Heartburn in Pregnancy

By Yolanda Smith, B.Pharm.Reviewed by Susha Cheriyedath, M.Sc.

Heartburn, also known as indigestion or dyspepsia, commonly affects women who are pregnant, and is reported by up to 80% of women at some point in the pregnancy. It occurs due to hormonal changes that occur during pregnancy and the physical pressure of the womb on the stomach.

Symptoms

The symptoms of heartburn in pregnancy are the same as for any other individual who may be affected by the condition. They include a burning pain or discomfort in the chest, nausea, vomiting, bloating, and belching. They usually present shortly after eating a meal, due to the stomach acid passing up from the stomach into the esophagus.

Women may experience symptoms of heartburn at any point throughout their pregnancy. However, the symptoms usually increase in frequency and severity in the third trimester due to hormonal changes and growth of the womb.

Causes

Heartburn is caused by the stomach acid coming up and out of the stomach to irritate the delicate protective lining of the esophagus. Pregnant women are more likely to be affected by heartburn than other individuals due to several reasons, including:

• Hormonal changes that occur during pregnancy
• Growth of the womb putting pressure on the stomach
• Relaxation of the lower esophageal sphincter, increasing ease of acid to exit the stomach

Most women will report some symptoms of heartburn at least once during their pregnancy. However, there are certain risk factors that are associated with an increased likelihood of being affected and increased severity of symptoms. These risk factors include a history of heartburn symptoms before pregnancy and during multiple pregnancies.

Dietary and lifestyle changes

There are several changes to diet and lifestyle that can help improve symptoms of heartburn and these may be a sufficient in mild cases. Modifications that can help in the management of heartburn include:

• Stopping smoking when pregnant
• Avoiding alcohol when pregnant
• Eating smaller and more frequent meals
• Reducing consumption of eating fatty, greasy or spicy foods
• Avoiding triggers such as chocolate, coffee, and curry
• Staying upright while eating
• Avoiding lying down within 2-3 hours of eating

There are some foods, such as milk and yogurt, which may help to ease symptoms of heartburn. Additionally, propping the head up at night when going to sleep can help to reduce symptoms.

Medical management

For women who are pregnant, it is important to consider safety in pregnancy first and foremost when selecting an appropriate medical treatment. Possible medications that are often used for treatment of heartburn symptoms in pregnancy include:

• Antacids: provides immediate symptomatic relief by neutralizing the stomach acid to reduce irritation of the gastrointestinal mucosa.
• Alginates: helps to relieve acid reflux by forming a foam barrier on top on the contents of the stomach, preventing it from coming up to irritate the esophagus.

These medications are considered to be safe for pregnant women when used at the recommended dosages for pregnancy.

Additionally, there are some medications that may be recommended as a second-line treatment option for pregnant women with heartburn. These medications help to suppress the production of acid in the stomach, thus reducing the acid that can move up to irritate the esophagus. These include H2 receptor blockers such as ranitidine and proton pump inhibitors such as omeprazole.

References

1. http://www.nhs.uk/conditions/pregnancy-and-baby/pages/indigestion-heartburn-pregnant.aspx
2. http://patient.info/health/dyspepsia-in-pregnancy
3. http://www.medscape.com/viewarticle/515100
4. https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=134&ContentID=10
5. http://www.cochrane.org/CD011379/PREG_interventions-heartburn-pregnancy

Further Reading

• All Pregnancy Content
• Early Signs of Pregnancy
• Is it Safe to Exercise During Pregnancy?
• Pregnancy: 0-8 weeks
• Pregnancy: 9 - 12 weeks