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What’s different about pregnancy heartburn?
Most women suffer from heartburn during pregnancy due to hormonal and physical changes, particularly during their second and third trimester. This is due to both the physical changes and the production of progesterone.
The hormone progesterone is produced at greater levels during pregnancy. It relaxes muscles including the digestive tract and lower esophageal sphincter (LES). The relaxed muscles in the digestive tract slow digestion causing food to remain in the stomach longer and triggering increased acid production.
The LES is the valve that closes off the stomach to keep stomach acid from refluxing back into the esophagus. When stomach acid leaks into the esophagus, it causes irritation. This irritation is what we know as heartburn.
The physical changes during pregnancy also contribute to heartburn. As the baby grows larger, it takes up more room pushing the stomach upward. The pressure of the baby on the stomach and the modified stomach position leads to the added pressure of stomach contents on the LES.
Both, progesterone and physical changes, lead to acid reflux and heartburn.
Preventing acid reflux instead of treating it once it has occurred is the best option.
WARNING! All remedies, supplements, and over-the-counter (OTC) medications you take during pregnancy should be approved by your doctor! Many can have side effects that can harm the baby or interfere with other medications or supplements you are taking. Use this list to discuss relief options with your doctor. Your doctor should be in agreement with your choice of treatment.
Heartburn During Pregnancy: Remedies
Those who are pregnant have fewer remedies for heartburn relief than those who are not. Many foods, herbs, and OTC medications used for treating heartburn are considered harmful to the mother and/or fetus. Since there are limited treatment options, it’s best to prevent heartburn during pregnancy. When prevention doesn’t work, the following are some options you and your doctor might consider.
Foods for Pregnancy Heartburn Relief
It is important to wash fruits and vegetables properly before peeling and/or eating to avoid harmful bacteria and germs. Raw fruits and vegetables can be contaminated with bacteria that can lead to serious illness.
Fruits for Pregnancy Heartburn Relief:
- Bananas contain natural antacids.
- Apples contain natural antacids and its acid content encourages the body to stop the natural production of stomach acid. You might try applesauce. It soothes going down and is easier to digest.
- Pears are alkaline and thus act as an antacid too. Just like the apple, pear sauce is a great alternative.
- Lemon helps prevent acid production. Combine the juice of one lemon with water and drink. Honey can be used to sweeten if needed.
- Grapes are good at relieving indigestion and upset stomach. Try 10 to see if they help. Though indigestion and heartburn aren’t the same, heartburn can be a symptom of indigestion.
- Fresh pineapple contains the enzyme bromelain, which can help the digestion process, reducing chances of acid reflux, and settle your stomach. Pineapple juice and canned pineapple are likely to contain little bromelain. The bottling and canning processes kill off the enzyme. Warning!: Do not take bromelain as a food supplement during pregnancy and watch how much pineapple you ingest. Eating a normal amount of fresh pineapple in pregnancy should not be harmful but excessive amounts could cause the cervix to soften and increase the risk of miscarriage.
- Papaya contains a digestive enzyme that aids in the breakdown of proteins. Warning!: Avoid unripened papaya. Unripened papaya contains a high concentration of latex which can cause uterine contractions and could be unsafe in pregnancy.1
- Mango and guava can also soothe the stomach and bring heartburn relief.
Vegetables for Pregnancy Heartburn Relief:
The alkalinity of many vegetables helps balance stomach acid. If you are a juicer, try making up your own blend that works well for your system. If not, there are many juice blends available at the grocery. The best choice, however, is to learn to eat more vegetables.
- Mixed vegetable juice. Look for a juice or create a blend that had mostly alkaline vegetables.
- Cabbage juice is alkaline and helps neutralize stomach acid. Cabbage juice has many other medicinal benefits and can even heal stomach ulcers.
- Potato juice is alkaline and helps neutralize acid and aids in healing the lining of the esophagus and stomach. When preparing potato juice, avoid green potatoes they contain toxins that are harmful to the fetus.
