Around the same time that little blue line appears on the pregnancy test, many women start to develop cravings and a ravenous appetite. Most times we can get away with it because that’s what “the baby” wants. But on the flip side of double midnight snacking is usually nausea associated with morning sickness, which by the way can last all day and the woes of constipation. The majority of the time heartburn follows suit and suddenly you realize that eating during pregnancy may not be that glamorous.
What is heartburn?
If you have ever experienced heartburn before, you are familiar with the very uncomfortable feeling. It has nothing to do with the heart but it does involve a severe burning sensation in the middle of your chest which is pretty much where your esophagus runs. The feeling sometimes starts with a churning in the stomach then burning which runs from the stomach, up the chest to the neck and throat. If you are pregnant, there is a high probability that you are experiencing or will experience heartburn.
"About 85% of women experience heartburn or other forms of gastroesophageal reflux in pregnancy," explains Dr. Aparna Sridhar, OB-GYN and associate professor in Obstetrics and Gynecology at UCLA, to INSIDER. "I discuss this with almost all of my patients at least once in pregnancy. With the majority of them, I keep discussing this problem at least every trimester." Typically, the discomfort of heartburn begins in the second or third trimester and what’s worse is that it can become more severe as you progress through the pregnancy.
Why is it worse during pregnancy?
Normally weight and genetic makeup factors predispose people to heartburn. But despite never previously being at high risk for heartburn, just the fact that you are now pregnant will increase your risks. Pregnant women who have never had heartburn before have complained about having severe bouts of it during pregnancy. And unfortunately, having experienced the discomfort of heartburn outside of pregnancy, makes you more prone to developing it during the gestation period.
Heartburn, known officially as gastroesophageal reflux, and also commonly known as acid indigestion or reflux, occurs when our acidic stomach juices, sometimes accompanied by partially digested food, backs up into the esophagus – the muscular tube that connects the mouth to the stomach. Dr. Renee Wellenstein, double board-certified OG-GYN, says "there are two main factors" which contribute to pregnancy heartburn.
Though inconclusive as to the exact reasons why pregnancy exacerbates heartburn, experts blame the pregnancy hormone, progesterone. During pregnancy, hormones help to relax your body’s muscles, which help your body’s organs contour to make room for the baby. Unfortunately, the hormones are not discriminatory and relax all the muscles in the body. The sphincter muscles, which act like a one-way valve between the esophagus and stomach, are among those muscles. When relaxed, they allow stomach fluids to flow in the opposite direction, up the esophagus, causing heartburn.
The extra progesterone also slows down digestion, keeping food contents for a longer period in the stomach. "The other factor is the growing uterus that physically pushes up on the stomach as it grows," explains Wellenstein to INSIDER.
It also does not help that your uterus is expanding. Your expanding uterus takes up most of the space in your abdomen and squeezes against the other organs. This causes heartburn to get worse as the pregnancy progresses. The stomach no longer has as much space as it used to and therefore cannot hold down as much food. These factors create an environment for heartburn which many pregnant women cannot escape.
What can you do about it?
The following strategies from Wellenstein, Sridhar and experts at the American College of Obstetrics and Gynecology can help:
- Avoid fatty, greasy or spicy foods: They are known for causing regular heartburn and it is no different when you are pregnant. Foods high in fat take longer than other foods to digest. Processed deli meats, caffeine, mint, chocolate and sodas, are other foods that pregnant women have associated with their heartburn. Some people have also reported sensitivity to acidic foods. Keep a log of the foods which consistently cause your heartburn so that you can weed them out of your diet.
- Eat smaller portions throughout the day: Large meals take longer to digest and will sit around in your stomach for a long while. Smaller portions, spread out through the day, will help your stomach digest food better and quicker.
- Time your meals: Waiting about two to three hours before you lie down or go to bed after a meal can make a huge difference. After eating, you should try to remain seated in an upright position so gravity can help move your food along to the intestines. This will also help prevent your stomach contents from flowing back up your esophagus.
- Elevate your upper body: Propping your head up on some pillows will help gravity keep your stomach contents flowing downwards to your intestines. Special pregnancy pillows also help keep you comfortable as your baby bump grows and you have to spend more time sleeping elevated and on your left side.
- Neutralize the acids: Chewing gum, drinking milk and ingesting baking soda are all ways you can help manage the amount of acid produced and thus relieve your heartburn. Chewing gum will trigger your salivary glands to produce more saliva, which counteracts your stomach acid. Similarly, drinking some warm milk or taking a couple tablespoons of yogurt can help keep stomach acids at bay. Baking soda also manages acid, working much like store-bought antacids. Wellenstein suggests mixing 1 teaspoon of baking soda with a glass of water to relieve heartburn symptoms.
- Avoid smoking: Smoking can cause heartburn and should be avoided; like it should be during any pregnancy.
Other non-medicinal methods which people have tried include:
- Acupuncture: Though the research regarding acupuncture and pregnant women is very limited a small trial published in the journal Acupuncture in Medicine in 2009 discovered that adding acupuncture to a treatment plan of antacids and dietary adjustments made the plan more effective in relieving pregnant women's heartburn symptoms.
- Drink fluids between meals rather than with meals: Adding fluid to a regular meal increases the number of contents in your stomach. Instead, some women have found it more comfortable to slowly drink fluids between meals.
When might you need to take medication?
If your heartburn is severe and the above techniques have not helped, your doctor may prescribe over-the-counter medication.
Most antacids are safe to use during pregnancy. They are usually chewable tablets or liquids and work by coating the lining of the esophagus and stomach and neutralizing stomach acid. Tums, Maalox and Rolaids are all examples of antacids.
H2 blockers like Pepcid are also commonly used to prevent heartburn when antacids don’t work. They simply reduce the amount of stomach acid, thus reducing the chances of the acid flaring up your esophagus.
If these still do not work, a proton pump inhibitor like Nexium or Prevacid would be your doctors next bet. These work in the same way as H2 Blockers, but have been claimed to have serious side effects. Most doctors use them as a very last resort.
As with all medications, always consult with your doctor before taking any of these over-the-counter medicines. You should also try to avoid taking any of these within the first trimester. According to Wellenstein, heartburn is not usually a major concern during pregnancy, especially when the pregnant woman never had heartburn before she became pregnant. However, some situations do require immediate attention.
You should see a doctor immediately if you are throwing up or feel nauseous because of your heartburn. Wellenstein also stresses the need to seek immediate medical attention if you begin vomiting blood as this can indicate a serious heartburn related issue. Very dark-coloured stool also indicates a need to quickly inform your healthcare provider.
In the end...
The good news? You can usually immediately kiss heartburn goodbye after you give birth.
Though it may be almost impossible to completely get rid of heartburn during your pregnancy, these methods can help reduce how often it occurs and how severely it affects you. Be sure to consult your doctor before trying any lifestyle and dietary advice and before taking any medication.
Sources: INSIDER, American Pregnancy Association, Stanford Children's Health