Acid Reflux during Pregnancy Overview
Have you experienced a burning feeling in your chest during pregnancy? Many women experience heartburn or acid reflux (gastroesophageal reflux disease or GERD) at some stage during pregnancy.
Heartburn or GERD are common discomforts which can start at any stage during pregnancy. An acid reflux pregnancy is not necessarily something to be alarmed about if managed with changes to your diet, lifestyle and, where necessary, treatment from a qualified physician following a thorough assessment.
With a little knowledge, most women with fairly mild symptoms can reduce or eliminate discomfort altogether. In more severe cases where GERD is diagnosed a physician can easily guide you through a treatment plan which is just as manageable. Yes, there are ways to treat heartburn and acid reflux symptoms that are safe for both you and your baby (See also: Acid reflux in babies and children).
Heartburn and GERD - What Actually Happens?
Heartburn during pregnancy is often as a result of changing hormones in the body. These changes cause the digestive system to slow down. Muscles in the body that normally aid digestion by pushing food down the oesophagus (the tube between your mouth and your stomach) also move slowly during pregnancy.
During normal digestion, food travels down the oesophagus and through a muscular valve known as the lower oesophageal sphincter (LES), and into the stomach. This ring of muscle acts as a gate between the stomach and the oesophagus. Normally this opens up to allow food to pass through and then closes in order to prevent stomach acid from coming back up.
Heartburn or acid reflux occurs when the LES relaxes more frequently and allows stomach acid, or even food, to seep back up into the oesophagus. Stomach acid coming into contact with the mucosa (the sensitive protective lining of the digestive system) thus causes the burning sensation you feel in your chest area known as heartburn and acid reflux.
As a woman’s uterus grows during the second and third trimesters to accommodate the growth of the baby, an increasing amount of pressure is placed on the stomach. This can sometimes cause an increase in levels of discomfort and pain, resulting in either heartburn (or mild indigestion) or acid reflux (GERD).
GERD is common during all three stages of pregnancy, not just towards the latter stages. It is rare, however, for GERD to cause any unmanageable complications such as esophagitis (inflammation of the oesophagus). Treatment for acid reflux in pregnancy is no different than it would be for any other person experiencing similar symptoms.
Much of the treatment involved in milder cases is managed by lifestyle changes which can help to prevent or minimise symptoms or discomfort. Most heartburn or acid reflux symptoms experienced during pregnancy usually clear up within a month or so once the baby is born. Hormone levels and the body usually begin to return to normal during the first month following the birth.
Factors to consider
Pain or discomfort can occur in the chest area or stomach at any time during pregnancy. Many expectant moms usually experience such discomfort soon after drinking fluids or eating a meal. Symptoms may become more frequent or severe during the third trimester (from about 27 weeks).
As well as pain, many women also experience the following:
- A heavy feeling or sensation in the stomach and bloating
- Belching / burping
- Regurgitation (a little food that is forced back up the oesophagus)
- Nausea and vomiting
You may be more prone to heartburn or acid reflux if:
- You frequently experienced indigestion before pregnancy
- You have previously been pregnant
- You are in the third trimester of your pregnancy
Treatment and Procedures
Heartburn and acid reflux during pregnancy may be quite painful for some women, but can be sufficiently managed. Treatment typically involves a period of trial and error with your physician.
In milder cases the following are some of the safest means of reducing the occurrence of discomfort for both you and your unborn baby:
Adjust your eating habits:
- As large meals are often one of the main causes of heartburn or acid reflux, it is found that consuming several smaller meals during the day instead can help to alleviate discomfort or pain. It is best to avoid drinking any liquids while eating as this often causes the LES to open up at inappropriate times, as well as place additional pressure on the stomach. It is better to drink water between meals instead.
- Take your time while eating, chewing each mouthful of food slowly.
- You can chew a piece of sugarless gum after meals. Chewing gum helps to increase levels of saliva which in turn helps to neutralise any acid seeping back up into the oesophagus.
- It is a good idea to wait at least 2-3 hours after a meal before you lie down. A leisurely walk between meals can encourage digestion (as well as get in some healthy exercise during your pregnancy too). If you’re prone to late-night snacking, you may want to try and better space your meals during the day so that you’re not feeling hungry too close to bedtime.
- Foods that can trigger or worsen GERD symptoms include chocolate, mint or peppermint, spicy foods, acidic foods (such as tomatoes and oranges), fruit juice, fatty foods, mustard, as well as carbonated and caffeinated beverages (such as sodas, tea and coffee). Refrain from over seasoning foods as well to avoid triggering heartburn or reflux.
- If you do feel some discomfort, eating a little yoghurt or a small glass of milk can help to alleviate symptoms. You can also add some honey to chamomile tea or a little warm milk.
