Severe heartburn pregnancy third trimester

Feeling the burn? Tips to manage heartburn, GERD in pregnancy | Your Pregnancy Matters

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Your Pregnancy Matters

July 30, 2019

Your Pregnancy Matters

Robyn Horsager-Boehrer, M. D. Obstetrics and Gynecology

Alan Kramer, M.P.H. Assistant Vice President for Health System Emerging Strategies

The pregnancy hormone progesterone can increase heartburn, starting in the first trimester.

Heartburn is common in adults – especially during pregnancy. While some research suggests women who have moderate heartburn during pregnancy give birth to babies with fuller heads of hair, having symptoms more than twice a week might be a sign of gastroesophageal reflux disease (GERD), or recurrent heartburn.

According to a study of 510 pregnant women, approximately 26% have GERD symptoms during the first trimester. The rate jumps to 36% in the second trimester and 51% during the third trimester. That’s substantial compared with the 20% of adults in the U.S. who experience heartburn.

Why the increase in symptoms during pregnancy? Progesterone, a hormone that increases early in pregnancy, relaxes smooth muscle in the body. It helps your uterus stretch to accommodate the growing fetus, but also reduces the reliability of the esophageal sphincter – a ring-like structure that seals off stomach contents from the throat.

Increased pressure placed on the stomach externally from the growing uterus, especially in the third trimester, can also worsen heartburn symptoms such as:

Burning pain in the center of the chest, especially after eating
Sour or bitter taste in the mouth
Sore throat or cough

Thankfully, there are several pregnancy-safe ways to deal with acute heartburn and ongoing cases of GERD.

"Progesterone, a hormone that increases early in pregnancy, also reduces the reliability of the esophageal sphincter, which means that certain foods such as spicy dishes may trigger heartburn symptoms."
Robyn Horsager-Boehrer, M.D.

Heartburn treatment options during pregnancy

Lifestyle changes

Consider these diet and sleep modifications to relieve or prevent heartburn:

Avoid tobacco and alcohol. These substances worsen the symptoms, and it’s already recommended for all women during pregnancy to avoid smoking, vaping, and drinking alcohol. Need to quit? We offer a free tobacco cessation program.
Shift your eating schedule. Smaller, more frequent meals fill the stomach less and may reduce symptoms. Also, avoid bending over or lying flat after meals to reduce acid reflux.
Prop yourself up in bed. Try sleeping with an extra pillow under your head or a small wedge under your pillow. The incline can help prevent stomach acid from splashing into your lower esophagus.
Skip the sauce or spice. If you notice that certain foods such as tomato sauces or spicy dishes trigger symptoms, avoid them until after the baby comes.

Oral antacids with calcium carbonate have the added benefit of supplementing calcium intake during pregnancy.

Medications

Heartburn and GERD symptoms are less severe when there is less acid in the stomach. That said, you need a certain amount of acid to properly digest food. Three types of medication can help create that balance.

Oral antacids like aluminum and magnesium hydroxide (think Maalox or Mylanta) and calcium carbonate (like TUMS) neutralize acid already present in the stomach. Calcium carbonate has the added benefit of supplementing calcium intake during pregnancy. It’s safe to follow the directions on the package – there’s no need to change the dosage or schedule due to pregnancy.

On the flip side, two types of medications actually reduce acid production before it can enter the stomach.

h3-receptor antagonists (h3-blockers) reduce h3 histamine, which stimulates cells in the stomach to produce acid. Thus, less stomach acid is produced. Examples include ranitidine (Zantac), cimetidine (Tagamet HB), and famotidine (Pepcid). All of these are available over the counter and in generic forms.

Proton pump inhibitors (PPIs) block an enzyme in stomach cells that’s needed to produce acid. These drugs are available over the counter but can take several days to provide maximum relief, so you might consider trying an antacid or h3 blocker first. Examples of PPIs include lansoprazole (Prevacid) and omeprazole (Prilosec), as well as generic versions. Both brand name and generic are considered safe during pregnancy.

Please note, because stomach acid is necessary for iron absorption, h3 blockers and PPIs can decrease the effectiveness of iron supplements. Talk to your doctor if this might be an issue for you.

