Overview

Heartburn is a common symptom during pregnancy, affecting up to 80% of expecting mothers. While it can be uncomfortable, the good news is that it resolves after you have your baby. In the meantime, there are many safe and effective ways to manage heartburn during pregnancy. Discover why heartburn is more prevalent during this time and the foods and behaviors that can trigger it. Learn about evidence-based interventions for relief, ranging from dietary and lifestyle adjustments to over-the-counter and prescription medications. Explore the evidence on the safety of heartburn medicines during pregnancy, including antacids, histamine 2 (H2) blockers, and proton pump inhibitors (PPIs). Plus, hear about the fascinating evidence that may link heartburn to how much hair your baby has.

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Despite its name, heartburn has nothing to do with your heart. Heartburn is caused by stomach acid rising into your esophagus which creates a burning sensation in the upper part of your digestive tract. Heartburn is also sometimes referred to as acid indigestion or acid reflux.

Heartburn During Pregnancy

Heartburn is very common during pregnancy. Data on the incidence varies widely, ranging from 17-80% of pregnant women experiencing symptoms. There are a few mechanisms that contribute to heartburn when you are pregnant. Your growing uterus puts pressure on your stomach. Digestion slows to deliver more nutrients to your baby. Plus, progesterone relaxes the smooth muscles in your digestive tract, which includes the valve between your stomach and your esophagus (lower esophageal sphincter). All of these factors increase the likelihood of acid being pushed upward into the esophagus, especially as your pregnancy progresses.

GERD (Gastroesophageal Acid Reflux Disease)

Serious complications of heartburn are rare. If your heartburn is particularly persistent and severe you could be diagnosed with gastroesophageal acid reflux disease. GERD is a chronic condition where stomach acid frequently flows back into the esophagus, causing irritation. This acid reflux can lead to symptoms like heartburn, regurgitation of food or sour liquid, and difficulty swallowing. While occasional acid reflux is common, GERD is diagnosed when it becomes frequent or severe enough to affect daily life. If this is diagnosed pre-pregnancy, it might be more troublesome when you are expecting. If you are experiencing heartburn, it is much more likely that you are experiencing a common pregnancy symptom, not GERD.

Preventing Heartburn

There are many things that can trigger or contribute to heartburn. Ideally, you can take preventative measures, like diet and lifestyle changes, to avoid heartburn before it happens.

The first step is to make adjustments to your eating habits. Large meals can put pressure on the stomach, increasing the likelihood of acid reflux. Eating smaller portions more frequently can reduce this pressure. You should also eat slowly. Digestion begins in your mouth. Chewing food thoroughly allows saliva to begin breaking it down, easing the workload on your stomach. Common foods that trigger heartburn include fatty, spicy, greasy, and acidic foods. You should consider avoiding or limiting these in your diet. Attention to how you feel after eating foods may help you identify additional triggers. You may consider a food journal to track what you eat and your symptoms to help identify trigger foods.

Adjustments to your diet may also help prevent or lessen heartburn. Consuming fluids between meals rather than with meals can prevent the stomach from becoming too full and reduce pressure on the lower esophageal sphincter. Chewing gum after meals stimulates saliva production, which can help neutralize acid and clear it from the esophagus. You may find that eating yogurt or drinking milk helps neutralize stomach acid.

What you do after eating can also affect your digestion and heartburn. Taking a walk after meals can aid digestion. Lying down after eating allows stomach acid to travel more easily through the esophagus, so it may be helpful to remain upright after meals. Refrain from eating within two to three hours of going to bed to allow your stomach to empty. If heartburn occurs at night, try using pillows to elevate your head, chest, or upper body. Tight-fitting clothes can put additional pressure on your stomach, worsening heartburn symptoms. Choose comfortable, loose-fitting clothing or maternity pants that will not put additional pressure on your midsection.

