What causes heartburn in pregnancy

WITHDRAWAL OF RANITIDINE

In April 2020, the Food and Drug Administration (FDA) requested that all forms of prescription and over-the-counter (OTC) ranitidine (Zantac) be removed from the U.S. market. This recommendation was made because unacceptable levels of NDMA, a probable carcinogen (cancer-causing chemical), were found in some ranitidine products. If you’re prescribed ranitidine, talk with your doctor about safe alternative options before stopping the drug. If you’re taking OTC ranitidine, stop taking the drug and talk with your healthcare provider about alternative options. Instead of taking unused ranitidine products to a drug take-back site, dispose of them according to the product’s instructions or by following the FDA’s guidance.

Ranitidine, brand name Zantac, is now marketed as Zantac 360, which contains a different active ingredient (famotidine). Famotidine is in the same class as ranitidine and works the same way but has not been found to contain unacceptable levels of NDMA.

You expected the swollen ankles, the morning sickness, and the burgeoning breasts. But this burning indigestion? Where’d that come from?

As the name implies, heartburn (also called gastroesophageal reflux and acid indigestion) feels like a fiery churning that starts behind your breastbone and travels up your esophagus, a tube connecting your throat to your stomach. These acids can even make it all the way up your throat.

In addition to feeling a burning sensation — which can last several minutes to several hours — you may also:

• feel bloated
• belch a lot
• have a sour taste in your mouth
• have a sore throat
• cough frequently

While the burrito you ate for dinner probably didn’t help matters (spicy foods can make heartburn worse), the burning feeling you have has more to do with hormones than jalapenos.

If you feel like you have a three-alarm fire dancing in your chest, you’re not alone. According to one study, up to 45 percent of moms-to-be experience heartburn. And if you had heartburn before pregnancy, you’re even more likely to have it during.

Heartburn can fire up, so to speak, at any point in pregnancy, but it’s most common during the second and third trimesters. Experts aren’t exactly sure what causes the smoldering, but they suspect it’s a three-pronged problem.

Hormones

Progesterone, also called the “pregnancy hormone” because it nurtures your womb and the baby inside it, is the leading culprit behind pregnancy-related heartburn.

Progesterone acts as a muscle relaxer. In the case of heartburn, the hormone can loosen the tight muscle (called the lower esophageal valve) that closes your stomach off from your esophagus.

When you eat or drink, the muscle normally opens to let contents into the stomach before shutting tightly. But the surging progesterone levels that occur during pregnancy can make that muscle slack, allowing stomach acid to backflow up your esophagus and even into your throat.

Growing baby

As your uterus expands with your growing baby, it competes for space with some of your other organs. Like a tube of toothpaste being squeezed, your growing uterus places pressure on your stomach, making it more likely stomach acids will spill out ― especially if your stomach is full.

The more your uterus grows, the more likely your stomach will get squeezed. This may help explain why heartburn is more common as you progress through pregnancy.

Slowed digestion

Thanks to progesterone, stomach contents stick around longer than normal. As digestion slows and the stomach remains fuller longer, the chances of heartburn increase.

Heartburn can be uncomfortable, but here’s how to fire back:

1. Watch what you eat

Not surprisingly, acidic and spicy foods create more stomach acid than bland ones (till we meet again, Taco Tuesday!). Avoid citrus, tomatoes, onions, garlic, caffeine, chocolate, sodas, and other acidic foods. Also steer clear of fried or fatty foods, which slow digestion.

2. Eat frequent small meals instead of three a day

This helps to avoid overwhelming the stomach and allows it to empty quicker.

3. Sit up straight when you eat

Your mom was actually right about this — and well, a lot of other things, too. Gravity will help your food stay put.

4. Don’t eat within three hours of going to bed

Giving digestion a head start before you lie down — which slows the emptying of your stomach — for the night will help control your heartburn.

5. Don’t smoke

There are a lot of reasons why you shouldn’t smoke during pregnancy, and heartburn is just one of them. Chemicals in cigarettes cause the valve that keeps stomach contents down to relax. This allows acids and undigested foods to splash upward and take their fiery aim.

