GERD in Pregnancy

It’s called heartburn, although that burning feeling in your chest has nothing to do with the heart. Uncomfortable and frustrating, it bothers many women, particularly during pregnancy.

The first question you may have is, "How can I make it stop?" The second may be, "Are treatments safe for my baby?" And finally, "Is my heartburn serious?"

What Causes Heartburn During Pregnancy?

During normal digestion, food travels down the esophagus (the tube between your mouth and your stomach), through a muscular valve called the lower esophageal sphincter (LES), and into the stomach. The LES is part of the doorway between your esophagus and your stomach. It opens to allow food through and closes to stop stomach acids from coming back up.

When you experience heartburn or "acid reflux," the LES relaxes enough to allow stomach acid to rise up into the esophagus. This can cause pain and burning in the chest area. During pregnancy, hormone changes can allow the muscles in the esophagus, including the LES, to relax more frequently. The result is that more acids may seep back up, particularly when you're lying down or after you've eaten a large meal.

In addition, as the fetus grows during the second and third trimesters and the uterus expands to accommodate that growth, the stomach is under more pressure. This can also result in food and acid being pushed back up toward the esophagus.

Is Acid Reflux a Sign of Pregnancy?

If you have heartburn or acid reflux, could it mean that you're pregnant? It's possible. Heartburn is a common occurrence for most people at one time or another, but doesn't necessarily mean you're pregnant. However, if you experience other symptoms, such as a missed period or nausea, these could be signs that you need to take a pregnancy test.

Does Pregnancy Cause Heartburn?

Pregnancy increases the risk that a woman may experience heartburn or acid reflux. During the first trimester, muscles in the esophagus push food more slowly into the stomach and the stomach takes longer to empty. This gives your body more time to absorb nutrients for the fetus, but can also result in heartburn.

During the third trimester, the growth of the baby can push the stomach out of its normal position, which can lead to heartburn. However, each woman is different and being pregnant doesn't necessarily mean you'll automatically have heartburn. It depends on many factors, including your physiology, your diet, your daily habits, and your pregnancy.

How Do I Make It Stop?

Relieving heartburn during pregnancy typically involves a period of trial and error. Lifestyle habits that can reduce the incidence of heartburn are the safest methods for both mother and baby, according to the March of Dimes. For example:

  • Eat smaller meals more frequently and avoid drinking while eating. Drink water in between meals instead.
  • Eat slowly and chew every bite thoroughly.
  • Avoid eating a few hours before bed.
  • Avoid those foods and beverages that trigger your heartburn. Typical culprits include: chocolate, fatty foods, spicy foods, acidic foods like citrus fruits and tomato-based items, carbonated beverages, and caffeine.
  • Stay upright for at least an hour after a meal. A leisurely walk may also encourage digestion.
  • Wear comfortable rather than tight-fitting clothing.
  • Maintain a healthy weight.
  • Use pillows or wedges to elevate your upper body while sleeping.
  • Sleep on your left side—lying on your right side will position your stomach higher than your esophagus, which may lead to heartburn.
  • Chew a piece of sugarless gum after meals. The increased saliva may neutralize any acid coming back up into the esophagus.
  • Eat yogurt or drink a glass of milk to quell symptoms once they start.
  • Add some honey to chamomile tea or a glass of warm milk.

Alternative medicine options include acupuncture and relaxation techniques, such as progressive muscle relaxation or guided imagery. Always check with your doctor before trying new treatments.

What Medications Are Safe to Take During Pregnancy?

Over-the-counter antacids like Tums, Rolaids, and Maalox may help you cope with occasional heartburn symptoms. Those made of calcium carbonate or magnesium are good options. However, it may be best to avoid magnesium during the last trimester, as it could interfere with contractions during labor.

Most doctors recommend avoiding antacids that contain high levels of sodium, as these can lead to excess buildup of fluid in the tissues, according to the American Pregnancy Association. Also, avoid any that list aluminum on the label (as in “aluminum hydroxide” or “aluminum carbonate”), as they can be constipating.

Finally, stay away from medications like Alka-Seltzer that contain aspirin. Ask your doctor for the best option.

If you find yourself downing bottles of antacids, your heartburn may have progressed to gastroesophageal acid reflux disease (GERD). In that case, you may need a stronger treatment.

GERD in Pregnancy

If you experience heartburn that often wakes you up at night, returns as soon as your antacid wears off, or creates other symptoms like difficulty swallowing, coughing, weight loss, or black stools, you may have a more serious problem that requires attention. Your doctor may diagnose you with GERD, which simply means that your heartburn needs to be controlled to protect you from complications like damage to the esophagus.

Your doctor may prescribe certain acid-reducing medications to reduce your symptoms. Research indicates that medications called h2 receptor antagonists—which help block the production of acid—appear to be safe. Another type of medication, called proton-pump inhibitors (PPIs), may be best reserved for those patients not responding to other treatments.

If you're concerned about the effects of medications, be sure to talk to your doctor. They can help you control your symptoms while protecting the safety of your unborn child.