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Pregnancy and Heartburn

Chances are good that you’re one of more than three-fourths of pregnant women 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 and moves upward to the neck and throat. It can last as long as two hours, and it’s often worse after eating. Officially, heartburn is known as gastroesophageal reflux, when acidic stomach juices or food and fluids back up into the esophagus, a hollow muscular tube between your mouth and your stomach.

Why does it happen in pregnancy?

Many women who have heartburn during pregnancy have never had problems before. And unfortunately, if you had heartburn before becoming pregnant, you’re more likely to have symptoms. 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, a tight circular band of muscle at the top of the stomach; this allows partially digested food and stomach acids to backflow, or reflux, into the esophagus. In addition, progesterone also slows the digestive process, which keeps food in the stomach longer. The mere mechanics of pregnancy—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 women. Because food doesn’t digest as well or move as quickly during pregnancy, eating large meals or overeating in general can also increase the risk for heartburn. Eating right before bedtime can cause problems, too.

What makes it better?

For most women, anything that helps reduce acid production or avoids reflux is helpful in preventing the discomfort of heartburn. Here are tips that may help:

  • Avoid classic spicy foods, as well as those with lots of fat or grease. Many people recommend avoiding citrus and chocolate, as well.

  • Eat multiple, small meals spread throughout the day, much like “grazing,” instead of three big meals.

  • Try elevating the head of your bed by several inches, and wait at least an hour or two after eating before going to bed or lying down.

Some women find that it’s better to drink any fluids between meals, rather than with a meal, which can increase the amount of food in the stomach.

Although the effectiveness of most methods of heartburn relief in pregnancy has not been proved, many are safe and just might work for you. Be sure to talk with your health care provider about your heartburn symptoms, and ask before using any over-the-counter medications. Antacids are available as chewable tablets and liquids and 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 produced by your stomach. Although most of these are considered safe in pregnancy, as with all medications, these should be avoided in the first trimester. Some antacids also contain aspirin, or aspirin derivatives, and shouldn’t be used in pregnancy.

When will it end?

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