How early can you have heartburn in pregnancy
Indigestion and heartburn in pregnancy
Indigestion, also called heartburn or acid reflux, is common in pregnancy. It can be caused by hormonal changes and the growing baby pressing against your stomach.
You can help ease indigestion and heartburn by making changes to your diet and lifestyle, and there are medicines that are safe to take in pregnancy.
Symptoms of indigestion and heartburn
Symptoms of indigestion and heartburn include:
- a burning sensation or pain in the chest
- feeling full, heavy or bloated
- burping or belching
- feeling or being sick
- bringing up food
Symptoms usually come on soon after eating or drinking, but there can sometimes be a delay between eating and developing indigestion.
You can get symptoms at any point during your pregnancy, but they are more common from 27 weeks onwards.
Things you can do to help with indigestion and heartburn
Changes to your diet and lifestyle may be enough to control your symptoms, particularly if they are mild.
Eat healthily
You're more likely to get indigestion if you're very full.
If you're pregnant, it may be tempting to eat more than you would normally, but this may not be good for you or your baby.
Find out more about a healthy diet in pregnancy and foods to avoid.
Change your eating and drinking habits
You may be able to control your indigestion with changes to your eating habits.
It can help to eat small meals often, rather than larger meals 3 times a day, and to not eat within 3 hours of going to bed at night.
Cutting down on drinks containing caffeine, and foods that are rich, spicy or fatty, can also ease symptoms.
Keep upright
Sit up straight when you eat. This will take the pressure off your stomach. Propping your head and shoulders up when you go to bed can stop stomach acid coming up while you sleep.
Stop smoking
Smoking when pregnant can cause indigestion, and can seriously affect the health of you and your unborn baby.
When you smoke, the chemicals you inhale can contribute to your indigestion. These chemicals can cause the ring of muscle at the lower end of your gullet to relax, which allows stomach acid to come back up more easily. This is known as acid reflux.
Smoking also increases the risk of:
- your baby being born prematurely (before week 37 of your pregnancy)
- your baby being born with a low birthweight
- sudden infant death syndrome (SIDS), or "cot death"
There's lots of help available to stop smoking.
Talk to your midwife or call the NHS Smokefree helpline on 0300 123 1044. Find out more about stopping smoking in pregnancy.
Avoid alcohol
Drinking alcohol can cause indigestion. During pregnancy, it can also lead to long-term harm to the baby. It's safest to not drink alcohol at all in pregnancy.
Find out more about alcohol and pregnancy
When to get medical help
See your midwife or GP if you need help managing your symptoms or if changes to your diet and lifestyle do not work. They may recommend medicine to ease your symptoms.
You should also see your midwife or GP if you have any of the following:
- difficulty eating or keeping food down
- weight loss
- stomach pains
Your midwife or GP may ask about your symptoms and examine you by pressing gently on different areas of your chest and stomach to see whether it's painful.
If you're taking prescription medicines
Speak to your GP if you're taking medicine for another condition, such as antidepressants, and you think it may be making your indigestion worse. They may be able to prescribe an alternative medicine.
Never stop taking a prescribed medicine unless you're advised to do so by your GP or another qualified healthcare professional who's responsible for your care.
Medicines for indigestion and heartburn
Medicines for indigestion and heartburn during pregnancy include:
- antacids – to neutralise the acid in your stomach (some are available over the counter from a pharmacist)
- alginates – to relieve indigestion caused by acid reflux by stopping the acid in your stomach coming back up your gullet
You may only need to take antacids and alginates when you start getting symptoms.
However, your GP may recommend taking them before symptoms come on – for example, before a meal or before bed.
If you're taking iron supplements as well as antacids, do not take them at the same time. Antacids can stop iron from being absorbed by your body.
If antacids and alginates do not improve your symptoms, your GP may prescribe a medicine to reduce the amount of acid in your stomach. 2 that are widely used in pregnancy and not known to be harmful to an unborn baby are:
- ranitidine – a tablet you take twice a day
- omeprazole – a tablet you take once a day
Causes of indigestion in pregnancy
Symptoms of indigestion come when the acid in your stomach irritates your stomach lining or your gullet. This causes pain and a burning feeling.
When you're pregnant, you're more likely to have indigestion because of:
- hormonal changes
- the growing baby pressing on your stomach
- the muscles between your stomach and gullet relaxing, allowing stomach acid to come back up
You may be more likely to get indigestion in pregnancy if:
- you had indigestion before you were pregnant
- you've been pregnant before
- you're in the later stages of pregnancy
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Indigestion and heartburn in pregnancy
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Many women experience indigestion and heartburn while they are pregnant, which can be painful or uncomfortable. There are ways to help avoid or treat indigestion and heartburn, especially if it is mild. Sometimes the feeling of heartburn can be confused with a more serious condition called pre-eclampsia.