Related reading: 4 common pregnancy-related GI issues

When to call the doctor

If heartburn symptoms are associated with headaches or swelling of the hands and face, talk with your provider before trying these remedies, especially if the symptoms are new and present in the last trimester of pregnancy.

Heartburn-like pain can be a symptom of preeclampsia, or dangerously high blood pressure during pregnancy. Preeclampsia puts mothers and babies at risk, and further evaluation may be necessary.

As mentioned, heartburn is very common in pregnancy. If your symptoms don’t resolve with diet changes or medication, let your provider know so you can find an effective treatment.

Tired of feeling the burn? Call 214-645-8300 or request an appointment online.

Pregnancy Heartburn? 7 Ways to Get Relief

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Kathryn Walker, MD May 20, 2021

Women and Newborn

Learn more about women and newborn services we offer.

Expectant mothers everywhere are aching to know one thing: “How can I get some relief from this awful pregnancy heartburn?”

To help ease your pain, here are some answers to your “burning” questions. (Pardon the pun.)

When you’re growing a human being, you don’t have time for that yucky acid reflux. But your usual go-to methods for treating it may not be safe for your unborn baby. (Remember Pepto Bismol? That’s on the No Fly List for moms-to-be, according to FDA recommendations.)

Instead, here are some of the safest and best ways to get rid of heartburn when you’re pregnant:

Dip into some yogurt. Its probiotics and soothing texture make yogurt a great option for extinguishing heartburn – or at least dousing the flames a little.
Drink milk with honey. According to the American Pregnancy Association, a tablespoon of honey mixed in a glass of warm milk may be just what you need to neutralize heartburn-causing acid.
Snack on almonds. Munching on a handful of almonds may provide heartburn relief since these nuts have a lower acidity level than others.
Eat pineapple or papaya. For some women, the digestive enzymes in pineapple and papaya have helped ease symptoms. Eating these fruits after your meals can aid digestion and reduce your chances of heartburn.
Try a little ginger. You probably knew ginger was a good remedy for an upset stomach. Well, that makes it a helpful candidate for fighting off heartburn, too. Among ginger’s many benefits, it can reduce inflammation and prevent stomach acid from traveling up the esophagus.
Chew sugar-free gum. Another effective method for taming the burn is to chew some sugar-free gum. One study found that chewing sugar-free gum for 30 minutes after a meal can reduce acid reflux.
Take (doctor-approved) medication. When all else fails, certain medications are considered safe to use for pregnancy heartburn relief. Just make sure you speak to your doctor or OB-GYN first. If your heartburn is severe, they may prescribe special medication to help control it.

While not every tip mentioned above may work to ease your symptoms, you’ve got nine months to try them all and figure out what works.

It’s important to be extremely careful about the medications you take when pregnant.

For heartburn relief, over-the-counter antacids (such as Tums, Mylanta, Rolaids, and Maalox) are all considered safe medications to use during pregnancy.

As always, consult with your provider about any medications you’re taking – even if they’re considered safe. (This is especially true for high-risk pregnancies.)

If you experience any unusual symptoms while taking an over-the-counter medication, call your doctor immediately.

They say prevention is the best medicine, so knowing common heartburn triggers can help you keep the acid at bay.

Of course, pregnancy itself is a major trigger for heartburn. As your growing uterus puts pressure on your stomach, this pushes stomach acid up your throat.

Those lovely hormones are no help either. They tend to relax the valve between your stomach and esophagus, which makes it easier for acid to make its way upward.

While there’s nothing you can do to stop this entirely, there are a few things that can help prevent heartburn from flaring up during pregnancy:

Avoid lying down after eating. It may be tempting to take a post-meal nap, but if you want to prevent heartburn, don’t lie down after eating. Consider napping in an upright recliner instead.

Prop yourself up at night. It’s hard enough to sleep well while pregnant without throwing acid reflux on top of everything. To prevent nighttime heartburn, try propping yourself up when you go to sleep to counteract the acid.

Don’t eat before bedtime. In addition to propping yourself up at night, try not to eat anything within three hours of hitting the sack.

Skip spicy, acidic, or fried foods. Ask yourself: Are those greasy chips worth being doubled over in pain later? (Probably not.) If you want to avoid the risk, steer clear of any and all rich, fatty foods. Not only will this help prevent heartburn, but making more nutritious choices helps ensure that you your baby is getting the important vitamins and minerals that they need to stay healthy in utero.

