Heartburn is described as a burning sensation in the upper part of the chest all the way to your throat.
It is a very common discomfort in pregnancy that should be treated. Recent studies reported that untreated heartburn and acid reflux can increase severity of pregnancy-related nausea & vomiting. Serious complications associated to heartburn are rare. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2711677/)
Heartburn symptoms include a burning feeling in the chest, hoarseness, cough, sore throat or tooth damage.
Heartburn affects 22% of pregnant women in the first trimester, 39% in the second trimester and between 60% and 72% in the third trimester. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4562453/
Causes of heartburn pregnancy (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4562453/)
- The sphincter, that allows food into the stomach and keeps acid in the stomach, closes less tightly during pregnancy. This happens due to increasing in progesterone & estrogen levels, and because the sphincter is being pushed up into the thoracic cavity.
- The transit of food slowdowns during pregnancy due to increased levels of hormones
- The growing uterus could also put pressure on the stomach, and push the sphincter a bit further up.
- Food stays longer in the stomach during pregnancy and bowel transit is slower, as well. https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2036.2005.02654.x
How to treat heartburn in pregnancy(https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2036.2005.02654.x)
- Begin with lifestyle modifications and dietary changes
- Add antacids or sucralfate, if necessary
- If symptoms persist, take histamine2‐receptor antagonists(H2 blocker)
- In women with intractable symptoms or complicated reflux disease, doctors could prescribe proton pump inhibitors
Step 1 Lifestyle modifications & dietary changes
To reduce heartburn during pregnancy without adding any chemical to your body, you should try the following:
- Eat smaller meals & frequently, avoid drinking while eating. Drink water in between meals instead.
- Eat slowly and chew every bite thoroughly.
- Avoid eating at least 3 hours before bed.
- Avoid foods and beverages that could trigger your heartburn: chocolate, fatty foods, spicy foods, acidic foods like citrus fruits and tomato-based items, carbonated beverages, and caffeine.
- Stay upright for at least one hour after a meal. A leisurely walk may also encourage digestion.
- Wear comfortable rather than tight-fitting clothing.
- Maintain a healthy weight.
- Use pillows or wedges to elevate your upper body while sleeping.
- Sleep on your left side. Lying on your right side will position your stomach higher than your esophagus, which may lead to heartburn.
- Chew a piece of sugarless gum after meals. The increased saliva may neutralize any acid coming back up into the esophagus.
- Eat yogurt or drink a glass of milk to quell symptoms once they start.
- Drink some honey in chamomile tea or a glass of warm milk.
- Sip liquids instead of drinking large glasses of liquid at once.
Step 2 Pharmacologic treatment
For more difficult-to-treat reflux symptoms, the doctor must discuss with the patient the benefits & the risk of drug therapy. Because medications are not tested in randomized‐controlled studies in pregnant women, most recommendations on drug safety isdata collected over the years and from manufacturers. (https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2036.2005.02654.x)
The National Institute of Health and Care Excellence (NICE, UK) antenatal care guidelines recommend that women who present with symptoms of heartburn in pregnancy should be offered information regarding lifestyle and diet modification.
Pharmacologic treatment for heartburn in pregnancy:
1st. line of treatment
Antacids: Many of these products combine aluminum, magnesium, or calcium with hydroxide or bicarbonate ions to stop stomach acid.
There are several products that contain antacids. Some worldwide brands are: Alka-Seltzer(aspirin, sodium bicarbonate, and anhydrous citric acid), Maalox(Aluminum hydroxide, Magnesium hydroxide, Simethicone), Rolaids(calcium carbonate and magnesium hydroxide), Tums(Calcium Carbonate), Milk of Magnesia(Magnesium Hydroxide), Gaviscon(sodium alginate, sodium bicarbonate and calcium carbonate)
2nd. line of treatment
Histamine 2 blockers or H2 blockers: Famotidine (Pepcid), Cimetidine (Tagamet), Nizatidine (Axid)&Ranitidine (Zantac)
3rd. line of treatment
Proton Pump Inhibitors: Dexlansoprazole (Dexilant), Esomeprazole (Nexium), Lansoprazole (Prevacid), Pantoprazole (Protonix), Rabeprazole (AcipHex)&Omeprazole (Zegerid and Prilosec)
Antacids
Antacids may be offered to women whose heartburn remains troublesome despite lifestyle and diet modification. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4562453/
Antacids are commonly available over the counter. The antacids can relief occasional heartburn symptoms. Those made of calcium carbonate or magnesium are good options. However, it may be best to avoid magnesium during the last trimester of pregnancy. Magnesium could interfere with contractions during labor.
