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 In Ask an Expert, Midwifery, OB/GYN & Women's Health, Pulse Blog

Q: Why is heartburn a problem during pregnancy?

Heartburn is one of the most common complaints in pregnancy. The hormone progesterone is elevated in pregnancy and causes muscles to relax. One of the muscles that relaxes is the pyloric sphincter, which is the “doorway” between the stomach and esophagus. When this muscle relaxes from the normal hormones of pregnancy, heartburn can occur. This situation is complicated by the expanding uterus, which can push on the stomach and force acid up toward the esophagus. Many women get heartburn during pregnancy and it worsens as pregnancy progresses. As with many other pregnancy aches and pains, it usually goes away after the baby is born.

The most common symptoms of acid reflux during pregnancy are:

  • Burning in the chest, known as heartburn
  • Burning in the throat or an acid taste in the mouth
  • Stomach or chest pain
  • Nausea or vomiting
  • Trouble swallowing
  • A raspy voice or sore throat
  • A dry cough.

Several lifestyle changes may help reduce heartburn symptoms. I suggest that pregnant women:

  • Avoid lying down within three hours of eating.
  • Eat five or six smaller meals a day rather than three square meals a day.
  • Avoid wearing tight-fitting clothes. Now is the time to be comfortable!
  • Avoid eating until they are very full.
  • Avoid foods that commonly make acid reflux worse, including coffee, cola, tea, citrus foods, tomatoes, chocolate, and fatty or fried foods.
  • Raise the head of the bed by six to eight inches by inserting blocks of wood between the mattress and box spring. A styrofoam wedge under the pillow can also help.

Certain foods may help with heartburn. Moms-to-be can try to:

  • Chew gum after eating. This can really help with digestion and acid levels in the stomach.
  • Eat raw almonds (not dry roasted). Raw almonds are a super food—good for heartburn and a great pregnancy snack.
  • Eat avocados.
  • Drink apple cider vinegar. Sometimes low stomach acid can actually contribute to heartburn, and apple cider vinegar remedies this issue. Mixing the apple cider vinegar with some water, honey, and a squeeze of lemon can make it taste better.
  • Take papaya enzymes. These tablets may be purchased at a health food store. They are usually chewable and some are flavored. While they don’t work for everyone, some pregnant moms get great relief.

Some medications can also provide relief. Antacids that have calcium (Tums) or magnesium (Maalox) are good options. Women should avoid taking antacids that contain aspirin (Alka-Seltzer and Pepto-Bismol) or sodium bicarbonate. Women should always tell their midwife about any over-the-counter medications they are using. If antacids don’t work, histamine blockers such as ranitidine (Zantac) and famotidine (Pepcid) have been found to be safe in pregnancy.

If the above lifestyle changes, foods, or medications don’t help, it’s a good idea for women to discuss other options with their midwife. The good news is that heartburn generally resolves on its own after the baby is born.

Lauren Andronici is a certified nurse midwife at Vancouver Clinic. She holds a master of science in nursing with a specialty in midwifery from Oregon Health & Science University. Lauren believes in giving women the education they need to be decision makers in their own care.