Indigestion, also called 'dyspepsia', is a feeling of pain or discomfort in the stomach (upper abdomen, or, tummy). This mostly occurs after eating or drinking but can happen some time after.
If you have indigestion in the early stage of your pregnancy, this may be caused by changes in your hormone levels. In the second or third trimester, indigestion becomes more common and may be caused by your baby pushing up against your stomach. As many as 8 in 10 women may have indigestion during their pregnancy.
Symptoms of indigestion may include:
- heartburn
- reflux or regurgitation (food coming back up from your stomach)
- burping
- feeling heavy, bloated or full
- feeling sick
- vomiting
Heartburn is a burning pain in the throat or chest, behind the breastbone, caused by stomach acid coming up the oesophagus (the tube that connects your mouth to your stomach) and irritating the lining.
In pregnant women, indigestion and heartburn can be caused by:
- eating a big meal
- eating high-fat foods
- eating chocolate or peppermint
- drinking fruit juice or caffeinated beverages (coffee, tea, cola drinks)
- doing physical activity soon after eating
- bending over
- feeling anxious
It's a good idea to take note of the particular foods, drinks or activities that give you indigestion while you are pregnant.
Avoiding indigestion and heartburn
If your symptoms are mild, it's possible that changes to your diet or lifestyle may help prevent indigestion and heartburn. You could try:
- eating smaller meals, more often
- avoiding eating just before bed
- avoiding foods and drinks that you suspect give you heartburn
- not drinking a lot of coffee at the end of the day
- avoiding eating and drinking at the same time, which can make your stomach more full
- sitting up straight while eating, and not lying down after a meal
- chewing gum, which may cause you to produce more saliva to help neutralise the acid
- stop smoking
- raise the head of your bed by 10 to 15cm
- sleep on your left side
If your indigestion is not helped by diet and lifestyle changes, or your symptoms are more severe, your doctor or midwife may suggest that you take a medicine for indigestion that is safe to use during pregnancy. Medicines can neutralise the acid in your stomach, reduce the amount of acid produced by your stomach and stop the acid rising into your oesophagus.
Heartburn symptoms and pre-eclampsia
If your heartburn symptoms don't go away with medicine, it's important to see your doctor as it may be a sign of something more serious, such as pre-eclampsia. A pregnant woman with pre-eclampsia usually has high blood pressure and problems with her kidneys. Pre-eclampsia could also seriously affect a woman's liver, blood and brain. Any pregnant woman can experience pre-eclampsia – almost 1 in 20 Australian women will develop it.
Because pre-eclampsia is dangerous for both you and your baby, you should let your doctor know if your heartburn medicine is not working. This is especially important if you're also feeling very unwell or you have:
- sudden swelling of your hands, feet or face
- a headache that doesn't go away with simple painkillers
- problems with your eyesight such as blurring or seeing flashing lights or dots
- a strong pain below your ribs
Find out more about how pre-eclampsia is treated here.
Call Pregnancy, Birth and Baby on 1800 882 436 to speak to a maternal child health nurse.
Sources:
Royal Australian and New Zealand College of Obstetricians and Gynaecologists (Pre-eclampsia and high blood pressure during pregnancy), Gastroenterological Society of Australia (Heartburn - Oesophageal Reflux), Gastroenterological Society of Australia (Heartburn - Reflux), King Edward Memorial Hospital (Minor symptoms or disorders in pregnancy), Raising Children Network (Health problems in pregnancy), Royal Australian and New Zealand College of Obstetricians and Gynaecologists (Antenatal care during pregnancy), Department of Health (Clinical Practice Guidelines: Pregnancy Care), Mater Mothers Hospital (Pregnancy information for women and families)Learn more here about the development and quality assurance of healthdirect content.
Last reviewed: May 2020
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- Common discomforts during pregnancy
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Heartburn during pregnancy. How to get rid of it?
One of the constant companions of pregnancy (in more than 80% of cases) is an unpleasant burning sensation behind the sternum - heartburn.
The feeling of heartburn occurs when the acidic contents of the stomach enter the esophagus. Normally, this is impossible, since there is a narrowing between the esophagus and the stomach - the so-called lower esophageal sphincter, the muscle tone of which is regulated by the nervous and hormonal systems.