- Other alkaline vegetables that help neutralize acid are:
Other Foods for Pregnancy Heartburn Relief:
- Almonds are an alkaline food that can help neutralize stomach acid and the oils help slow acid production. Don’t eat too many. Three to eight should be enough. Because of their high-fat content, they might cause your heartburn to worsen if you eat too many.
- Pasteurized apple cider vinegar can help when the LES isn’t closing properly and allowing acid to reflux into the esophagus. It can help the LES tighten and close off. A tablespoon can be swallowed if you can withstand the taste and burning as it goes down or you can mix with water, apple juice, or apple cider. Diluting may reduce its effectiveness. You may have to experiment with the mixture to see if you can find what is acceptable to swallow without reducing its effectiveness. Vinegar is acidic and too much can cause the problem to worsen, so don’t overdo it. I specifically state pasteurized. It is advised not to consume anything that isn’t pasteurized during pregnancy due to the possibility of harmful bacteria in unpasteurized products.
- Pasteurized buttermilk… You may have heard that milk helps. Don’t believe it! It can help temporarily but will stimulate stomach acid causing your heartburn to return with a vengeance shortly after. Buttermilk can soothe and also promotes healthy bacteria in the intestinal tract which can lower the instances of heartburn. Again, I specifically state pasteurized. It is advised not to consume anything that isn’t pasteurized during pregnancy due to the possibility of harmful bacteria in unpasteurized products.
- Your saliva is an acid buffer. One of the substances in your saliva is bicarbonate, which neutralizes stomach acid. Try chewing gum to stimulate your saliva production. Some gum flavors like mints might irritate heartburn. You may need to experiment to see which ones work best for you.
- Bland food like brown rice can help absorb acid and is easily digestible.
Herbal Teas for Pregnancy Heartburn Relief:
There is very little data on the use of herbs in pregnant women which means the safety of their use in teas is questionable due to the unknown. Herbal teas may contain substances that can cause miscarriage, premature birth, uterine contractions, or harm to the fetus.
The FDA encourages caution when consuming herbal teas. If consumed, they should be consumed in moderation because of their unknown effect on mother and baby.
Please consult your doctor before using herbal teas.
- Ginger tea helps a number of stomach issues from nausea to heartburn. Ginger lemon tea is also a good choice.
- Chamomile tea reduces stomach inflammation and balances stomach acid levels. It also promotes relaxation reducing the sensitivity to heartburn brought on by stress.
- Slippery elm tea protects the esophagus and stomach lining against stomach acids by thickening the mucous lining.
- Marshmallow root tea can be used to coat the esophagus and stomach as well.
- Dandelion root tea is used to improve digestion, as well as a mild laxative to increase bowel movements and improve beneficial intestinal bacteria. Slowed digestion can lead to acid reflux and heartburn. Warning!: Do not drink dandelion root tea if you have gestational diabetes or taking high blood pressure medication.
Related Content: Marshmallow Root For Acid Reflux
Supplements for Pregnancy Heartburn Relief:
There is very little data on the use of many herbal supplements in pregnant women which means the safety of their use is questionable due to the unknown. Please consult your doctor before using supplements.
Probiotics are good bacteria that can improve the digestive process thus helping reduce heartburn.
Probiotic supplements and fermented foods are great ways of introducing them into your system. According to the National Center for Biotechnology Information, U.S. National Library of Medicine, probiotics do not appear to pose any safety concerns for pregnant and lactating women.2
OTC Heartburn Medications for Pregnancy Heartburn Relief:
Antacids for Pregnancy Heartburn Relief:
Certain antacids may be ok to take when pregnant. Those containing calcium or magnesium are typically considered safe. Those containing aluminum, aspirin, and bismuth subsalicylate should be avoided. Aluminum can cause constipation and toxicity in large dosages. Baking soda (sodium bicarbonate) should be avoided due to its high sodium content. And the use of bismuth subsalicylate can result in absorption of salicylate which can cause an increase in fetal cardiac malformation.3 Antacids containing calcium or magnesium include:
- Milk of Magnesia
H2 Blockers for Pregnancy Heartburn Relief:
Do not use H2 blockers without a doctor’s advice if you are pregnant.
