It is late, you are finally lying down, and the burning starts again. Heartburn during pregnancy affects roughly 4 in 10 expecting mothers, and the advice is all over the place. Some of it is folklore. Some of it points to medications that were pulled from shelves years ago. In this episode, you will learn why pregnancy makes heartburn so much worse, which simple changes actually have research behind them, how the medication options compare on safety, and the one type of pain that is not heartburn at all.

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What Heartburn Actually Is

Despite the name, heartburn has nothing to do with your heart. It happens when stomach acid rises into your esophagus, the tube that carries food from your mouth to your stomach. That acid irritates the lining and creates a burning feeling in your chest or throat. You may also hear it called acid indigestion or acid reflux.

Most of the action happens at a ring of muscle called the lower esophageal sphincter. It sits where your esophagus meets your stomach. Its job is to open when you swallow and stay closed the rest of the time. When that muscle relaxes at the wrong moment, or stomach pressure overwhelms it, acid flows backward.

Every heartburn treatment works in one of three ways. Some reduce how much acid your stomach makes. Others neutralize acid that is already there. The rest help keep acid where it belongs. Once you know that, the long list of options becomes much easier to sort through.

Why Pregnancy Causes Heartburn

Three changes stack up during pregnancy, and each one makes reflux more likely. First, progesterone relaxes smooth muscle throughout your digestive tract, including the lower esophageal sphincter. A valve that should stay shut becomes less reliable.

Second, your digestion slows down. That is useful, because slower digestion gives your body more time to pull nutrients from your food for your baby. The tradeoff is that food sits in your stomach longer, so acid has more chances to back up.

Third, your growing uterus takes up space your other organs used to have. As a result, it presses on your stomach and pushes everything upward. That is why heartburn so often gets worse in the final months. Research on heartburn in pregnancy points to these same causes, plus weight gain.

How Common Heartburn Is and When It Starts

You will see wildly different numbers for how common heartburn during pregnancy is. Older estimates ranged anywhere from 17% to 80%. That range is so wide that it does not tell you much.

A 2025 systematic review and meta-analysis was the first to pool global data on this question. It included 21 studies with nearly 9,500 pregnant women. Overall, reflux symptoms affected about 41% of them. In the studies that also included women who were not pregnant, the odds of reflux symptoms were about eight times higher during pregnancy. The numbers also climb as pregnancy goes on. In that analysis, about 26% of women had symptoms in the first trimester and 33% in the second trimester. By the third trimester, that rose to about 56%. In other words, the prevalence of heartburn increases as your pregnancy progresses.

For most women, heartburn fades quickly after birth. However, that is not universal. According to a 2022 review, about 20% of women continue to have reflux symptoms after birth, and heartburn during pregnancy makes postpartum reflux more likely. If you are one of them, it helps to know which treatments are preferred while breastfeeding, and we will cover that.

When Heartburn Is Not Just Heartburn

Pain in your upper abdomen during the second half of pregnancy can be a warning sign of preeclampsia or a related complication called HELLP syndrome. HELLP stands for hemolysis, elevated liver enzymes, and low platelet count. This pain is easy to mistake for bad heartburn.

The Preeclampsia Foundation describes it as pain that usually sits under the right ribs. It can be confused with heartburn, gallbladder problems, the flu, or indigestion. Sometimes it also reaches the right shoulder. The foundation is clear: pain in this area should never be brushed off; call your provider right away.

I don’t want you panicking that your heartburn may be something more serious, so here are a few features that help you tell the two apart. Heartburn is a burning feeling that tends to rise toward your throat, and it usually eases with an antacid. By contrast, the American College of Obstetricians and Gynecologists lists persistent, severe pain under the right ribs or in the upper middle of your abdomen that does not respond to medication as a severe feature of preeclampsia. Heartburn that settles with an antacid is reassuring. Upper abdominal pain that doesn’t resolve warrants a call to your doctor and midwife.

According to the same guidance, the main symptoms of HELLP syndrome are pain in the upper right abdomen and a general feeling of being unwell, which occur in up to 90% of cases. Nausea and vomiting occur in about 50%. Other warning signs of preeclampsia include swelling in your face or hands, a headache that will not go away, and changes in your vision, such as spots or blurriness. Sudden weight gain, shortness of breath, and new nausea or vomiting after mid-pregnancy are also on the list.

The overwhelming majority of heartburn during pregnancy is exactly what it seems. The goal is not to worry every time your chest burns. The goal is to know which pain deserves a closer look or a call to your provider. For a full breakdown of these warning signs, including after birth, listen to the episode on hypertension during pregnancy.