Eat small meals, but more frequently. Your pregnant tummy doesn’t love to be hit with large amounts of food to digest in one go. Make things easier on your gut by eating several small meals throughout the day instead of three large ones.

Eat slowly. Wolfing down those small meals will defeat the purpose of spreading them out. Eating quickly increases the risk of acid reflux, so slow down and enjoy your food.

Wear loose clothing. Tight-fitting clothes are not your stomach’s best friend when you’re trying to prevent heartburn – particularly during pregnancy. Wear clothing that offers support without being restrictive.

Drink your liquids between meals. If you’re the type of person who likes to take a swig of their drink between each bite, it’s time to change course. Drinking liquids during meals can exacerbate heartburn symptoms, so take little sips if you’re thirsty at mealtime.

Someday, scientists may very well invent a miracle medication that promises permanent pregnancy heartburn relief. Unfortunately, that hasn’t happened yet.

So, if you’re wondering how long you can expect to deal with heartburn while you’re pregnant, it will probably be throughout your entire pregnancy. (Now may be a good time to remind yourself that you get a cute little baby out of this when you’re done.)

However, just because there’s no cure, that doesn’t mean you can’t find some relief in the meantime.

If severe pregnancy heartburn is getting in the way of everyday life, it’s time to see a doctor.

Intermountain Healthcare offers individualized and compassionate pregnancy care for women of all ages and health needs.

To get the care you need, search for a provider or find an Intermountain Healthcare location near you.

Intermountain Moms Women's Health, Baby Your Baby, Pregnancy, Women and Newborn
Last Updated: 5/21/2021

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Copyright ©2022, Intermountain Healthcare, All rights reserved.

How to get rid of heartburn during pregnancy

Boltovsky Vladimir Anatolievich

Pediatrician, Nephrologist

Children's clinic "Mother and Child" Samara

If, after some time after eating, the expectant mother has a feeling of warmth or burning behind the sternum, then this is heartburn.

Not all antacids can be used during pregnancy. For example, preparations containing bismuth nitrate ( Vikalin , etc.), should not be taken by expectant mothers due to the fact that the effect of bismuth on the development of the child is unknown.

Heartburn usually appears after the 20th week of pregnancy and torments the expectant mother until the birth of the child.

what she looks like

If, after some time after eating, the expectant mother has a feeling of warmth or burning behind the sternum, then this is heartburn. And most often these unpleasant sensations occur in the evening. Heartburn usually appears after the 20th week of pregnancy and torments the expectant mother until the birth of the child. According to popular belief, she worries the expectant mother when the baby's hair grows. In fact, heartburn occurs due to the fact that the acidic contents of the stomach are thrown into the lower esophagus. This happens because during pregnancy, the muscular sphincter, located between the esophagus and stomach, relaxes under the influence of the hormone progesterone. Another cause of heartburn is an enlarged uterus (and it just increases greatly after the 20th week) presses on neighboring organs: the stomach, intestines. As a result, the volume of the stomach decreases and even the usual amount of food leads to its overflow and the reflux of food back into the esophagus.

what will help

If heartburn occurs infrequently and does not bother you much, then in order to reduce its symptoms, you just need to eat right and change your lifestyle. The simplest thing that helps with heartburn:

Fractional meals: eat often 5-6 times a day at intervals of 1.5-2 hours and in small portions. Eat slowly, chewing your food thoroughly.

Healthy food: Avoid fatty and fried foods and chocolate. All these products provoke additional relaxation of the esophageal sphincter.

Heartburn usually occurs within the first two hours after eating, so do not lie down immediately after eating.