2 main causes of heartburn during pregnancy
In early pregnancy, during the first trimester of pregnancy, heartburn occurs due to a sharp increase in the level of the sex hormone progesterone.
Progesterone relaxes all smooth muscles, incl. and muscles of the lower esophageal sphincter. This results in backflow of acidic contents into the esophagus. Usually this type of heartburn goes away by 13-14 weeks of pregnancy.
In the later stages of pregnancy, in the third trimester, due to the displacement of the internal organs, the stomach is squeezed and lifted, and thus the acidic contents more easily overcome the barrier between the stomach and esophagus and provoke a feeling of heartburn.
This must be understood!
Folk remedies for heartburn during pregnancy: milk, soda, seeds are unacceptable treatments. With their continued use, complications can occur.
Milk is not an adult dietary product. Most people develop physiological lactose intolerance after the age of 2 years, and excessive consumption of milk (more than 1-2 glasses per day) can cause diarrhea, bloating and abdominal pain.
Taking soda to suppress heartburn during pregnancy provokes an increase in the amount of gases and causes a "mirror response" of the stomach to a sharp alkalization of the contents - an increase in the acidity of the stomach and an increase in the alkalinity of the blood.
This can provoke a feeling of heartburn, nausea, vomiting, diarrhea.
How to get rid of heartburn during pregnancy?
What can and cannot be done during pregnancy with heartburn? First of all, it is necessary to avoid taking foods that can increase the increase in stomach acidity - these are fatty, spicy, heavy foods. It is also not recommended to consume chocolate, coffee, freshly squeezed juices.
Recommended for heartburn during pregnancy to eat more vegetables and cereals. Eating should be fractional - about 5-6 times a day in order to evenly distribute the load on the stomach during the day, so that the gastric juice is always with food, and not in a free state.
Try to avoid stress, adhere to a normal mode of work, rest, sleep. After eating, walks are required (in no case do not lie down). The position of the body during the day should be such as not to increase intra-abdominal pressure - while sitting, do not cross your legs, the level of the knees should not be higher than the level of the hips. It is recommended to lie with a slightly raised upper body.
Preparations during pregnancy for heartburn.
The simplest and most reliable remedy is still alkaline water, bananas, pears, peeled peaches (but the doses should not be excessive). If there is no effect, they resort to well-established drugs that can be used to combat heartburn: Rennie or Gaviscon forte (WARNING!!! Self-medication can be harmful to your health).
MC "Academy of Your Health" recommends that you consult with a professional gastroenterologist or gynecologist to solve the problem associated with heartburn during pregnancy. The doctor will be able to competently assess the causes of your heartburn and offer an optimal and harmless treatment regimen, taking into account concomitant pregnancy.
Author: Dushinsky Yuri Sergeevich
why it occurs and how to get rid of it
The prevalence of heartburn increases from the 20th week of pregnancy and covers the vast majority of women by the time of delivery.
Usually, the symptom is provoked by the "heavy" food eaten the day before, so it can be repeated many times throughout the day, and one episode of heartburn lasts minutes or even hours. In addition to heartburn itself, there may be belching of air, pain behind the sternum, and swallowing is disturbed 1 .
Causes of heartburn in pregnant women
There are a number of factors that predispose to heartburn during pregnancy. These include2:
episodes
heartburn before pregnancy
multiple pregnancy
overweight before or
significant weight gain
during pregnancy
The main causes of heartburn in pregnant women are divided into: mechanical (physical) and hormonal 2 .
The mechanical cause of is an increase in the size of the pregnant uterus.
The growing uterus displaces and compresses other organs in the abdomen, which increases intra-abdominal pressure. At the same time, the stomach is “squeezed” to the diaphragm, the locking mechanism that separates the esophagus from the stomach is weakened, which predisposes to the development of hiatal hernia. In general, the described mechanisms often lead to acid reflux - the backflow of gastric contents into the esophagus, accompanied by heartburn 2 .
Hormonal causes include an increase in progesterone production. Progesterone reduces the tone of the smooth muscles of the uterus, protecting the pregnancy from the threat of termination. In the same way, progesterone acts on other smooth muscle organs. Under the influence of hormones during pregnancy, there may be a decrease in the tone of the lower esophageal sphincter and a weakening of intestinal motility, including due to a violation of the sensitivity of intestinal receptors to biologically active substances - serotonin and histamine.
As a result, food can linger in the stomach, increasing the likelihood of acid reflux. Due to the weakening of peristalsis, there is also a risk of constipation and changes in the intestinal microflora 2 .