When It Might Be GERD

Serious complications from heartburn are rare. If your symptoms are persistent and severe, though, you could be diagnosed with gastroesophageal reflux disease, usually shortened to GERD.

GERD is a chronic condition in which stomach acid frequently flows back into the esophagus. Symptoms include heartburn, regurgitation of food or sour liquid, and difficulty swallowing. Occasional reflux is common in anyone. By contrast, doctors diagnose GERD when reflux becomes frequent or severe enough to affect daily life. If you had GERD before pregnancy, it may become more troublesome now. If heartburn started for the first time at 30 weeks, the cause is usually simpler. You are most likely dealing with an ordinary pregnancy symptom.

Diet Changes for Heartburn During Pregnancy

For most women, diet and lifestyle changes are the first line of defense. There is evidence that for mild symptoms, these changes may be all you need. Start with trigger foods. Fatty, greasy, spicy, and acidic foods are the usual culprits, so consider limiting them and noticing how you feel afterward. Your triggers may not match anyone else’s. For that reason, a food journal can help. Writing down what you eat and when symptoms start can reveal patterns you would otherwise miss.

Timing your drinks matters too. Drinking between meals rather than with them keeps your stomach from getting overly full, which reduces pressure on the lower esophageal sphincter. Don’t cut back on fluids, just time them differently.

Green vegetables may also help. In one small study of 64 pregnant women, those who ate green vegetables more often were less likely to develop heartburn. It was a small, observational study, so it cannot prove cause and effect. Still, it’s one more reason to add more greens to your diet.

Some women find that yogurt or milk helps, and others swear by family remedies. The research on most home remedies is thin. Still, if something is easy, low-risk, and safe during pregnancy, it is reasonable to try it. Finding what works for you may take some trial and error.

How and When You Eat

Large meals put pressure on your stomach and make reflux more likely. Eating smaller portions more often reduces that pressure. This can also help with morning sickness, which is important because heartburn and reflux are linked to how severe nausea and vomiting are during pregnancy. Eat slowly and chew thoroughly. Digestion begins in your mouth, where saliva starts breaking food down. The more work your mouth does, the less your stomach has to do.

Chewing gum after a meal is an intervention that has some research behind it. In one study, researchers measured acid in the esophagus of 12 people with reflux and 24 people without it after a standard breakfast. Chewing gum for an hour afterward reduced acid exposure in both groups. The effect was strongest in people with reflux, and it lasted up to three hours. A separate randomized study of 31 people with reflux symptoms tested a shorter window. Chewing sugar-free gum for just half an hour after a meal significantly reduced acid in the esophagus. The reason is simple. Chewing makes saliva, saliva is alkaline, and swallowing more often washes acid back down.

Walking after meals is often recommended for heartburn, but the research is not as strong. In that same study, an hour of walking after eating helped only the people with reflux, and the effect was mild and brief. Gum did considerably better. A walk after a meal still has plenty of benefits. It just should not be your main tool for heartburn.

What you do after eating matters too. Lying down lets acid travel more easily into your esophagus, so stay upright after meals. Try to finish eating two to three hours before bed, which gives your stomach time to empty. In fact, a systematic review of lifestyle changes for reflux found that in randomized trials, late evening meals increased acid exposure while lying down compared with earlier meals.

Finally, look at what you are wearing. Tight clothing adds pressure to your midsection. In a small study of 14 people with reflux, a tightly cinched belt doubled their reflux episodes after a meal. That study did not include pregnant women. Still, it shows how pressure on your stomach can push acid upward. Loose, comfortable clothing or maternity pants with a soft waistband are a better choice. You deal with a lot during pregnancy. You don’t need to deal with uncomfortable clothing.

Nighttime Heartburn and Sleep

According to a 2022 review, reflux affects emotions, eating, and daily functioning, but it most significantly impacts sleep. If heartburn is keeping you awake, here are some steps you can take to address it.

Sleeping on your left side is one of the most useful changes you can make. A systematic review and meta-analysis found that sleeping on your left side reduced both how long acid stayed in the esophagus and how long it took to clear. This held true compared with sleeping on your right side and on your back. Interestingly, the right side and the back performed similarly.

The same review included a randomized trial of a wearable device that vibrated when people rolled onto their right side. Compared with a sham device, it increased time on the left side and improved nighttime reflux symptoms. You do not need a gadget. The takeaway is that deliberately favoring your left side works. The evidence comes from only three studies, but they all point in the same direction. Conveniently, doctors already recommend sleeping on your left side during pregnancy for other reasons.