Digestive Enzymes

Digestive enzymes aid in digesting carbohydrates, proteins, and fats, which can reduce the strain on your stomach. By promoting more efficient digestion, enzymes can help food move through the stomach faster, lowering the likelihood of acid backing up into the esophagus. If you notice heartburn symptoms after eating specific foods or large meals, digestive enzymes may help.

Most digestive enzyme supplements are considered safe during pregnancy, but you should always check with your healthcare provider before taking any supplement. I am a big fan of the Garden of Life Organic Enzyme Supplement. This contains papain, which is from the papaya plant. Papain helps digestion by breaking down amino acids into smaller proteins. Taking this with any meals that I knew would trigger heartburn was tremendously helpful when I was pregnant. While I should have probably avoided my favorite taco shop, digestive enzymes allowed me to enjoy my favorite spicy meal during pregnancy without heartburn and acid reflux.

Medications to Treat Heartburn

Diet and lifestyle changes are the first line of defense for heartburn. If these interventions are not alleviating your heartburn, you may want to consider an over-the-counter medication. Let’s examine your options and discuss the pros and cons. As with any medication, you always want to run it by your doctor or midwife, even if it is available over the counter.

Antacids

Antacids are over-the-counter medications designed to neutralize stomach acid and quickly relieve heartburn, acid reflux, and indigestion. Antacids work by raising the pH of the stomach acid, making it less acidic and alleviating the burning sensation in the chest or throat.

Antacids may contain several active ingredients. Typically, calcium carbonate and magnesium hydroxide are considered safe during pregnancy. Calcium carbonate provides fast and effective relief and is the active ingredient in Tums and included in Rolaids. Calcium can interfere with iron absorption, so you may want to space out your prenatal vitamin and calcium-containing antacid to avoid taking the two simultaneously. Magnesium hydroxide acts quickly and has a mild laxative effect, this is also an active ingredient in Rolaids.

Aluminum hydroxide is slower-acting but provides longer-lasting relief. This may also cause constipation, so it may not be the best choice during pregnancy. Sodium bicarbonate works to quickly neutralize acid but may lead to bloating and gas. Antacids containing sodium can contribute to fluid retention and swelling and are generally advised against during pregnancy. This is one of the active ingredients in Alka-Seltzer, although this brand also offers chews that use calcium carbonate as the active ingredient.

Many over-the-counter antacids may also contain artificial colors and other ingredients like corn syrup and hydrogenated oils, which may not be ideal, depending on how you feel about those ingredients.

Histamine 2 or H2 blockers

Histamine 2 or H2 blockers are a class of medications that reduce stomach acid by inhibiting chemical reactions in receptors on cells in your stomach that produce acids. These relieve symptoms like heartburn and allow the esophagus and stomach lining to heal if they’ve been irritated by excess acid. Some are available over the counter, and higher doses may require a prescription. H2 blockers include medications like Pepcid, Tagamet, and Zantac. H2 blockers take longer to work than antacids but provide longer-lasting relief.

A meta-analysis that looked at the safety of H2 blockers during pregnancy found no significant difference in the number of congenital malformations, spontaneous abortions, preterm delivery, or babies small for their gestational age in women who used H2 blockers and women who didn’t.

Proton Pump Inhibitors (PPIs)

Proton Pump Inhibitors (PPIs) are a class of medications that significantly reduce the production of stomach acid. These are treatments for acid-related conditions, including GERD, peptic ulcers, erosive esophagitis, and stomach acid overproduction disorders. PPIs work by blocking the proton pump in the stomach lining, which is the final step in the production of stomach acid. They reduce acid secretion for an extended period to help relieve symptoms, prevent acid reflux, and allow the esophagus and stomach lining to heal from acid damage. PPIs don’t provide immediate relief like antacids or H2 blockers. Relief may take 1-4 days and target severe or persistent symptoms.

PPIs are available both over-the-counter and by prescription. Common brands are Prilosec (omeprazole), Nexium (esomeprazole), Prevacid (lansoprazole), Protonix (pantoprazole), Aciphex (rabeprazole), and Dexilant (dexlansoprazole).

