If you feel an annoying burning sensation in your chest or a sour taste in your mouth after eating, you are not alone. Heartburn is one of the most common symptoms during pregnancy, especially as the months progress. Although it rarely poses a danger to the fetus, it can disrupt your daily comfort, making it difficult to sleep or eat. Because pregnancy requires caution when taking any medication, it is essential to know which treatments are safe and effective, along with the habits that help relieve symptoms. In this article, we explain the causes of heartburn during pregnancy, the best ways to treat it, approved medications, and when your symptoms warrant a doctor's consultation.
What Causes Heartburn in Pregnant Women?
Heartburn is one of the most common symptoms during pregnancy, affecting a large percentage of pregnant women, particularly in the third trimester. It is linked to two main factors working together: hormonal changes and the pressure of the growing uterus on the digestive organs.
Hormonal Changes and Their Effect on the Digestive System
The level of progesterone rises significantly during pregnancy, as it is the hormone responsible for maintaining the pregnancy. However, this hormone has a side effect: it relaxes smooth muscle throughout the body, including the lower esophageal sphincter (LES), the muscular valve separating the esophagus from the stomach.
Under normal circumstances, this muscle acts as a tight valve that prevents stomach contents from flowing back into the esophagus. However, when progesterone causes it to over-relax, stomach acid can leak upward into the esophagus and throat, causing the well-known burning sensation.
In addition, progesterone slows down the movement of the digestive tract, causing food to remain in the stomach longer. This, in turn, increases the likelihood of bloating and constipation alongside heartburn.
Pressure of the Growing Uterus on the Stomach
As pregnancy progresses and the fetus grows, the uterus gradually expands until it begins to press against the stomach and surrounding organs. This increased pressure pushes stomach contents, including acid, upward into the esophagus.
For this specific reason, heartburn is more common and severe in the third trimester, when the uterus reaches its maximum expansion and exerts the greatest amount of pressure on the stomach. Furthermore, positions like bending over or lying down after eating can worsen symptoms because gravity is no longer helping to keep the acid in place.
Symptoms of Heartburn in Pregnant Women
The symptoms of heartburn in pregnant women are similar to those in non-pregnant individuals, but they may appear more frequently due to the factors mentioned above. The most prominent symptoms include:
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A burning sensation behind the breastbone, which may extend upward toward the throat.
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A sour or bitter taste at the back of the throat.
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A feeling of fullness or bloating after eating.
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Frequent burping or mild nausea.
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Worsening of symptoms when bending over, lying down, or after eating a heavy meal.
These symptoms usually appear within 30 minutes to an hour after eating and may last for several minutes or stretch into hours.
How to Tell the Difference Between Normal Heartburn and Concerning Symptoms
In most cases, heartburn during pregnancy is a mild and annoying symptom, but it is not dangerous and almost always disappears immediately after childbirth. However, some signs require immediate communication with a specialist, as they may indicate more serious complications:
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Severe or sudden chest pain, especially if it radiates to the arm or back.
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Difficulty swallowing or feeling like food is stuck in the esophagus.
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Vomiting blood or passing dark, tarry stools, both of which are signs of internal bleeding.
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Severe shortness of breath or a rapid heart rate accompanied by chest pain.
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A severe headache accompanied by vision disturbances or pain in the upper right side of the abdomen, as these signs could be related to preeclampsia, not just heartburn.
The Difference: Normal heartburn is usually limited to a burning sensation related to meal times and physical posture. On the other hand, concerning symptoms are accompanied by additional signs such as bleeding, breathing difficulties, or vision disturbances. If any doubt or unfamiliar symptom arises, it is always best to contact a healthcare provider rather than relying on self-assessment.
Severe Heartburn in Pregnant Women: Is It Normal?
Severe heartburn is very normal and common during pregnancy, and it is usually not considered an indicator of a serious health problem. As pregnancy progresses, the percentage of pregnant women suffering from heartburn tends to increase gradually, peaking in the final weeks before delivery.
