Question: I have had heartburn since about my eighth week. Now in my second trimester, the pain has gotten very bad and lasts pretty much all day long. I took some antacids, but now they don’t help at all. It is actually making me nauseous and I don’t feel like eating anymore. Can the heartburn be causing a more serious problem or damaging my digestive tract? Is there something else I can take?
Answer: How miserable! You must be feeling like this pregnancy is going to be really long!
Heartburn is a very common problem in pregnancy. It is caused by the double whammy of the sphincter at the top of the stomach relaxing from the pregnancy hormones, combined with the pressure of your uterus pushing up on your stomach (which becomes more of an issue in the second half of pregnancy). Acid from your stomach flows up into the esophagus (food tube) and creates a burning sensation.
Usually heartburn is harmless in pregnancy, but it can be very uncomfortable. Chewable antacids like Tums neutralize acid and may give temporary relief, but the calcium in the antacid actually stimulates more acid production an hour later, and symptoms can actually get worse. Tums are a great source of calcium but not a great antacid.
So what can you do to prevent and treat heartburn? I usually divide treatments into lifestyle measures and medications. Talk to your doctor or midwife before taking any medications.
- Don’t lie down right after you eat. Allow gravity to help move the food and acid through your stomach and beyond. Eat small meals, and eat dinner early.
- Sleep propped up in a semi-sitting position, or put the top legs of you bed up on cinder blocks so your chest is higher than your stomach.
- Avoid spicy or acidic foods that stimulate acid production. Caffeine, chocolate, alcohol and mint are frequent culprits too.
- Magnesium-based liquid antacids like Mylanta and Maalox are safe in pregnancy, give quick relief, and don’t stimulate an increase in stomach acid. The dose isn’t critical so you can keep the bottle by your bed and take a few sips periodically during the night if that works for you. If you are getting too much it will give you diarrhea and you will need to back off.
- Over-the-counter H2 blockers like Pepcid, Tagamet, and Zantac are usually considered safe in pregnancy.
- A prescription-only medication called Sucralfate (Carafate is the brand name) in its liquid form coats your stomach without being absorbed into your system, making it a good choice for pregnant moms—except that it can be constipating.
- Stronger antacids like Nexium and Prilosec may be used during pregnancy if the benefits outweigh the potential risks.
Most heartburn is treatable if you find the right combination of lifestyle changes and medications. Symptoms that are so severe that you are losing weight, vomiting blood, having black tarry stools, or suffering every day despite medications can be signs of serious medical conditions. Talk to your doctor or midwife about your symptoms and work together to get adequate relief. You have a long pregnancy in front of you and you want to be able to enjoy it!