach to managing acid reflux cough during pregnancy. Eating smaller, more frequent meals throughout the day can reduce pressure on the stomach and prevent overfilling. It is also helpful to avoid trigger foods like spicy, fatty, or acidic items, caffeine, and chocolate, which can relax the LES or increase stomach acid production. Drinking fluids between meals instead of with them can also be beneficial.
Positional changes can alleviate reflux symptoms. Avoiding lying down immediately after eating, ideally waiting two to three hours, allows for better digestion and reduces the chance of acid reflux. Elevating the head of the bed by six to eight inches can also prevent stomach acid from flowing upward during sleep. Wearing loose-fitting clothing, particularly around the abdomen, minimizes external pressure on the stomach. Staying hydrated helps neutralize stomach acid.
Over-the-counter remedies can offer relief, but consult a healthcare provider before taking any medication during pregnancy. Antacids containing calcium carbonate, like Tums, are generally considered safe for occasional use during pregnancy. These work by neutralizing stomach acid and can also contribute to daily calcium intake. Adhere to recommended dosages to avoid potential side effects like constipation or interference with other mineral absorption.
Non-pharmacological methods can soothe the throat and reduce irritation. Warm liquids, such as ginger tea, can help calm the esophagus. Honey, if not contraindicated by conditions like diabetes, may soothe the throat. Chewing sugar-free gum after meals can increase saliva production, which helps neutralize acid in the esophagus.
When to Consult a Healthcare Provider
Seek medical advice if lifestyle modifications and over-the-counter remedies do not alleviate the acid reflux cough. If symptoms are persistent, worsening, or significantly impacting daily life, a healthcare provider can assess the situation. This includes situations where the cough does not improve or consistently returns despite management efforts.
Certain severe or new symptoms warrant immediate medical attention. These include severe pain, difficulty swallowing, or unexplained weight loss. Any concerning symptoms like fever, shortness of breath, or chest pain should also prompt a consultation, as these could indicate other health issues unrelated to reflux. Heartburn-type pains below the ribs, for instance, can sometimes signal preeclampsia.
A healthcare provider can rule out other causes for the cough and recommend stronger, pregnancy-safe treatments if necessary. It is also important to discuss all medications, both over-the-counter and prescription, with a doctor during pregnancy to ensure safety for both the expectant mother and the baby.