This heartburn usually resolves spontaneously right after birth, as hormone levels return to normal and the pressure exerted by the uterus on the stomach is relieved. However, the severity and frequency of heartburn vary significantly from one pregnant woman to another, as they are influenced by several individual factors.
Factors That Increase the Severity of Heartburn During Pregnancy
A group of factors makes some pregnant women more prone than others to experiencing heartburn or suffering from more severe symptoms, including:
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Having heartburn or acid reflux before pregnancy: Women who have previously suffered from this problem are more likely to experience its recurrence and worsening during pregnancy.
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Multiparity (multiple pregnancies): Studies indicate that the risk of heartburn increases with each additional pregnancy. Its occurrence rises significantly in women who have undergone four or more pregnancies compared to first-time mothers.
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Advanced gestational age: The closer the due date approaches, the larger the uterus grows and the more it presses against the stomach, increasing the likelihood of heartburn appearing or intensifying.
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Weight gain during pregnancy: Especially in the third trimester. Some research shows a relationship between cumulative weight gain and worsening symptoms, though study results in this area are not entirely consistent.
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Carrying twins or multiples: The larger-than-normal expansion of the uterus increases pressure on the digestive system earlier in the pregnancy.
Ways to Treat Heartburn in Pregnant Women Without Medication
Before resorting to any medication, you can try some simple dietary and behavioral adjustments, which have proven effective in relieving heartburn symptoms for a large percentage of pregnant women without the need for medical intervention.
Dietary and Behavioral Tips to Eliminate Heartburn
Dietary Tips:
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Divide meals into small, frequent portions throughout the day instead of three large meals to reduce the burden on the stomach.
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Eat slowly and chew food thoroughly.
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Stay away from spicy, fatty, and fried foods, as well as acidic foods like citrus fruits and tomatoes.
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Reduce or avoid chocolate and mint, as they may increase the relaxation of the esophageal sphincter in some pregnant women.
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Avoid drinking too much liquid during meals; instead, drink fluids between meals.
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Try a glass of low-fat milk or a serving of yogurt, as this can relieve the burning sensation for some.
Behavioral Tips:
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Maintain an upright sitting position while eating and afterward, and avoid bending over or lying down immediately after meals.
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Wait at least 1 to 2 hours between your last meal and going to sleep.
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Elevate your head and shoulders slightly while sleeping by using an extra pillow or raising the head of the bed to prevent acid from rising at night.
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Completely abstain from smoking and alcohol, as they increase stomach acid secretion and worsen symptom severity, in addition to their negative effects on fetal health.
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Wear loose clothing that does not press against the abdominal area.
Safe Heartburn Medications for Pregnant Women
If dietary and behavioral adjustments fail to relieve heartburn, you can resort to certain medications that are considered relatively safe during pregnancy. Keep in mind that any medication must be used after consulting a specialist doctor or pharmacist and within the recommended dosage.
Approved Antacids
Antacids are usually the first line of treatment recommended, as they work locally to neutralize acid without entering the bloodstream in large quantities. The safest options include:
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Calcium Carbonate: This is considered one of the safest options. In addition to relieving heartburn, it helps supply the body with a portion of its daily calcium requirement during pregnancy.
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Magnesium Hydroxide: This is also used as a relatively safe option, but it is preferable to avoid using it excessively in the third trimester, as high doses of magnesium may be linked to inhibiting uterine contractions close to the delivery date.
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Aluminum Hydroxide: This is sometimes used in combination formulas, but caution is advised for those suffering from constipation, as it can make this symptom worse.
Tip: It is best not to exceed the daily recommended dose stated on the package, and to space antacids out from iron supplements or vitamins, as they can reduce their absorption.