If antacids aren’t working, the next level of over the counter acid control is an H2 blocker like Axid, Pepcid, Tagamet, and Zantac. The FDA has assigned H2 blockers to the pregnancy category B. Animal testing has shown no evidence of impaired fertility or harm to the fetus, but no human studies have not been done. The benefit of taking these drugs during pregnancy should certainly outweigh any risk to you or the baby.4,5
PPI’s for Pregnancy Heartburn Relief:
Do not use proton pump inhibitors (PPI’s) without a doctor’s advice if you are pregnant.
Proton pump inhibitors are used to reduce stomach acid when antacids and H2 blockers aren’t providing the necessary relief. They expose the fetus to some level of risk, though it is considered minimal.5 PPIs include:
- Aciphex (rabeprazole)
- Nexium (esomeprazole)
- Prevacid (lansoprazole)
- Prilosec (omeprazole)
- Protonix (pantoprazole)
- Rapinex (omeprazole)
Heartburn During Pregnancy: Prevention
Wear loose clothes. Tight clothes will cause more pressure on the stomach and thusly the LES.
Eat healthy foods and high fiber foods. Constipation is a concern during pregnancy due to hormones slowing the digestive tract. A high fiber diet can keep the digestive tract moving at a good pace preventing stomach contents lingering longer than needed and triggering an increase in stomach acid production. Fiber supplements are available if supplementation is needed.
The following foods can be heartburn triggers for many people: Processed food, fatty food, fried food, dairy products high in fat, spicy food, tomatoes, citrus, coffee, carbonated drinks, mint, chocolate, candy containing citrus and mint, and the allium family of produce (garlic, onions, shallots, leeks, and chives).
Avoid drinking a large amount of liquid during a meal. This will dilute stomach acids. The stomach acid is needed to help trigger the LES to stay closed and for efficient digestion. It’s better to sip liquids throughout the day to keep up with your water intake.
Liquids should also be avoided 2-3 hours before bedtime or any laying down to prevent stomach acid from leaking through the LES.
Alcohol should be avoided during pregnancy. But if you do imbibe know that it increases acid production, slows the digestive process, and relaxes the LES. All of these side effects can lead to heartburn.
- Eat slowly, chew thoroughly, stop before getting full, and eat smaller meals more often. Five or six meals are better than three.
- Stop eating 2-3 hours before bedtime to prevent added pressure on the LES.
- Sitting up straight and not reclining or laying down during waking hours is important to prevent pressure on the LES.
- Avoid bending over at the waist when picking up items, doing chores, or exercising to prevent pressure on the LES as well.
- Due to the shape and position of the stomach and digestive tract, lying on your left side causes your stomach to hang lower preventing your stomach contents from placing as much pressure on the LES.
- Gravity can be a help in keeping stomach contents in their place when you raise the head of your bed 6 inches by using blocks. Wedge pillow systems and mattress bed wedges are also extremely effective solutions.
Maintaining a healthy weight during pregnancy is important. Ask your doctor how much weight you should be gaining. Too much weight gain will increase the pressure you already have on the stomach.
Since avoiding stress is virtually impossible to manage the stresses you encounter. Stress may cause increased stomach acid production and causes greater sensitivity to acid irritation in the esophagus. Some ways to reduce stress are:
- Participate in enjoyable activities
- Listen to soothing music
- Soak in the tub
- Sex with a partner
Medications including over the counter medications (OTC) and supplements can contribute to heartburn. If you have to take medications that contribute to heartburn, check to see if they should be taken with or without a meal. If medications taken in the evening are giving you nighttime heartburn, see if they can be taken in the morning instead.
As you know, the intake of nicotine should be eliminated during pregnancy for the baby’s health. It can also relax the LES and irritate the esophagus, even second-hand smoke can also irritate the esophagus.
Heartburn During Pregnancy: Unsafe Remedies
During pregnancy, many OTC heartburn medications and natural heartburn remedies are unsafe, though typically fine for those who are not pregnant or breastfeeding. Below are the ones I’ve come across in my research. Over time, I will add others I learn of through the healthcare industry, researchers, and from you, my readers.