Most doctors recommend avoiding antacids that contain high levels of sodium. These antacids can lead to a buildup of fluid in the tissues. You should also avoid any antacids that list aluminum on the label, as in “aluminum hydroxide” or “aluminum carbonate”. These antacids can lead to constipation.
Calcium Carbonate
Studies have shown that women taking calcium carbonate during the first three months of pregnancy do not have a higher chance to have a baby with a birth defect. In fact, taking calcium carbonate at recommended doses any time during a pregnancy has not been associated with negative effects.
The Recommended Dietary Allowance (RDA) of calcium for pregnant and breastfeeding women is 1,000 mg to 1,300 mg.
https://reference.medscape.com/drug/tums-calcium-carbonate-341983#10
calcium carbonate (Tums)
Take Tums at the first onset of symptoms, but not as a preventative measure.
Taking it with food will increase absorption of Calcium but do not improve heartburn outcomes. Do not exceed the daily-recommended dose. You could experience constipation or diarrhea associated to use of Calcium Carbonate
Histamine 2 blockers or H2 blockers
https://www.ncbi.nlm.nih.gov/pubmed/15749258
There is no indication for an increased risk of major malformations after the use of H2-blockers during pregnancy.
https://www.rxlist.com/zantac-drug.htm#indications_dosage
Ranitidine(Zantac) like other H2-blockers are not recommended more than twice daily. You could take the medication 30-60 min before a meal, as a preventive dose, if required. Take it with a full glass of water. Do not exceed daily-recommended dose.
Proton Pump Inhibitors
https://mothertobaby.org/fact-sheets/proton-pump-inhibitors/
Proton pump inhibitors (PPIs) are a group of medicines that treat the symptoms of acid reflux, stomach and intestinal ulcers.
Available information suggests no increased risk for miscarriage, low birth weight, or premature delivery with use of PPIs during pregnancy.
It is unlikely that proton pump inhibitors would cause an increased risk for birth defects. Omprezole is the best studied of the proton pump inhibitors. Multiple studies including over 6,610 women exposed to omeprazole, 1,630 exposed to lansoprazole, 560 exposed to pantoprazole, 700 exposed to esomeprazole, and 44 exposed to rabeprazole have shown no increase in risk of birth defects.
https://www.rxlist.com/prilosec-drug.htm#indications_dosage
Omeprazole(Prilosec)
Omeprazole must be recommended by your doctor. You should take it once daily(although in specific case you could take it twice). Omeprazole should be take 30 min before eating, every day at the same time.
https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/018703s068,019675s035,020251s019lbl.pdf
Finally, stay away from medications like Alka-Seltzer that may contain aspirin. https://www.healthline.com/health/gerd/pregnancy#5
- Antacids may reduce the absorption of iron in the diet, and magnesium-containing antacids could slow labor. Consult your doctor before taking any medications, even over-the-counter (OTC) medicines, while you are pregnant.
Home remedies traditionally used for heartburn in pregnancy
- Apple cider vinegar (2-3 teaspoons in an 8-ounce glass of water) to balance the acid production in the stomach or buffer the acid activity.
- Baking soda (which is sodium bicarbonate) to neutralize stomach acid – mix one tablespoon in ½ cup of water and drink to relieve symptoms. However, products containing sodium bicarbonate are not recommended(https://cks.nice.org.uk/dyspepsia-pregnancy-associated#!topicsummary)
Tell your doctor before using any natural remedies.
You must call your doctor anytime HEARTBURN IS:
- severe or you feel more like a chest pain.
- not getting better despite lifestyle changes and medical treatment.
- associated with fever, nausea or vomiting.
- making you choke while eating or you feel that food is “stuck” in your throat
- causing weight loss
- associated with vomiting bright red blood or your vomit looks like coffee grounds
- associated with having black, tarry stools