Heartburn, also known as indigestion or acid reflux is common in pregnancy. It is an irritation of the esophagus that is caused by stomach acid that travels from the stomach to the esophagus (the tube between the stomach and the throat).
Heartburn is caused by several factors that occur exclusively during pregnancy such as hormonal changes, the increased pressure of the growing baby on the mother’s stomach, and the relaxation of the muscles between the stomach and the esophagus (which allows the acid to easily reflux or seep back into the esophagus and cause a burning sensation).
Causes of heartburn explained
Hormones: The hormone progesterone is released during pregnancy. The role of progesterone is to nurture the womb and growing baby, but it is also a muscle relaxant. High levels of progesterone loosen the usually tight muscle (known as lower esophageal valve/ sphincter) which is responsible for preventing the reflux of stomach contents back into the esophagus and even the throat.
Increased intraabdominal pressure: As the baby grows, the uterus pushes on the stomach and places pressure on the stomach. This increased pressure makes it more likely for the stomach contents to spill out into the esophagus, especially when the stomach is full- usually after a meal.
Slowed digestion: Progesterone also causes a decrease in the rate of digestion, meaning that the stomach stays fuller for longer, increasing the chances of acid reflux.
Symptoms of heartburn during pregnancy
Symptoms of indigestion and heartburn include:
a burning sensation or pain in the chest, especially after bending over, lying down, or eating
burning in the throat, or a hot, sour, or salty tasing fluid at the back of the throat
belching or burping frequently
chronic cough
hoarseness
wheeze or other asthma like symptoms (this is because the stomach acid my travel to the lungs causing irritation).
Tips to prevent and manage heartburn during pregnancy
Changes in diet and lifestyle are usually sufficient to manage mild symptoms of heartburn. You can try the following tips to alleviate the discomfort of heartburn:
eat several meals a day instead of three large meals
avoid spicy, fatty, and fried foods
avoid chocolate, coffee, and other caffeinated drinks
drink less fluids while eating
avoid citrus fruits and juices
do not smoke or drink alcohol (these can cause health problems for the baby)
do not lie down immediately after eating
Try sleeping on the left side (it is harder for acids to enter into the esophagus because the stomach is on the left).
There are safe medicines that you can take during pregnancy to alleviate the symptoms. These are known as antacids and alginates. They are usually available over the counter from a pharmacy. Consult with your doctor or healthcare provider before taking these. If the symptoms are not relieved by lifestyle and diet changes, as suggested above, then the doctor may prescribe medicines that help reduce the amount of acid in the stomach (these are rantidine or omeprazole).
Important: Do not take antacids and iron supplements at the same time because antacids reduce the amount of iron absorbed by the body.
When should I consult a doctor/healthcare professional about heartburn during pregnancy?
Although heartburn is common in pregnancy there are some warning signs that you should look out for. You should also seek further medical attention if the lifestyle changes and diet do not alleviate your symptoms. Seek medical attention if you experience any of the following:
weight loss
difficulty eating or keeping food down
having trouble sleeping because of the heartburn
vomiting blood
have black tarry stool.
Take home message
Heartburn is a common symptom during pregnancy, especially during the third trimester. You can prevent and manage the symptoms by making a few lifestyle changes mentioned above. If these do not work or you experience any of the warning signs listed above, seek medical attention.
This article is written by Dr Itumeleng Buti MBChB( Pret)
References:
1. NHS UK. Pregnancy Related Condition: Heartburn and Indigestion in Pregnancy. [ Internet] [updated: 2020 December; Cited 2022 February 8] Available from: https://www.nhs.uk/pregnancy/related-conditions/common-symptoms/indigestion-and-heartburn.
2. WebMD. Pregnancy and Heartburn. [Internet]WebMD; Nivin Todd; [Updated; 2020 October 16; Cited 2022 February 8] Available from: https://www.webmd.com/baby/guide/what-is-heartburn
3. Healthline Media. Parenthood: Heartburn in Pregnancy: 11 Treatments to Put Out the Fire. [ Internet] Healthline Media; Donna Christiano; [ updated 2019 August 19; Cited 2022 February 8] Available from:
4. Cleveland Clinic. Heartburn During Pregnancy. [Internet][updated 2021 January 29; Cited 2022 February 8] Available from: https://my.clevelandclinic.org/health/diseases/12011-heartburn-during-pregnancy.
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