Heartburn during Pregnancy

What is heartburn?

Heartburn refers to "acid indigestion," a burning feeling in the lower part of the chest behind your breastbone. You may have the feeling of food coming back into your mouth, with a sour or bitter taste. Heartburn does not mean that anything is wrong with your heart.

How does it occur?

Changes in your body during pregnancy may cause or worsen heartburn. The increase in hormones early in your pregnancy can cause heartburn. It is more common, however, during the last months of pregnancy, when the growing baby presses against your stomach and your hormones are at high levels. One in four pregnant women have heartburn daily.

Food travels from your mouth down your esophagus to the stomach. Between your esophagus and stomach there is a muscular ring. This muscular ring opens to allow food to pass from the esophagus into the stomach. It then closes to prevent food from backing up into the esophagus. Heartburn occurs when this muscular ring does not close tightly. The ring may not close tightly because of the changes in your hormones. Or, the baby may be pressing against the lower part of your stomach, forcing the ring to open slightly.

When the muscular ring opens, food mixed with stomach acid backs up into the esophagus. The esophagus does not have the protective lining the stomach has and becomes irritated by the food and acid. This irritation of the esophagus causes the burning feeling of heartburn.

What are the symptoms?

Symptoms of heartburn are:

• a burning feeling in your chest after you eat large amounts of food (for example, after a complete meal)
• a burning feeling in your chest when you lie down, bend over, or exercise
• pain or burning in the chest that may be mistaken for a heart attack and may extend into your neck and arms
• backing up of sour or bitter material into your throat and mouth, especially when you lie down or sleep
• bloating and belching
• feeling of fullness after eating a small amount of food
• stomach pain.

How is it diagnosed?

Your health care provider will take your medical history and ask about your symptoms.

How is it treated?

Your health care provider may ask you to do the following:

• Stop smoking. Cigarette smoking increases the acidity of your stomach's contents. (Smoking can also hurt your baby.)
• Eat five or six small meals of healthy foods instead of two or three large ones each day.
• Sit with good posture when you are eating. Slouching can put extra pressure on your stomach.
• Not eat, or eat less of, the following foods (they can cause the esophageal muscle to relax and not close tightly):
  • coffee (caffeinated and decaffeinated)
  • carbonated beverages
  • very sweet foods or drinks such as syrups, honey, or liqueurs
  • tomato sauce and tomato paste
  • citrus juice, such as lemonade or orange and grapefruit juice
  • fatty or fried foods
  • chocolate
  • peppermint and spearmint oils or products
  • whole milk
  • alcohol
  • red and black pepper and other spices.
• Wait an hour or longer after eating before you lie down. If you have to lie down after a meal, lie on your left side. Keep your head and shoulders slightly higher than the rest of your body.
• Drink plenty of fluids between meals. Drink slowly. Drink no more than one cup with meals. Fluid with food can overfill your stomach.
• Chew gum or suck on lozenges (not mints) to produce a flow of saliva. Saliva may help control stomach acid.
• Raise the head of your bed 6 inches by placing blocks under the legs. Or you can wedge pillows in place so that your head and shoulders are higher than your stomach when you down.
• Do not eat anything in the 2 to 3 hours before you go to bed. An empty stomach produces less acid, so you are less likely to have heartburn while you sleep.

If you have occasional heartburn after meals or at bedtime, your health care provider may tell you to take a specific antacid. CAUTION: Don't start taking an antacid on your own without first checking with your health care provider. Also, do not take baking soda (sodium bicarbonate). It tends to make you hold fluid and swell.

If you are taking any medication, ask your health care provider if it could be making your heartburn worse.

How can I take care of myself?

Follow the treatment guidelines recommended above to help prevent heartburn. Talk to your health care provider if you do not get relief and your heartburn gets worse.