Please consult your physician if you are ingesting or plan to ingest any of these during your pregnancy or while breastfeeding.
Natural Remedies to Avoid for Pregnancy Heartburn Relief
1) Avoid Aloe Vera for Pregnancy Heartburn Relief
Aloe vera may stimulate uterine contractions and should not be used during pregnancy or breastfeeding. Also, in a study, rats fed dried aloe leaves during pregnancy had offspring with an increased rate of embryonic death and skeletal abnormalities.6
2) Avoid Pineapple for Pregnancy Heartburn Relief
Fresh pineapple in excess can be harmful. Pineapple contains the enzyme bromelain, which can help the digestion process, reducing chances of acid reflux, and settle your stomach but excessive amounts of could cause the cervix to soften and increase the risk of miscarriage.
Pineapple juice and canned pineapple are likely to contain little bromelain. The bottling and canning processes kill off the enzyme.
Do not take bromelain as a food supplement during pregnancy and watch how much pineapple you ingest.
3) Avoid Papaya for Pregnancy Heartburn Relief
Papaya contains a digestive enzyme that aids in the breakdown of proteins, but unripened papaya should be avoided then pregnant. Unripened papaya contains a high concentration of latex which can cause uterine contractions and could be unsafe in pregnancy.1
4) Avoid Herbs for Pregnancy Heartburn Relief
There is very little data on the use of herbs in pregnant women which means the safety of their use in teas is questionable due to the unknown. Many herbs and spices may be toxic when ingested in larger amounts for heartburn treatment, yet fine for culinary use. Herbal teas may contain substances that can cause miscarriage, premature birth, uterine contractions, or harm to the fetus.
The FDA encourages caution when consuming herbal teas. If consumed, they should be consumed in moderation because of their unknown effect on mother and baby. Please consult your doctor before using herbal teas. Everyone’s chemistry is different. Your doctor knows your body and condition and is the best source to ask if you are concerned.
5) Avoid Licorice for Pregnancy Heartburn Relief
Natural licorice is the root of Glycyrrhiza glabra. It contains a component called glycyrrhizic acid or glycyrrhizin. Glycyrrhizin in larger amounts can cause high blood pressure, cause low birth weight and shorter gestation periods, miscarriage, and allows the stress hormone, cortisol, to pass through the placenta to the fetus impairing brain development in the fetus. Significant reduction in verbal and visuospatial abilities, narrative memory, and a significant increase in attention deficit-type behaviors, rule-breaking, and aggression problems were found overexposed to glycyrrhizin during gestation.7,8,9,10,11
Though regular licorice is unsafe during pregnancy, deglycyrrhizinated licorice (DGL) is available to avoid the side effects of the glycyrrhizin in licorice. DGL is considered safer and is available in chewable tablets. Having not found clinical trials on the safety of DGL during pregnancy, I have not listed this as a viable treatment option. Please consult your doctor before taking.
6) Avoid Cinnamon for Pregnancy Heartburn Relief
Cinnamon sticks, powder, and essential oil can cause the uterus to contract.
7) Avoid Fennel for Pregnancy Heartburn Relief
Fennel tea can cause contractions and may also cross the placenta and disrupt a developing baby’s endocrine system.
8) Avoid Sage for Pregnancy Heartburn Relief
Sage tea has thujone. It has been linked to high blood pressure and miscarriage.
9) Avoid Dandelion for Pregnancy Heartburn Relief
Do not drink dandelion root tea if you have gestational diabetes or taking high blood pressure medication during pregnancy.
OTC Heartburn Medications to Avoid for Pregnancy Heartburn Relief
1) Antacids to Avoid for Pregnancy Heartburn Relief
Those containing aluminum, aspirin, and bismuth subsalicylate Are considered to be unsafe during pregnancy. Aluminum can cause constipation and toxicity in large dosages. Baking soda (sodium bicarbonate) should be avoided due to its high sodium content. And the use of bismuth subsalicylate can result in absorption of salicylate which can cause an increase in fetal cardiac malformation.3 Some popular antacids containing aluminum, aspirin, or bismuth subsalicylate:
2) Avoid H2 Blockers for Pregnancy Heartburn Relief?