First trimester
A complaint in pregnant women at an early stage appears due to toxicosis with repeated vomiting, when the mucosa of the esophagus is constantly irritated by vomit 1 .
First trimester
A complaint in pregnant women at an early stage appears due to toxicosis with repeated vomiting, when the mucosa of the esophagus is constantly irritated by vomit 1 .
Second and third trimesters
In the second and third trimesters, symptoms may occur due to decreased pressure in the esophagogastric sphincter and functional failure of the upper stomach 1 . Also, in late pregnancy, the factors provoking heartburn may include an increase in intra-abdominal pressure due to an increase in the volume of the uterus and an increase in the level of gastrin in the blood of pregnant women 1 .
Second and third trimesters
In the second and third trimesters, symptoms may occur due to a decrease in pressure in the esophagogastric sphincter and functional insufficiency of the upper stomach 1 . Also, in late pregnancy, the factors provoking heartburn may include an increase in intra-abdominal pressure due to an increase in the volume of the uterus and an increase in the level of gastrin in the blood of pregnant women 1 .
postpartum period
Unfortunately, the symptoms of heartburn do not always disappear without a trace after childbirth: about 20% of women who experience heartburn during pregnancy also notice it in the postpartum period 2 . It is possible that the development of heartburn in the postpartum period may be associated with the lactation period, this relationship has yet to be established.
According to the instructions for the medical use of the drug Maalox®, the absorption of combinations of aluminum hydroxide and magnesium salts in the mother is limited, therefore, Maalox® can be used during lactation after consulting a doctor. For occasional heartburn, use 15 ml or 1-2 tablets of Maalox® once . 4-6
Unfortunately, the symptoms of heartburn do not always disappear without a trace after childbirth: about 20% of women who experience heartburn during pregnancy also notice it in the postpartum period 2 . It is possible that the development of heartburn in the postpartum period may be associated with the lactation period, this relationship has yet to be established. According to the instructions for the medical use of the drug Maalox®, the absorption of combinations of aluminum hydroxide and magnesium salts in the mother is limited, therefore, Maalox® can be used during lactation after consulting a doctor.
For occasional heartburn, use 15 ml or 1-2 tablets of Maalox® once . 4-6
Symptoms of heartburn in pregnant women
Heartburn is an unpleasant burning sensation, warmth behind the sternum, which can spread to the neck area 3 . The symptom may appear about an hour after eating. Often entails heartburn eating fried, spicy, fatty, sour foods, as well as overeating. Physical activity and changes in body position, such as leaning forward or lying down, may increase heartburn symptoms 3 . In pregnant women, heartburn is often accompanied by belching and difficulty swallowing 1 .
Heartburn is an unpleasant sensation of burning, warmth behind the sternum, which can spread to the neck area 3 . The symptom may appear about an hour after eating. Often entails heartburn eating fried, spicy, fatty, sour foods, as well as overeating.
Physical activity and changes in body position, such as leaning forward or lying down, may increase heartburn symptoms 3 . In pregnant women, heartburn is often accompanied by belching and difficulty swallowing 1 .
Why is heartburn dangerous in pregnant women?
Heartburn that occurs during pregnancy may increase the chance of developing GERD after childbirth. Moreover, the risk of developing the disease is proportional to the number of births. It was noted that in the presence of heartburn in the 1st pregnancy, GERD subsequently develops in 17.7% of women , and two pregnancies with heartburn increase this figure to 36% 2 .
It is important to note that if heartburn occurs during pregnancy, it is imperative to consult a doctor, since heartburn can manifest other diseases of the digestive system, including severe pathology of the gestation period - acute fatty liver of pregnant women.
In this case, heartburn is short-lived at first, then its intensity and duration increase, accompanied by painful swallowing of not only food, but also liquids. Heartburn in this case is often accompanied by vomiting of the color of "coffee grounds", weakness, lethargy. Such a dangerous condition requires close medical attention and control 1 .
Heartburn that occurs during pregnancy may increase the chance of developing GERD after childbirth. Moreover, the risk of developing the disease is proportional to the number of births. It has been noted that in the presence of heartburn in the 1st pregnancy, GERD subsequently develops in 17.7% of women , and two pregnancies with heartburn increase this figure to 36% 2 .
It is important to note that if heartburn occurs during pregnancy, it is imperative to consult a doctor, since heartburn can manifest other diseases of the digestive system, including severe pathology of the gestation period - acute fatty liver of pregnant women.
