Acid reflux, commonly known as heartburn, is a highly frequent complaint during pregnancy. However, acid reflux is generally not considered a warning sign of preeclampsia. Preeclampsia is a serious, high-blood-pressure disorder specific to pregnancy that requires medical attention, while heartburn is a common side effect of normal physiological changes. Although both conditions can cause discomfort in the upper abdomen, their underlying causes and implications are vastly different. Understanding the distinction between common pregnancy discomforts and the true symptoms of preeclampsia is important for timely communication with a healthcare provider.
Understanding Acid Reflux in Pregnancy
Heartburn, the burning sensation caused by acid reflux, affects a large percentage of pregnant individuals, with some reports suggesting up to nine out of ten experience it by the third trimester. This common occurrence stems from two primary physiological changes that happen as the pregnancy progresses.
The first factor is hormonal, specifically the increased production of progesterone. Progesterone relaxes smooth muscles throughout the body to accommodate the growing uterus, but it also causes the lower esophageal sphincter (LES) to relax. The LES is the muscular ring that acts as a valve between the esophagus and the stomach. When the LES relaxes, stomach acid can flow back up, creating the burning sensation in the chest and throat.
The second factor is mechanical pressure, which becomes more pronounced in the later stages of pregnancy. As the uterus expands, it physically pushes upward on the stomach. This increased abdominal pressure forces stomach contents and acid into the esophagus, which is why heartburn often becomes more frequent and intense during the second and third trimesters.
Defining Preeclampsia
Preeclampsia is a disorder of pregnancy characterized by the new onset of high blood pressure, typically occurring after 20 weeks of gestation. It is a multisystem disorder that can affect various organ systems, most commonly the kidneys, liver, and brain. Diagnosis relies on specific medical parameters, not subjective symptoms alone.
The primary diagnostic criteria involve a sustained elevation of blood pressure. This is defined as a systolic reading of 140 mm Hg or higher or a diastolic reading of 90 mm Hg or higher, measured on two occasions at least four hours apart. Preeclampsia is diagnosed when this high blood pressure is accompanied by signs of damage to other organ systems. While historically proteinuria (protein in the urine) was required, current guidelines recognize that organ damage can occur without it.
Signs of organ damage can include a low platelet count, impaired liver function indicated by elevated liver enzymes, or the development of new renal insufficiency. Preeclampsia is considered severe if blood pressure reaches 160/110 mm Hg or higher, or if specific symptoms like persistent headache, visual disturbances, or severe upper abdominal pain are present. Close monitoring and medical intervention are required to prevent progression to complications like eclampsia, which involves seizures.
Key Warning Signs of Preeclampsia
While acid reflux is a common discomfort, distinct symptoms signal a potential problem with preeclampsia and should be addressed immediately.
Specific Symptoms
One frequently reported warning is a severe, persistent headache that does not improve with over-the-counter pain relievers. This type of headache often signals high blood pressure affecting the brain.
Changes in vision are another major warning sign, including seeing flashing lights, spots, auras, or experiencing blurred or double vision. These visual disturbances indicate an effect on the central nervous system. Sudden, excessive swelling, particularly in the hands and face, is also concerning, especially if accompanied by rapid weight gain of more than three to five pounds in a week.
The symptom most likely to be confused with typical heartburn is a severe, persistent pain in the upper abdomen, often located just below the ribs on the right side. This is called epigastric or right upper quadrant (RUQ) pain. This pain is a serious sign because it can indicate a problem with the liver capsule stretching due to swelling. Unlike typical heartburn, which is a burning sensation that responds to antacids, this pain is often described as intense pressure or a stabbing ache that does not ease with common reflux medications.
When to Seek Medical Attention
Understanding when a symptom warrants immediate medical attention is important for managing a healthy pregnancy.
Urgent Symptoms Requiring Evaluation
If the upper abdominal pain is severe, persistent, or located specifically under the right ribs, and is not relieved by antacids, contact a healthcare provider immediately. This distinction between the burning of acid reflux and the sharp ache of liver pain is important.
Urgent medical evaluation is required for any new-onset severe headache unresponsive to medication, or any changes in vision like blurring or flashing lights. Individuals should also contact their provider if they notice a sudden, significant increase in swelling in the face or hands.
Emergency care is warranted if blood pressure readings are 160/110 mm Hg or higher, or if symptoms are severe and rapidly worsening.