Raising the head of your bed is the other change worth making. In a randomized trial of 39 people with reflux, researchers raised the head of the bed by 20 centimeters, which is about 8 inches, for 6 weeks. About 69% improved their reflux symptoms with the bed raised, compared with 33% while sleeping flat. However, quality-of-life scores did not change, and about half the participants reported some side effects, so the authors called for more research.

How you raise your bed matters. These studies raised the bed itself rather than stacking pillows. Pillows may simply bend you at the waist, so blocks under the head of the bed or a wedge that supports your whole upper body is closer to what was studied.

Your Prenatal Vitamin and Heartburn

Iron supplements are well known for causing digestive side effects, and nearly every prenatal vitamin contains iron. If your stomach symptoms started shortly after you began a prenatal vitamin or a separate iron supplement, pay attention. The form of iron makes a difference. Ferrous sulfate is the most common form and the one most associated with digestive side effects. Gentler options include ferrous bisglycinate, also called chelated iron. A higher-quality prenatal vitamin typically uses a gentler form of iron to begin with.

The timing of when you take your prenatal vitamin matters too. Stomach acid helps your body absorb iron, and antacids reduce that acid. For that reason, one review advises against taking antacids within two hours of iron and folic acid supplements. Calcium, which is in many antacids, can also interfere with iron absorption. Spacing them out protects the nutrients you take your prenatal vitamin for in the first place.

Digestive Enzymes

The case for digestive enzyme supplements is plausible on paper. Enzymes help break down carbohydrates, proteins, and fats. In theory, faster digestion empties your stomach sooner, which leaves less time for acid to push upward. Unfortunately, nobody has tested that for heartburn. I could not find research on digestive enzymes for heartburn or reflux in pregnancy, or even in people who are not pregnant.

There is also a safety question. Many popular enzyme products contain papain, an enzyme that comes from papaya latex, the milky sap of the fruit. In a study in rats, crude papaya latex triggered uterine contractions similar to those caused by oxytocin and prostaglandin. In uterine tissue from rats late in pregnancy, those contractions became sustained spasms. Ripe papaya juice, by contrast, had no significant effect, and rats that ate ripe papaya had normal pregnancies.

These are animal findings, and no research shows that papain supplements cause contractions in people. Still, with no evidence that these products help heartburn and a plausible reason for caution, I would skip papain-containing enzyme supplements during pregnancy. As with any supplement, check with your doctor or midwife first.

How the Step-Up Approach Works

When diet and lifestyle changes are not enough, medication is a reasonable next step. Most providers use a step-up approach. You start with lifestyle changes, then move to antacids and alginates, then histamine 2 (H2) blockers, and then proton pump inhibitors (PPIs) if needed. At each step, you see whether it is working before moving up. The 2022 review lays out this treatment ladder for both pregnancy and breastfeeding.

That ladder reflects expert consensus, but the trial evidence underneath it is not overwhelming. A Cochrane review looked for randomized trials of heartburn treatments in pregnancy. It found nine trials with 725 women, but five of those trials did not contribute any usable data.

What the review did find is still useful. In two trials with 256 women, those who took medication were more likely to get complete heartburn relief than those who took a placebo or nothing. Side effects were similar between the groups. In addition, one small trial found that sucralfate beat diet and lifestyle advice for complete relief. Another trial of 36 women looked at acupuncture. It did not report on heartburn relief itself, although the women who had acupuncture said they slept and ate better. The authors described the data as limited and called for more trials. This explains why your provider may suggest trying something and seeing how it goes. The research to give you a more precise answer does not exist yet.

Like everything during pregnancy, you are weighing the risks, or unknown risks, of a medication against the benefit of relief. The severity of your symptoms and their effect on your quality of life both matter. Heartburn that wakes you up every night is a different problem from heartburn after one spicy dinner. As with any medication, run it by your doctor or midwife first, even if it is sold over the counter.

Antacids

Antacids neutralize stomach acid that is already there, which makes them the fastest option for relief. Because very little is absorbed into your bloodstream, they are a common first choice during pregnancy.

The active ingredient matters. Calcium carbonate works quickly and is the active ingredient in Tums. Magnesium hydroxide also acts quickly and has a mild laxative effect, which some women welcome. Rolaids contain both. Aluminum hydroxide works more slowly but lasts longer, though it may contribute to constipation. Sodium bicarbonate is the one to avoid. One review found it can lead to fluid overload and metabolic alkalosis, which is a disruption of your body’s acid balance, in both you and your baby. That includes plain baking soda dissolved in water, which is a common home remedy for heartburn.

