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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 of 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 reduced 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 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 .

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 experienced 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 - an unpleasant burning sensation, warmth behind the sternum, which can spread to the neck 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 other diseases of the digestive system can manifest as heartburn, including a 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 was noted that in the presence of heartburn in the 1st pregnancy, GERD subsequently develops in 17.7% of women , and two pregnancies occurring 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 other diseases of the digestive system can manifest as heartburn, including a 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 .

Diagnostics

Usually, to identify the cause of heartburn, the doctor is enough data from the questioning and examination of the pregnant woman. In some cases, ultrasound of the liver, gallbladder, pancreas, general and biochemical blood tests may be needed. In difficult cases, it is possible to examine the esophagus, stomach, duodenum using an endoscope. This method is not contraindicated during pregnancy, has high information content and diagnostic accuracy ¹ .

In most cases, a physician may only need information from a questioning and examination of a pregnant woman to determine the cause of heartburn. In some cases, ultrasound of the liver, gallbladder, pancreas, general and biochemical blood tests may be needed. In difficult cases, it is possible to examine the esophagus, stomach, duodenum using an endoscope. This method is not contraindicated during pregnancy, it has high information content and diagnostic accuracy ¹ .

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, drugs containing bismuth nitrate ( Vikalin and others) 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 medicines, 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.

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