Antacids Available in Al-Jawaher Al Motamyza Pharmacies
Works through a different mechanism than traditional antacids. It contains alginate and sodium bicarbonate, which form a protective gel layer that floats on top of the stomach contents. This prevents acid from refluxing into the esophagus rather than just neutralizing it. Because its effect is local on the stomach wall, it does not enter the bloodstream significantly, making it a commonly prescribed option for pregnant women. However, it is preferable to check with a doctor first, especially for those suffering from high blood pressure or following a low-sodium diet, because the formula contains salt.
Contains calcium carbonate and magnesium carbonate. It works to neutralize excess stomach acid immediately upon consumption, providing fast relief from heartburn within minutes. These tablets are easy to carry and take at any time, whether after meals or during a sudden bout of heartburn, and their refreshing taste makes them a comfortable choice for many pregnant women. It is advised not to exceed the recommended daily dose and to consult a doctor if they need to be used frequently or daily.
Other Medications Under Medical Supervision
If antacids are not enough to control the symptoms, a doctor may prescribe other classes of medication under direct medical supervision:
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H2 Receptor Blockers (such as Famotidine): These work by reducing the amount of acid produced by the stomach and are considered acceptable options if symptoms persist despite using antacids.
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Proton Pump Inhibitors (PPIs) (such as Omeprazole and Lansoprazole): These are typically used as a subsequent line of treatment in cases that do not respond to previous options, and must be taken under a doctor's supervision.
Medications to Avoid During Pregnancy
There are some medications and compounds that pregnant women are advised to avoid when managing heartburn due to the potential risks they pose to the pregnancy or the fetus:
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Antacids containing sodium bicarbonate (such as certain effervescent preparations): These can lead to fluid retention and high blood pressure due to their high sodium content.
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Preparations containing aspirin or bismuth subsalicylate: Aspirin compounds are associated with potential risks to the fetus, especially in the third trimester.
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Magnesium trisilicate: Long-term use or high doses are not recommended due to its potential negative effects on the fetus.
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Ranitidine: This medication was withdrawn from the market after it was found to be contaminated with a potential carcinogen. Anyone who was using it is advised to stop and consult a doctor to find a suitable alternative.
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Any medication not specifically recommended by a doctor or pharmacist for your condition: Even if it is sold over the counter, the safe dose or type of ingredient can vary depending on the stage of pregnancy.
Always read the active ingredients listed on the packaging of any medication before taking it during pregnancy, and do not rely solely on the fact that it is available without a prescription as proof of its safety.
When Should You Consult a Doctor Regarding Heartburn?
It is recommended to contact your doctor in the following situations:
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Before starting any Stomach medication or antacid, even if it is an over-the-counter type.
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If heartburn persists despite following dietary and behavioral changes for a sufficient period without noticeable improvement.
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If symptoms become a daily occurrence or start affecting your sleep or your ability to eat normally.
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When there is a need to use an antacid daily and continuously, as this may require a more precise evaluation to choose the most appropriate treatment.
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If you had a pre-existing condition of GERD (gastroesophageal reflux disease) or chronic heartburn before pregnancy.
You should also seek medical care without delay if any of the following signs appear, as they may indicate a condition other than normal heartburn:
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Severe or sudden chest pain.
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Difficulty swallowing, vomiting blood, or dark stools.
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Shortness of breath or heart palpitations accompanying chest pain.
Conclusion
In conclusion, in most cases, heartburn during pregnancy is a normal symptom resulting from hormonal changes and the pressure of the uterus on the stomach. It can be controlled by making some simple adjustments to your diet and lifestyle. If these measures are not enough, a doctor can recommend safe medications that help relieve symptoms without harming the mother or the fetus. However, you should not take any medication on your own, even if it is available over the counter, because choosing the right treatment depends on the stage of pregnancy and each woman's specific health condition. If the heartburn is accompanied by unusual symptoms or is severe and frequent, it is important to see a doctor to rule out any other health issues and obtain the most appropriate treatment.
