Research has shown that more than half of all pregnant women experience heartburn at some point in their pregnancy, generally during the third trimester. Heartburn is the burning feeling in the chest, which is often accompanied by a sour or bitter taste in the back of the throat. Contrary to its name, heartburn is not associated with the heart. However, since the discomfort starts from behind the breastbone, one may feel that the burning sensation is of the heart. Heartburn occurs when bile or acids from the stomach flows to the food pipe (oesophagus). Changes in hormone levels and body shape due to the baby growing may be the cause of heartburn in pregnant women.

What are the signs of heartburn?

Some of the common signs of heartburn experienced by women during pregnancy include: 

• A constant burning sensation (sometimes pain) in the middle of the chest 
• A feeling of being full or heavy
• Bloating
• Burping or belching
• A feeling of being sick

These symptoms can also be present due to other underlying conditions. Therefore, pregnant women experiencing any such symptoms must consult their gynaecologist.  

Why do women experience heartburn during pregnancy? 

Heartburn is more commonly seen in women who have had a history of Gastroesophageal reflux disease (GERD) before pregnancy or have conceived before. The typical causes of heartburn in pregnant women include:

• Increased levels of the progesterone hormone during pregnancy relax the smooth muscles (muscles that aid contraction) and slows down digestion. This slows the movement of food, resulting in bloating and heartburn.
• After swallowing, the food travels down from the oesophagus (the food pipe) to the stomach. There is a muscular valve, called the lower oesophagal sphincter, between the food pipe and the stomach, which prevents the backflow of acid from the stomach to the food pipe. Progesterone, also known as the pregnancy hormone, relaxes this sphincter, resulting in acid backflow into the oesophagus.
• As the baby grows in size, the womb (uterus) gets bigger and squeezes the organs around it. This pushes the stomach acid upwards into the oesophagus, resulting in heartburn. That is the reason why heartburn is more common during the third trimester.

How can heartburn be treated?

Usually, heartburn symptoms are mild and manageable during pregnancy. However, in some cases, some medications such as proton pump inhibitors (omeprazole or lansoprazole) and H2 blockers (cimetidine and famotidine) may be prescribed to relieve the symptoms. 

It is advised to avoid self-medication as many antacids contain some salts that could be harmful during pregnancy. Some of these salts include: 

• Sodium bicarbonate: It can cause fluid build-up and metabolic acidosis (build-up of acid in the body).
• Magnesium trisilicate: It can increase the risk of respiratory distress, decreased muscle tone, and kidney stones in the fetus.
• Aluminium hydroxide or carbonate: They can lead to constipation.
• Aspirin: The use of high-dose aspirin during pregnancy can increase the risk of miscarriage, heart defects, and brain bleed in premature infants. 

Ways to avoid heartburn during pregnancy

• Instead of having two or three large meals, eat several small meals in a day.
• Avoid acidic and spicy foods such as citrus fruits, tomatoes, oranges, onions, garlic, coffee, chocolate, sodas, and fried foods as they slow down digestion and aggravate GERD. 
• Quit the use of cigarettes and smokeless tobacco. 
• Sit straight while eating food.
• Do not drink water while eating. Drink it between the meals.
• Do not lie down immediately after you eat, wait for at least 2 to 3 hours.
• Sleep on your left side as it can greatly reduce acid reflux. This happens because gravity helps in returning the acid into the stomach. 
• GERD symptoms tend to worsen at night. Raising the head of the bed by 15 to 18 centimetres (cms) by putting bricks or foam wedge under the bed can prevent stomach acids from rising into the chest.
• Avoid wearing tight-fitted clothing. 
• Some women may also benefit from eating yoghurt or drinking a glass of milk to get relief from heartburn.
• Avoid the consumption of alcohol as it may not only cause heartburn but has also been associated with low birth weight and learning disabilities in the baby.

When to contact a doctor? 

Persistent and severe heartburn could be a sign of pre-eclampsia (extremely high blood pressure), which can be dangerous for both mother and the baby. Therefore, pregnant women must seek medical help if they experience: 

• Persistent headache that does not go away even after taking painkillers
• Swelling in the hand, feet or face
• Trouble swallowing
• Blurring of vision or viewing flashing lights or dots
• Pain below the ribs or in the stomach
• Weight loss
• Dark-coloured stool
• Blood in the sputum.

Takeaway

Heartburn during pregnancy is usually mild and can be managed by making some changes to the diet and lifestyle. Usually, heartburn resolves on its own after the baby is born but in some cases, the mother may require some medications. One should consult the doctor if the heartburn is severe or is accompanied by a headache, stomach-ache, dark-coloured stools or other persisting health conditions.

Talk to your gynaecologist if you experience any heartburn during your pregnancy.