Sleep with the head of the bed raised by adding another pillow.

simple remedies

The simplest thing that helps with heartburn is some foods. For example, a burning sensation behind the sternum perfectly removes low-fat milk, just a few sips - and heartburn goes away or is significantly reduced. Ice cream works the same way, as well as grapefruit and carrot juices. You can get rid of heartburn by eating nuts (walnuts, hazelnuts, almonds), but they are more likely to prevent heartburn than to eliminate an existing one. And ordinary seeds help someone cope with heartburn. In general, the expectant mother can only choose the right product for herself, but here, as with food in general, one must observe the measure. No need to eat a block of ice cream or a package of seeds every day, drink glasses of juice or endlessly eat nuts. Of course, they will help, but ice cream and nuts are high in fat and calories, and juices in large quantities hit the pancreas and increase sugar levels. A small amount of one of some product will completely cope with an attack of heartburn.

be careful

Some medications, especially antispasmodics (drugs that relieve spasms of the smooth muscles of the internal organs), such as No-shpa , Papaverine , relax the esophageal sphincter and thus contribute to heartburn. Some herbs, such as mint, also work. Tight clothing under the chest (elastic bands, belts), a change in body position (tilts, turns) can also cause heartburn.

In general, every expectant mother can carefully observe herself and identify her personal cause of heartburn, then it will be much easier to deal with it.

old remedy

Baking soda is often used to treat heartburn. It really helps to relieve the unpleasant burning sensation very quickly, but at the same time it does not last long. In addition, when soda interacts with gastric juice, carbon dioxide is formed, which irritates the stomach - as a result, new portions of hydrochloric acid are produced and heartburn resumes. It turns out that a teaspoon of soda in a glass of water instantly relieves heartburn, but in response to taking soda, the next time the heartburn attack will be even stronger.

safe drugs

During pregnancy you can use the so-called antacids (Maalox, Almagel, Rennie, Gaviscon) . They contain salts of magnesium and aluminum, they neutralize the acid of gastric juice, form a protective film on the wall of the stomach, increase the tone of the lower esophageal sphincter. True, sometimes some antacids cause constipation (due to calcium or aluminum salts), and magnesium, on the contrary, has a laxative effect. Therefore, long-term use of these drugs is not worth it. Antacids can absorb other medications, so there should be some time between taking antacids and other medications.

Despite the fact that heartburn is quite unpleasant for the mother, it does not affect the child in any way. Start the fight against heartburn with proper nutrition, and you may not need medication.

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Children's Clinic "Mother and Child" Samara

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Heartburn during pregnancy - symptoms, causes and methods of treatment of the disease

Contents

Causes of heartburn during pregnancy

What to do with heartburn during pregnancy?

Preparations for heartburn during pregnancy

Heartburn is an unpleasant feeling of burning or warmth behind the breastbone or in the epigastric region. The symptom occurs after eating or on an empty stomach and is associated with food reflux, that is, the reflux of food processed by gastric juice back into the esophagus. Since the mucous membrane of the esophagus is not adapted to the action of gastric juice, it becomes irritated, which is subjectively felt in the form of heartburn.

Heartburn in pregnant women is an independent symptom that appears only during the period of bearing a child against the background of the absence of chronic diseases that cause reflux of gastric juice ¹ . According to statistics, 30-50% of pregnant women suffer from heartburn, there is evidence that more than 80% of pregnant women complain of heartburn, especially in the third trimester ⁴ .

Causes of heartburn during pregnancy
Heartburn in pregnancy is a condition that is caused by the changes that occur to the female body during the period of gestation. All factors that can cause heartburn in women in an interesting position can be divided into physiological (natural) and pathological (disease-related).

Physiological heartburn of pregnant women can occur for two reasons:

Hormonal - associated with a weakening of the tone of the lower esophageal sphincter. This is the name of the circular muscle between the stomach and the esophagus, which regulates the flow of food into the stomach and prevents its movement in the opposite direction. During pregnancy, the level of progesterone in the blood rises, which relaxes the uterine muscle, simultaneously acting on all other muscles of the body, including the esophageal sphincter. As a result, the sphincter does not close after eating, but remains open. Any change in body position or contraction of the stomach causes food reflux ⁴ . Heartburn also occurs if it is disturbed by the movement of food through the esophagus, for example, if the frequency of "reverse" contractions of the esophagus increases in the direction from the stomach to the esophagus ¹ .

Physical - due to the increase in the size of the uterus, the location of the internal organs changes and intra-abdominal pressure increases, which is transmitted to the wall of the stomach and contributes to reflux ⁴ .

In connection with such changes in the gastrointestinal tract during pregnancy, all pathologies that cause heartburn can worsen.