The FDA has assigned H2 blockers to the pregnancy category B. Animal testing has shown no evidence of impaired fertility or harm to the fetus, but no know human studies have been done. The benefit of taking these drugs during pregnancy should certainly outweigh the many risks to you or the baby.4,5 H2 Blockers include:
3) Avoid PPI’s for Pregnancy Heartburn Relief
Proton pump inhibitors (PPIs) are used to reduce stomach acid when antacids and H2 blockers aren’t providing the necessary relief. They expose the fetus to some level of risk, though it is considered minimal.12 PPIs include:
- AcipHex (rabeprazole)
- Nexium (esomeprazole)
- Prevacid (lansoprazole)
- Prilosec (omeprazole)
- Protonix (pantoprazole)
- Rapinex (omeprazole)
What Triggers Your Pregnancy Heartburn?
All people are different and some things trigger heartburn in some people where they won’t in others. You will have to spend time learning what actions and foods trigger your heartburn. Keeping a heartburn trigger journal can help make that process easier.
If you are suffering from heartburn during pregnancy, there are options for relief but remember it’s easier to prevent than to treat once it’s occurred.
1) Adebiyi A, Adaikan PG, Prasad RN. “Papaya (Carica papaya) consumption is unsafe in pregnancy: fact or fable? Scientific evaluation of a common belief in some parts of Asia using a rat model.” National Center for Biotechnology Information, U.S. National Library of Medicine, British Journal of Nutrition, August, 2002.
2) Jackie Elias, RPh, Pina Bozzo, & Adrienne Einarson, R. “Are probiotics safe for use during pregnancy and lactation?.” National Center for Biotechnology Information, U.S. National Library of Medicine, Canadian Family Physician, March, 2011.
3) “Bismuth subsalicylate Pregnancy and Breastfeeding Warnings.” Drugs.com, Medically reviewed on Dec 9, 2016.
5) Gill SK, O’Brien L, Koren G. “The safety of histamine 2 (H2) blockers in pregnancy: a meta-analysis.” National Center for Biotechnology Information, U.S. National Library of Medicine, Digestive Diseases and Sciences, September, 2009.
6) Kathi J. Kemper, MD, MPH, & Victoria Chiou, BA. “Aloe vera (Aloe vera).” The Longwood Herbal Task Force, & The Center for Holistic Pediatric Education and Research, July 29, 1999.
7) “Licorice Root.” National Center for Complementary and Integrative Health (NCCIH), September 2016.
8) Strandberg TE, Järvenpää AL, Vanhanen H, & McKeigue PM. “Birth outcome in relation to licorice consumption during pregnancy.” National Center for Biotechnology Information, U.S. National Library of Medicine, American Journal of Epidemiology, June 1, 2001.
9) Strandberg TE, Andersson S, Järvenpää AL, & McKeigue PM. “Preterm birth and licorice consumption during pregnancy.” National Center for Biotechnology Information, U.S. National Library of Medicine, American Journal of Epidemiology, November 1, 2002.
10) Hesham R. Omar, Irina Komarova, Mohamed El-Ghonemi, Ahmed Fathy, Rania Rashad, Hany D. Abdelmalak, Muralidhar Reddy Yerramadha, Yaseen Ali, Engy Helal, & Enrico M. Camporesi. “Licorice abuse: time to send a warning message.” National Center for Biotechnology Information, U.S. National Library of Medicine, Therapeutic Advances in Endocrinology and Metabolism, August, 2012.
11) Räikkönen K, Pesonen AK, Heinonen K, Lahti J, Komsi N, Eriksson JG, Seckl JR, Järvenpää AL, & Strandberg TE. “Maternal licorice consumption and detrimental cognitive and psychiatric outcomes in children.” National Center for Biotechnology Information, U.S. National Library of Medicine, American Journal of Epidemiology, November 1, 2009.
12) Majithia R, & Johnson DA. “Are proton pump inhibitors safe during pregnancy and lactation? Evidence to date.” National Center for Biotechnology Information, U.S. National Library of Medicine, January 22, 2012.