Heartburn during pregnancy - Causes and Treatment
Pregnancy induces several physical as well as hormonal changes in a woman’s body. Heartburn, also known as acid reflux or acid indigestion is one of the several signs and symptoms of pregnancy experienced by more than 50% women. Acid reflux – meaning the stomach contents that come back (reflux) causes burning sensation in the food pipe .
It is one of the major causes of discomfort and uneasiness for women during the second and third trimester of pregnancy. It usually begins in the first trimester but tends to worsen in the later stages . Heartburn is characterized by burning sensation that begins from the bottom part of the breastbone and extends up to the lower part of the throat region .
Causes of heartburn during pregnancy
The several hormonal changes taking place inside the body causes heartburn during pregnancy. The placenta produces a hormone known as progesterone that causes the muscles of the uterus to relax.
This hormone also relaxes the valve that separates the esophagus from the stomach, which in turn is unable to prevent the back flow of the stomach acids into the esophagus. This backflow of stomach acids to the food pipe (esophagus) causes burning sensation, known as heartburn . Pregnancy hormones also affect the working of the stomach muscles. They are known to :
- Slow down the muscles that push the food from the esophagus to the stomach.
- Slow down the contraction of the muscles required for digestion of food.
All these processes also significantly contribute to development of heartburn.
In addition to the hormonal changes, the growing fetus also has a significant role to play in causation of heartburn. The growing fetus exerts pressure on the stomach that compels the stomach acids to flow backwards into the esophagus .
There are several other factors that can cause heartburn during pregnancy. These are :
- Consumption of onions and garlic either in raw or cooked form
- Consumption of spicy foods
- Consumption of oily and greasy foods
- Eating very quickly
- Eating a large meal
- Consumption of caffeine containing beverages
- Medications that cause acidity
Measures to get relief from heartburn during pregnancy
There are several steps that can be followed to get relief from heartburn during pregnancy. These are [6, 7]:
- Eat less and more often
- Avoid gulping down food. Eat slowly, chew every morsel of food. This shall prevent indigestion and heartburn.
- Drink plenty of fluids – not while dining, but in between meals. While eating, just sip liquids and avoid drinking large glasses of water at one go.
- Engaging in light activities after meal will allow better digestion and prevent heartburn. Activities that do not involve bending just after meal will help avoid heartburn. It is also advised to bend from the knees and not from the waist as the latter position exerts more pressure on the abdomen.
- Avoid hitting bed immediately after a meal. It has been recommended to eat at least 3 hours before going to bed.
- Keep your chest and head at an elevated position while sleeping. This position shall help prevent the back flow of stomach acids.
- Foods that trigger acidity may be different for every pregnant woman. It is therefore advised that you should know your “trigger foods” and those should be avoided to prevent heartburn.
- Wearing loose clothing especially loose from the breast bone region will help to ease the acidity. Tight clothing will cause more discomfort and can worsen acid reflux.
- Ginger has been found to an effective alternative for soothing heartburn.
Treatment of heartburn during pregnancy
Dietary and lifestyle changes can help ease heartburn to a great extent. The lifestyle and dietary changes include [8, 2]:
- Abstinence from alcohol and tobacco
- Smaller meals
- Frequent meals
- Chewing gums help stimulate salivary glands that neutralizes the acids
- Avoid late night dining
- Elevation of head and neck while sleeping
- Avoid foods that may trigger acidity
All these factors will help ease mild symptoms of heartburn and will also prevent the development of acid reflux. However, for more severe symptoms the doctor may recommend antacids and a few changes in the food habits. As per ACG President, Amy E. Foxx – Orenstein, DO, FACG, medications prescribed for treating heartburn should be balanced in such a way that they help alleviate the symptoms of heartburn and also cause no harm to the developing fetus.
Antacids work pretty fast and are very effective for relieving heartburn . Antacids work by neutralizing the acid in the stomach so that they can no longer cause irritation and burning sensation. In some cases, antacids are also given along with alginates. Alginates are medications prescribed for indigestion. These work by creating a barrier in the stomach and keep the stomach acids in place and prevent its’ backflow into the esophagus. Antacids can be taken before meal and before going to bed .
If antacids and alginates fail to provide relief from heartburn then the doctor may advice acid – suppressing medicines that are considered to be safe during pregnancy. These medications are ranitidine and omeprezole. Ranitidine does not induce any side effects and can be taken twice daily. It has no fatal effects on the developing fetus and has proved to be an effective medication for those in whom antacids fail to bring about any relief . Omeprezole should be taken once daily, but it has many side effects. Otherwise this drug has proved to be safe for both the mother and the fetus. The side effects of omeprezole include:
Precautions while taking antacids
There are several precautions that need to be taken while popping in antacids. These include [3, 10]:
- It is advised that antacids should not be taken simultaneously with iron supplements. Here is the reason - antacids prevent iron absorption. Hence, it is better to keep a gap of at least 2 – 3 hours between these medications.
- Antacids that contain magnesium must be avoided during the 3rd trimester of pregnancy as it can lead to uterine contractions during labor period.
- Antacids containing sodium – bicarbonate should also be avoided as it can lead to metabolic alkalosis and fluid buildup in mother and fetus.