- Maintaining a healthy weight throughout your pregnancy will also help prevent to many heartburn or acid reflux occurrences. Additional weight and fat places more pressure on the stomach. It is best to follow your physician’s guidelines for healthy weight gain during your pregnancy.
- Ensure that your clothing is comfortable and not too tight-fitting. Tightness around the waist and stomach can trigger heartburn or reflux.
- Sleep on your left side. Higher levels of discomfort or pain are commonly experienced when lying on your right side as the stomach is positioned higher than the oesophagus. You can use pillows or wedge pillows to elevate the upper body (head and shoulders) a little while sleeping.
- It is strongly advisable not to smoke or chew tobacco, as well as consume alcoholic beverages during pregnancy.
- Try and bend at the knees, rather than at the waist. This helps to avoid any unnecessary pressure on the stomach. Good posture also helps to prevent the stomach from being pushed up against the oesophagus, and thus placing additional pressure on the LES.
Medication and alternative medicine options
Some medications are safe to use during pregnancy at recommended doses. It may be recommended that medications be taken before a meal or before going to bed.
- Antacids: Most non-prescription antacids are generally safe to use during pregnancy. Antacids to avoid are those that contain sodium bicarbonate which can cause fluid build-up, as well as maternal or foetal metabolic alkalosis. Aluminium or magnesium based antacids can cause constipation or diarrhoea, and are best avoided during the third trimester as they can interfere with contractions during labour. Antacids which contain calcium carbonate (such as Tums and Gaviscon) are safe for expectant moms in specific doses. Taken on an empty stomach, calcium carbonate antacids neutralise acid for between 30 and 60 minutes. If taken with food or shortly after a meal, this protective effect may provide relief for up to 2 or 3 hours. Many antacids are available over-the-counter without a prescription and may be suggested for milder cases. It is advisable to chat to your pharmacist for advice about which ones are most suitable for you before purchasing. If your pain is more severe, it is best to consult your physician for stronger treatment that is also safe in pregnancy.
- Alginates: These are antacids that are combined with another type of medicine. Alginates work by forming a foam barrier on the surface of the stomach, which help to prevent acid from leaking back up.
- Iron supplements: If you are taking an antacid along with iron supplements, it is best not to take the two at the same time. Antacids can prevent iron from being properly absorbed in the body. Antacids can be taken at least 2 hours before or after your iron supplement.
- Acid-suppressing medications which may be prescribed include Ranitidine and Omeprazole.
Alternative medicinal options may include:
- Relaxation techniques, such as progressive muscle relaxation and guided imagery.
*It is strongly advisable to check with your doctor before trying any new or alternative treatments, as well as check all labels of medications before purchasing in the case of ingredient changes to a product.
Is acid reflux a sign of pregnancy?
Heartburn and acid reflux are common for most people to experience at some point or another. It’s not, however, necessarily an indication that you may be pregnant. If you experience other symptoms, such as nausea or a missed period in addition to heartburn related discomforts you may need to take a pregnancy test or consult a medical health professional.
Can pregnancy cause heartburn or acid reflux?
Pregnancy increases the risk of experiencing heartburn or acid reflux. During the first trimester, food passes through the oesophagus slowly and the stomach takes longer to empty. The body then has more time to absorb nutrients for the foetus, which can cause indigestion discomforts. By the third trimester, the growing baby can place additional pressure on the stomach, pushing it out of its normal position. This can cause acid reflux discomfort.
When to visit your doctor?
If you find that changes to your eating and lifestyle habits aren’t sufficient enough or the discomfort escalates to pain, it is a good idea to visit your physician. Pain that wakes you up at night or returns as soon as your antacid wears off, difficulty swallowing, coughing, weight loss or even black stools are also flags to visit your doctor.
Your doctor may suggest medications (prescription and non-prescription) that are safe to use during each stage of pregnancy to help alleviate your discomfort. If diagnosed with GERD, it simply means that your heartburn is severe and needs to be controlled in order to protect you from any complications likely to cause damage to the oesophagus, as well as ensure the continued safety of your unborn child.
What can you expect at your doctor’s visit?
Your physician will likely ask you several questions before diagnosing indigestion, heartburn or GERD. Questions which may be asked include:
- Are the symptoms experienced affecting your day-to-day life? And how?
- What are your usual eating habits?
- Have you tried any preventative measures or treatments before your appointment? What were these?
- Have you frequently experienced indigestion discomfort before falling pregnant?
Your physician will examine your chest and stomach by gently pressing on these areas in order to assess where you are experiencing pain and discomfort. Appropriate treatment will then be discussed with you, enabling you to best manage your symptoms and ensure a safe and comfortable pregnancy.