Why You Have Heartburn During Pregnancy—and How to Treat It

Your body goes through many ups and downs when you’re pregnant. Some of the changes are exciting, while others are just really uncomfortable. Having heartburn during pregnancy definitely falls into the latter and, unfortunately, it’s a pregnancy pain you can’t avoid easily. That’s not just because your baby bump is nudging stomach acid upward—although that can happen—it’s also due to the way your body evolves during pregnancy in general.

“As the pregnancy progresses, so does the risk of heartburn,” says Megan Gray, M.D.¹, an ob-gyn at Orlando Health Physician Associates in Florida. “Some people will experience this more than others, but it’s so extremely common that the overwhelming majority of pregnant people will have at least a few episodes of heartburn.”

What is heartburn? | Pregnancy heartburn causes | Pregnancy heartburn symptoms | Lifestyle changes for pregnancy heartburn | Pregnancy heartburn relief | When to see a doctor

Despite its name, heartburn has nothing to do with your heart. Instead, the burning sensation is caused by powerful stomach acid that “backs up” into your esophagus, the tube that connects your throat and stomach, according to the Cleveland Clinic².

Typically, when you swallow something, your lower esophageal sphincter—a ring of muscles that act as a valve at the end of your esophagus—will relax to give food or liquid a clear path to your stomach. Then, if that valve is working properly, it will tighten back up so the contents of your stomach stay where they should. But if your lower esophageal sphincter is malfunctioning for some reason, those acids can bubble their way back up into your esophagus, causing a burning sensation. This is known as acid reflux, and heartburn is a telltale symptom of the condition.

There are two major reasons that heartburn during pregnancy is so common in the first two trimesters, according to G. Thomas Ruiz, M.D.³, ob-gyn lead at MemorialCare Orange Coast Medical Center in California.

One is that pregnancy causes what’s known as “delayed gastric emptying,”⁴ which means food sits in your stomach longer before heading toward your colon. To deal with that, your stomach tends to make more acid, he says. That’s particularly true with larger meals, and it gets more problematic if you have that big meal within a couple of hours before bedtime.

“The combination of food sitting in your stomach, more acid, and lying down can increase the risk of heartburn,” he says. (Think about the effect of gravity here!) That risk can go up due to the second major factor: hormones.

During pregnancy, your body creates more of the hormone progesterone, which is secreted in larger amounts to prepare the uterus to accommodate the growing fetus. It does that by causing relaxation of ligaments and smooth muscles—not just in the uterus, but throughout the body, which is one of the reasons that your joints and muscles during pregnancy feel looser, Dr. Ruiz says. The progesterone surge causes the valve between your stomach and esophagus to relax as well, making it much easier for acid to reflux back into your esophagus. 

In the third trimester, the size of the uterus becomes the third factor because it’s pushing your stomach upward, and this can cause the acid to move in the wrong direction, especially as that valve is still loosened from the progesterone increase.

The top way to identify heartburn during pregnancy is that burning sensation in your chest, thanks to the acid backup. But Dr. Gray says that’s not the only sign of acid reflux.⁵ You could also experience:

• Pain in the chest
• An acidic taste in your mouth or the back of your throat
• Slight cough or hoarseness due to acid affecting your vocal cords
• Worsening symptoms of burning or pain when lying down or bending over
• Painful or difficulty swallowing

Many pregnant people also report feeling nauseous, Dr. Gray adds, and some may even vomit as a result. That’s why heartburn can sometimes be mistaken for morning sickness, particularly in the first trimester.

Here’s some good news: Although heartburn is one of the biggest complaints during pregnancy, it’s also one of the easiest to treat for many people, says Dr. Ruiz.

Lifestyle changes can make a big difference. For example, eating smaller and more frequent meals may be enough for relief. This helps the stomach expand less, potentially reducing any problematic pressure against the lower esophageal sphincter. As an added bonus, the approach tends to be better for keeping energy levels consistent, Dr. Ruiz says. If heartburn at night is a problem—and even if it’s not—it’s helpful to avoid eating within two to three hours before bed, he adds.

The kind of advice given to non-pregnant heartburn sufferers about diet applies here, too. That means staying away from highly acidic foods like tomatoes, citrus fruits, and onions, as well as spicy choices that may kick off more acid production. Dr. Gray says three options that tend to exacerbate heartburn during pregnancy are chocolate, caffeine, and carbonated beverages.