Alka-Seltzer is a good example of why you need to read package labels. The original version contains sodium bicarbonate and aspirin. Aspirin is a medication to discuss with your provider during pregnancy, and the dose in those tablets is far higher than the low dose sometimes prescribed to help prevent preeclampsia. Other products under the same brand use calcium carbonate instead. Read the active ingredients rather than trusting the brand name, and see the guidance on over-the-counter medications during pregnancy for more on pain relievers.

There is also a limit to how many calcium antacids you should take. Tums are easy to eat like candy. Even so, the review advises pregnant women to limit antacid intake to no more than 1,000 milligrams of elemental calcium per day. Too much can cause calcium-alkali syndrome, which involves high blood calcium, an acid-base imbalance, and kidney strain. Follow the dosing on the package rather than treating them as unlimited.

The good news is that after you have your baby, antacids are generally considered acceptable while breastfeeding. That is mainly because calcium, magnesium, and aluminum are poorly absorbed.

Many antacids also contain artificial colors, corn syrup, or other additives. Check the inactive ingredients if that matters to you, because formulas vary a lot between brands.

Alginates

Alginates come from seaweed, and they work differently from every other option. When they meet stomach acid, they form a gel that floats on top of your stomach contents. That gel sits like a lid over the pocket of acid that collects near the top of your stomach after a meal. Most alginate products also include an antacid, so you get quick neutralizing plus longer-lasting protection.

Alginates don’t get much attention in the United States, yet they have some of the best pregnancy-specific research of any option. A randomized, double-blind trial compared an alginate product with a magnesium and aluminum antacid gel in 100 pregnant women under 36 weeks. All of them had heartburn at least twice a week. Both treatments reduced heartburn frequency and intensity, with no meaningful difference.

In an open-label study described in a review, 150 pregnant women used an alginate product as needed for four weeks, and everyone knew what they were taking. More than half felt relief within 10 minutes. Their blood sodium and potassium levels barely changed, which is important because some alginate products contain sodium.

Because very little alginate is absorbed, alginates are also considered acceptable while breastfeeding. There is one caveat here. Formulas differ by country, so a familiar brand name may not match the one studied. Look for sodium alginate or alginic acid on the label, and ask your pharmacist if you are unsure.

H2 Blockers

H2 blockers reduce how much acid your stomach makes. They block histamine receptors on the acid-producing cells in your stomach lining. As a result, symptoms ease, and an irritated esophagus has time to heal. They take longer to start working than antacids, but the relief lasts longer.

Older advice often lists Zantac, and that information is now out of date. Zantac’s original active ingredient was ranitidine. In April 2020, the U.S. Food and Drug Administration asked manufacturers to withdraw all ranitidine products from the market. The reason was a contaminant called N-nitrosodimethylamine or NDMA, which is a probable human carcinogen. Its levels in ranitidine increased over time and at higher storage temperatures.

A product called Zantac 360 is back on shelves, but it contains famotidine instead. Today, the main options are famotidine (Pepcid and Zantac 360) and cimetidine (Tagamet). Lower doses are sold over the counter, and higher doses require a prescription.

Safety data on these during pregnancy are reassuring. A meta-analysis on the safety of H2 blockers in pregnancy compared 2,398 women who took H2 blockers in at least the first trimester with 119,892 women who did not. It found no increased risk of birth defects, pregnancy loss, preterm birth, or babies born small for their gestational age. Those are large numbers for a pregnancy safety question.

If you are breastfeeding, famotidine is generally the preferred H2 blocker. Research shows it passes into breast milk in the smallest amounts and lasts the longest.

Proton Pump Inhibitors

Proton pump inhibitors, often called PPIs, are the strongest acid reducers. They block the proton pump in your stomach lining, the final step in acid production. Doctors use them for GERD, ulcers, and erosive esophagitis, which involves damage and inflammation in the esophagus lining.

PPIs do not provide the immediate relief antacids do. Relief may take one to four days, so they are meant for severe or persistent symptoms rather than the burning you feel right now. Some are sold over the counter, and others require a prescription. Common brands include Prilosec (omeprazole) and Nexium (esomeprazole). Prevacid is lansoprazole, and Protonix is pantoprazole. Aciphex is rabeprazole, and Dexilant is dexlansoprazole.

On safety, a decade-long study of nearly 2.7 million pregnancies examined first-trimester PPI use. Overall, PPIs were not associated with a substantial increase in birth defects. The researchers did see small increases in major birth defects and heart defects. However, analyses comparing siblings suggested PPIs are unlikely to be major teratogens, which are substances that cause birth defects. Researchers pointed to other differences between families as a likely explanation for the small signal.