A study spanning a decade and including nearly 2.7 million participants examined the use of PPIs during the first trimester. The study found the use of PPIs during early pregnancy was not associated with a substantial increase in the risk of congenital malformations, although small increased risks were observed for major congenital malformations and congenital heart defects; findings from sibling-controlled analyses revealed that PPIs were unlikely to be major teratogens. No associations were observed between individual PPIs and each primary outcome, except for esomeprazole (Nexium), which was associated with a small increase in the risk of major congenital malformations. There was a modest increase in the risk of major congenital malformations and congenital heart defects in the groups taking higher doses of PPIs.

Considerations for Over-the-Counter Medicines

An article in the American Family Physician Journal summarizes the generally accepted guidelines on over-the-counter medications during pregnancy. There are a couple of guidelines that relate to medications for heartburn.

Avoid medications in the first 12 weeks. The first trimester is when miscarriage is the highest; all your baby’s systems are being put into place during that period, and it is considered the most sensitive for development. Heartburn has the lowest incidence during the first trimester and is more common in the second and third trimesters.

If you take an over-the-counter medication, avoid using extra strength or long-lasting drugs, and avoid combination medicines that treat many symptoms at once. You want to minimize your exposure to medications that you do not need. You also do not want to take medicines for an extended period or longer than required. Some medications for heartburn may also contain active ingredients for other symptoms like gas, bloating, or upset stomach. Limit your medications to only those that treat your specific symptoms.

Brand Name vs. Generic Medications 

You have many options for medications from name brands, or there are less expensive, generic options. There is an argument that if the active ingredients are identical, there is no difference in taking a generic over a brand-name medication. If the active ingredients are identical, then that would be true. Unfortunately, there is a lot of fraud in generic drug manufacturing. There is an excellent episode of the Drive Podcast with Peter Attia, M.D., and Katherine Eban, an investigative journalist, about widespread fraud in the generic drug industry. This podcast episode compelled me to spend a little more to purchase only brand-name medications. 

What Treatment is Right for You?

Many reviews (like this one from the Cochrane Library) examine multiple studies on different interventions ranging from lifestyle modifications to prescription medications. The consensus is that the first line of defense is lifestyle modifications, followed by antacids, then H2 blockers, and then PPIs. You would evaluate the efficacy of each intervention before moving to the next course of action. You should discuss any symptoms with your doctor or midwife. They can help you navigate what course of action is most appropriate for you, starting with the least invasive and increasing the treatment with varying levels of medications if necessary.

Like everything during pregnancy, you are weighing the risks or unknown risks of medications with the benefit of heartburn relief. The severity of your symptoms and their effects on your quality of life will also play a role in your decision-making. There is no one size fits all, and the right choice for someone else may not be the right choice for you. Please consult with your care provider before taking any medications, and utilize their expertise to assist you in navigating the best treatment course. Like all symptoms that arise during pregnancy, this is temporary, and heartburn should subside after you have your baby.

Heartburn and Your Baby’s Hair

There is an old wives’ tale that suggests that if you experience a lot of heartburn during pregnancy, your baby will be born with a full head of hair. According to this wives’ tale, if you don’t have heartburn, your baby will be born with little hair. Interestingly, there may be some truth to this.

A study of 64 women reported on the severity of heartburn during pregnancy and the amount of hair their babies were born with. 23 of 28 women who reported moderate to severe heartburn had a baby who had an above-average amount of hair. 10 of 12 women who reported no heartburn had babies with a below-average amount of hair. The link between heartburn and the amount of hair a baby has is progesterone. This critical hormone during pregnancy can relax the esophageal sphincter and modulate fetal hair growth. Anecdotally, I did not get heartburn during my first pregnancy, and my son was essentially bald at birth. I had frequent heartburn in my second pregnancy, and my daughter had a lot more hair when she was born.

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