“Nobody wants to hear that about chocolate, sorry,” she says with a laugh. “I promise you can probably go back to it later.” Another favorite you should probably skip is peppermint. The flavor is heavily associated with calming the stomach⁶ and it’s common for pregnant people to use peppermint candy to alleviate morning sickness. But Dr. Gray says this might be making your heartburn worse in the long run since peppermint can relax the lower esophageal sphincter, irritating the esophagus in the process.

Another hack: Sleep with your upper body elevated slightly⁷, so it’s at least above the height of your stomach. You can prop up the top of your bed, use an adjustable bed frame, or sleep on a wedge pillow. That may be difficult as your pregnancy progresses and you can’t lie on your back, but if you’re in the first or second trimester, it may be a way to get relief from nighttime heartburn.

You’ve cut out chocolate (grudgingly), propped up for sleep, cut out the tomato sauce and peppermint, but the heartburn is still there. So, what now? What’s the best medication to take for heartburn while pregnant?

The next step is to try an over-the-counter antacid like Tums, Maalox, or Gaviscon, says Dr. Ruiz. They work by neutralizing stomach acid⁸, so even if it does come up, it won’t burn. With lifestyle tweaks, an occasional antacid tends to help about 70% of his patients, and it’s considered a safe, conservative method.

If the issue is still burning strong, that’s when you switch over to the next level, he says, which means a low dose of Pepcid, which is part of a class of drugs known as H2 blockers. These work by reducing the amount of stomach acid that’s secreted by the glands in the lining of your stomach.⁹ This is also considered safe to use during pregnancy but it’s best to try other approaches first if your heartburn is mild, says Dr. Ruiz.

A small percentage of people will still experience problems past this point, and that’s when prescription options like proton pump inhibitors (PPIs) might be considered, which block the production of stomach acid, Dr. Gray says. The most common in pregnancy is Protonix, which the Food and Drug Administration has classified¹⁰ as a category B drug, meaning it’s safe to take during pregnancy.

That said, it’s generally used when all other options are exhausted, Dr. Gray says, since it’s preferable to start with lifestyle changes and antacids, rather than using prescriptions as a first-line treatment. That’s because even though they’re generally well tolerated, there’s a higher risk with PPIs for side effects like headache, nausea, rash, and constipation—not just for pregnant people, but for everyone.¹¹ In the most extreme cases when heartburn is part of gastroesophageal reflux disease (GERD)—which is when acid reflux and heartburn become chronic and happen more than twice a week—surgery may be an option to help keep the lower esophageal sphincter closed when it needs to be. Some people with a history of GERD choose to have the surgery before becoming pregnant to reduce the chance that it will be an issue later on.¹²

Thankfully, if heartburn wasn’t an issue for you before pregnancy, it tends to resolve after childbirth. But even so, that doesn’t mean you need to ride it out until delivery.

Even if your heartburn is simply annoying and not intense, don’t hesitate to tell your doctor about it, says Dr. Gray. That’s because it can become more serious if it’s left untreated, so what starts as mildly uncomfortable pain might cause you to eventually avoid eating enough because you don’t want to deal with the heartburn, she notes. That’s not great for you or for your baby.

“I wish women would stop struggling at home and saying they don’t want to bug their doctors or midwives with something minor like this,” she says. “We’re here to help. More than that, it’s easier to treat heartburn when it’s not much of a problem than it is when it becomes severe. So bring it up and get some relief.”

Sources:

1. Orlando Health Physician Associates, Megan Gray, M.D.
2. Cleveland Clinic, Gastroparesis
3. MemorialCare Orange Coast Medical Center, G. Thomas Ruiz, M.D.
4. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Gastroparesis
5. Mayo Clinic, Heartburn
6. Icahn School of Medicine at Mount Sinai, Peppermint
7. NIDDK, Treatment for GER & GERD
8. U.S. National Library of Medicine, Antacids
9. U.S. National Library of Medicine, H2 blockers
10. U.S. Food and Drug Administration, Protonix
11. Cureus, Adverse Effects Associated With Proton Pump Inhibitor Use
12. Mayo Clinic, Gastroesophageal reflux disease (GERD)

Related: 

• 6 Gastrointestinal Issues That Can Affect You During Pregnancy
• My Exercise-Induced Acid Reflux Almost Made Me Stop Running
• The 5 Worst Foods to Eat Right Before Bed