Heartburn During Pregnancy – Causes and Relief

Heartburn During Pregnancy

Heartburn (medically known as pyrosis) is one of the most common complaints experienced during pregnancy. Studies suggest that up to 80% of pregnant women are affected at some point during their pregnancy. The burning sensation behind the breastbone occurs when stomach acid flows back into the esophagus – a process known as gastroesophageal reflux.

Causes

Heartburn during pregnancy has several typical causes, all closely related to the physical changes that occur during this time:

• Hormonal changes: The pregnancy hormone progesterone relaxes smooth muscle throughout the body – including the lower esophageal sphincter. This allows stomach acid to travel more easily back into the esophagus.
• Growing uterus: Especially in the second and third trimesters, the expanding uterus pushes against the stomach, increasing abdominal pressure and promoting acid reflux.
• Slowed gastric emptying: Progesterone also slows digestion, causing stomach contents to remain longer in the stomach and increasing acid pressure.
• Changes in eating habits: Frequent cravings and altered food preferences during pregnancy may lead to consumption of foods that trigger heartburn.

Symptoms

Typical symptoms of heartburn during pregnancy include:

• Burning sensation behind the breastbone, often radiating upward toward the throat
• Sour or acidic taste in the mouth due to regurgitation
• Feeling of pressure or fullness in the upper abdomen
• Nausea, especially after eating
• Hoarseness or a dry cough (if acid reaches the throat)

Symptoms are most common after meals, when bending over, or when lying down, and they often worsen as the pregnancy progresses.

When to See a Doctor

In most cases, heartburn during pregnancy is harmless. However, medical evaluation is strongly recommended in the following situations:

• Severe or persistent upper abdominal pain
• Difficulty or pain when swallowing
• Blood in vomit or black stools (possible signs of internal bleeding)
• Significant unexplained weight loss
• Symptoms that do not improve with treatment

Diagnosis

During pregnancy, heartburn is typically diagnosed based on the description of symptoms alone. Invasive procedures such as a gastroscopy (endoscopy of the stomach) are usually not necessary and are only considered in cases with severe or unclear symptoms. The treating obstetrician or general practitioner can assess the condition in a consultation and recommend appropriate measures.

Treatment and Relief

General Measures (Non-Pharmacological)

In many cases, simple lifestyle adjustments can significantly reduce heartburn during pregnancy:

• Eat several small meals throughout the day instead of a few large ones
• Eat slowly and chew food thoroughly
• Avoid triggers: Fatty, spicy, or acidic foods, coffee, carbonated drinks, chocolate, and citrus fruits can worsen heartburn
• Stay upright for at least 2–3 hours after eating and avoid lying down immediately
• Elevate the upper body slightly when sleeping (e.g., by using an extra pillow)
• Avoid tight-fitting clothing that puts pressure on the abdomen
• Reduce stress, as it can stimulate stomach acid production

Home Remedies

Some pregnant women report relief from:

• A glass of lukewarm water after meals
• Plain crackers or dry toast, which may help absorb excess stomach acid
• Unsalted almonds, which are said to have a mildly alkaline effect
• Small amounts of ginger tea (after consulting a healthcare provider)

Medical Treatment

If lifestyle changes are not sufficient, medications may be used after consultation with a healthcare provider. Extra caution is required, as not all medications are safe during pregnancy:

• Antacids (e.g., calcium carbonate, magnesium hydroxide): Neutralize stomach acid and are generally considered safe during pregnancy when taken short-term at recommended doses. Antacids containing sodium bicarbonate or aluminum should be avoided in pregnancy.
• Alginates (e.g., sodium alginate): Form a protective gel layer on top of stomach contents to prevent reflux. They are generally regarded as safe in pregnancy.
• H2 blockers (e.g., ranitidine – no longer available in some countries): Reduce acid production and may be used on medical advice.
• Proton pump inhibitors (PPIs) (e.g., omeprazole, pantoprazole): Used only for severe symptoms and after careful medical evaluation, as safety data in pregnancy are not yet fully conclusive.

Important: Any medication use during pregnancy should always be discussed with the treating healthcare provider first.

Outlook and Prognosis

Although heartburn during pregnancy is uncomfortable, it is generally harmless and does not cause lasting damage. After delivery and the normalization of hormone levels, symptoms typically resolve completely or improve significantly in most women. Only in rare cases does a clinically relevant gastroesophageal reflux disorder persist after pregnancy.

References

1. Richter JE. - Gastroesophageal reflux disease during pregnancy. Gastroenterology Clinics of North America, 2003. Available via PubMed.
2. National Institute for Health and Care Excellence (NICE) - Antenatal care guideline. London: NICE, 2021. Available at: nice.org.uk
3. World Health Organization (WHO) - Recommendations on antenatal care for a positive pregnancy experience. Geneva: WHO, 2016.