No single PPI stood out, except for one. Esomeprazole, sold as Nexium, was linked to a small increase in major birth defects. Higher doses of PPIs were also linked to a modest increase in risk. This is why PPIs sit at the top of the ladder. The 2022 review notes they are generally reserved for complications or for symptoms that have not responded to other treatments. That is not because they are considered dangerous. There is simply no reason to start with the strongest option when a gentler one may work.

If you need a PPI while breastfeeding, very little passes into breast milk. In addition, stomach acid breaks PPIs down, so your baby likely absorbs even less than what reaches the milk.

Other Prescription Options

There are also some prescription options. Sucralfate is a mucosal protectant. Rather than changing your stomach acid, it sticks to the lining of your digestive tract and forms a barrier against acid. According to the 2022 review, one gram taken three times a day has managed reflux symptoms without problems for mothers or babies. Because very little is absorbed, it is considered safe during pregnancy.

Metoclopramide speeds up stomach emptying and tightens the lower esophageal sphincter. A study of 3,458 babies exposed in the first trimester found no link with major birth defects, low birth weight, preterm birth, or other serious problems around birth. However, the U.S. Food and Drug Administration has placed its strongest warning, called a boxed warning, on metoclopramide. The concern is tardive dyskinesia, a movement disorder reported with high-dose or long-term use. As a result, it is a conversation for your provider rather than a first choice.

Acid-Reducing Medications and Your Baby

Research has linked acid-reducing medications during pregnancy to childhood asthma, and the context matters a lot here. A meta-analysis of eight population studies found that these drugs were associated with about a 45% higher risk of asthma in childhood. The link appeared for both PPIs and H2 blockers. Other studies, summarized in the 2022 review, have also found associations with eczema and hay fever.

Now for the context. None of the studies in that meta-analysis adjusted for every known confounder, which is an outside factor that can create a misleading link. The review points to the mother’s own asthma as a likely main confounder. Asthma runs in families, and asthma and reflux often occur together.

A study of nearly 200,000 children adds an important clue. Children had a similar increase in asthma risk when their mothers took PPIs in the year after pregnancy but not during it. A medication taken after birth cannot affect a baby’s development in the womb. The authors concluded that the link may reflect the mothers’ underlying conditions, although they could not rule out an effect of the drugs.

Where does that leave you? These are observational findings that cannot prove cause and effect. You also have to weigh them against symptoms that may be wrecking your sleep and quality of life. That is a real tradeoff, and it is exactly the kind of decision to make with your doctor or midwife.

Ground Rules for Any Medication

An article in the American Family Physician Journal summarizes generally accepted guidelines for over-the-counter medications during pregnancy. A few apply directly to heartburn.

If you can, avoid medications in the first 12 weeks. The first trimester is when your baby’s major organs and body systems form, which makes it the most sensitive period for development. Fortunately, you’re also least likely to experience heartburn then.

Use the lowest effective dose for the shortest time. Skip extra-strength and long-lasting versions, because they mean more exposure. Also avoid combination products that treat several symptoms at once. Some heartburn products include ingredients for gas, bloating, or upset stomach, and there is no reason to take medicine for a symptom you do not have.

Brand Name vs. Generic Medications

You have many options: name brands or less expensive generic options. Some argue that if the active ingredients are identical, there is no difference between taking a generic and 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. An excellent episode of the Drive Podcast features Peter Attia, M.D., and Katherine Eban, an investigative journalist, discussing widespread fraud in the generic drug industry. That conversation compelled me to spend a little more on brand-name medications only.

Heartburn and Your Baby’s Hair

An old wives’ tale says that lots of heartburn during pregnancy means your baby will be born with a full head of hair. According to the same tale, no heartburn means a baby with very little hair. Interestingly, there may be some truth to it.

A study of 64 women compared heartburn severity during pregnancy with how much hair their babies had at birth. Of the 28 women with moderate to severe heartburn, 23 had babies with an average or above-average amount of hair. Of the 12 women with no heartburn, 10 had babies with less than average hair or none at all. The researchers propose that pregnancy hormones both relax the esophageal sphincter and influence fetal hair growth.

My own experience matched it, though. 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. So maybe there is some truth to this wives’ tale.

The Bottom Line on Heartburn During Pregnancy

Heartburn during pregnancy is common and usually worsens as your pregnancy progresses. The best evidence-backed interventions cost nothing, including smaller meals, sugar-free gum after eating, an earlier dinner, sleeping on your left side, and raising the head of your bed. If you need more relief, antacids, alginates, H2 blockers, and PPIs all have reasonable safety data, and the goal is the lowest step that works. If you experience heartburn, bring it up with your doctor or midwife so you can discuss the best options for your specific situation.

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