Pathological causes of heartburn during pregnancy include the following:

Gastroesophageal reflux disease (reflux esophagitis) is a pathology of the esophageal sphincter, which occurs more often with diaphragmatic hernia, when the natural curve between the esophagus and stomach disappears, preventing reverse reflux ⁴ .

Other diseases of the gastrointestinal tract - gastritis, peptic ulcer of the stomach and duodenum, pancreatitis, diseases of the liver and biliary tract, inflammatory bowel disease ² . With gastritis and ulcers, the acidity of the stomach increases, and pathologies of other digestive organs cause bloating, constipation, enlargement of the liver, which increases intra-abdominal pressure.

Taking drugs that relax the lower esophageal sphincter - heart drugs, theophylline, anti-inflammatory drugs, progesterone, antidepressants ⁴ .

What to do about heartburn during pregnancy?
In the first two hours after eating, hydrochloric acid is produced in the stomach, which is needed for food processing. It is at this time that heartburn is more likely to torment, especially if a woman consumes fatty, fried and spicy foods ⁷ . Burning behind the sternum can last for several minutes or several hours. Heartburn may recur several times during the day. It is characterized by its strengthening in a horizontal position, with torso tilts, as well as when turning to the other side.

To reduce the severity of heartburn, you first need to adjust the diet and some habits. This helps to reduce the increased acidity of the stomach and prevent the reflux of food back into the esophagus.

Pregnant women should follow the following dietary recommendations ⁴ :

Do not eat excessively high-calorie foods.

Eliminate night snacks and especially overeating.

Eat often and in small portions.

Do not lie down immediately after eating, do not sleep in a strictly horizontal position, it is necessary to raise the head end of the bed.

Walk for 30 minutes after eating.

Eat dinner no later than 3-4 hours before going to bed.

Do not lift weights, do not make strong and frequent torso bends, do not overstrain the abdominal muscles.

Do not wear corsets, bandages, tight belts that increase intra-abdominal pressure.

From the diet for heartburn should be excluded ⁴ :

Carbonated drinks (they increase pressure in the stomach and stimulate the formation of hydrochloric acid).

Cream, whole milk, fatty meats, fatty fish, goose, pork (fatty foods take a long time to digest).

Chocolate, cakes, pastries, spices (relaxes the lower esophageal sphincter).

Citrus fruits, tomatoes, onions, garlic (irritate the mucous membrane of the esophagus).

For heartburn, pregnant women can eat the following foods ⁶ :

wheat bread, dry biscuits, dry biscuits;

baked pies with apples, boiled meat or fish;

soups of meat, fish, vegetables;

lean beef, poultry, fish;

soft-boiled eggs and scrambled eggs;

sugar, copper, butter cream;

tea, cocoa, sweet fruit juices, jams, compotes.

Pregnancy heartburn preparations
In 80% of pregnant women, heartburn disappears after childbirth, but severe heartburn during pregnancy, especially if it lasts for several weeks, may persist after the birth of a child ⁴ .

Often, proper nutrition and adherence to lifestyle recommendations do not always help get rid of heartburn. If heartburn is caused by any disease, adequate treatment of the underlying pathology with medications helps to eliminate unpleasant symptoms.

The use of folk and non-traditional ways to eliminate heartburn during pregnancy is also not effective enough and even potentially dangerous. Many of the herbs used during pregnancy can harm both the woman and her unborn baby ⁴ .

Therefore, it is advisable to discuss the choice of a drug with a doctor who will help you choose the right remedy for heartburn during pregnancy, paying attention from the standpoint of safety for the fetus and potential impact on the course of pregnancy ⁴

The results of epidemiological studies of Omez ^® 10 mg in the treatment of heartburn in pregnant women show no clinically significant adverse effects on pregnancy and the health of the fetus or newborn ⁵ .

Omez ^® 10 mg is dispensed without a doctor's prescription, but you can take it yourself without specialist advice for no longer than 14 days ⁵ .

THERE ARE CONTRAINDICATIONS, READ THE INSTRUCTIONS FOR MEDICAL USE OR CONSULT A DOCTOR.

References:

Vyuchnova E.S., Yurenev G.L., Mironova E.
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