6. Elevate your head 6 to 9 inches when you sleep

The easiest way to achieve this is by placing pillows under your shoulders, raising the head of your bed with blocks placed underneath the bed’s legs, or buying a special wedge pillow to place between the mattress and box spring. Sleeping propped up is another way to have gravity work for you.

7. Wear loose-fitting clothing

Step away from the Spanx and any other garment that creates pressure around your midsection. Rock your bump, and the stretchy, comfy pants, too!

8. Drink after meals, not with them

Drink liquids along with your food and you could be creating an overfull, sloshy stomach environment primed for heartburn.

9. Give acupuncture a try

In a 2015 study, pregnant women who received acupuncture versus those who didn’t showed no difference in their symptoms — but the women who had acupuncture did report improvement in their ability to sleep and eat.

10. Don’t drink alcohol

Besides the fact that exposure to alcohol can cause all kinds of problems for your developing baby ― everything from low birth weight to learning disabilities ― alcohol can also relax the valve that keeps stomach contents in the stomach.

11. Talk to your doctor about heartburn medications

This includes over-the-counter (OTC) ones — some are safe to take during pregnancy.

Antacids help neutralize the acid in your stomach and quell that burning sensation. The University of Wisconsin School of Medicine and Public Health says OTC antacids containing calcium carbonate (like Tums) are safe to use.

If you haven’t been able to quiet your heartburn with lifestyle changes, your doctor may suggest heartburn drugs like Tagamet and Prilosec, which are generally considered safe during pregnancy. While these drugs are available OTC, you might receive a prescription for a stronger dose if your doctor thinks it’s warranted.

When you’re pregnant, you have to think about the safety of everything you put into and on your body. Some heartburn medications that might be OK for your nonpregnant sister ― but not for you ― include:

• Antacids containing sodium bicarbonate, which can increase swelling.
• Antacids containing aspirin, which can be toxic to your baby. Aspirin use during pregnancy has been associated with pregnancy loss, heart defects, and bleeding on the brain in premature infants. (In some cases, your doctor may have you on aspirin as a treatment or preventative for other pregnancy complications, like preeclampsia.)
• Antacids containing magnesium trisilicate, which haven’t been proven safe to use in pregnancy.

While pregnancy heartburn is common and uncomfortable, the sizzle should subside once you give birth and hormone levels return to normal.

You may not be able to prevent heartburn, especially if you’re prone to it even when you’re not pregnant, but you can help put out the flames with some simple lifestyle changes, such as eating small meals, avoiding spicy or fatty foods, and sleeping with your head and shoulders elevated.

If these measures don’t bring enough relief, talk to your doctor about medications that are safe to use during pregnancy.

It’s called heartburn, although that burning feeling in your chest has nothing to do with the heart. Uncomfortable and frustrating, it bothers many women, particularly during pregnancy.

The first question you may have is how to make it stop. You may also wonder if treatments are safe for your baby. Learn what causes heartburn during pregnancy and what you can do about it.

During normal digestion, food travels down the esophagus (the tube between your mouth and stomach), through a muscular valve called the lower esophageal sphincter (LES), and into the stomach.

The LES is part of the doorway between your esophagus and your stomach. It opens to allow food through and closes to stop stomach acids from coming back up.

When you have heartburn, or acid reflux, the LES relaxes enough to allow stomach acid to rise up into the esophagus. This can cause pain and burning in the chest area.

During pregnancy, hormone changes can allow the muscles in the esophagus, including the LES, to relax more frequently. The result is that more acids may seep back up, particularly when you’re lying down or after you’ve eaten a large meal.

In addition, as your fetus grows during the second and third trimesters and your uterus expands to accommodate that growth, your stomach is under more pressure. This can also result in food and acid being pushed back up into your esophagus.

Heartburn is a common occurrence for most people at one time or another, but it doesn’t necessarily mean you’re pregnant. However, if you also experience other symptoms, such as a missed period or nausea, these could be signs that you need to take a pregnancy test.

Pregnancy increases your risk of heartburn or acid reflux. During the first trimester, muscles in your esophagus push food more slowly into the stomach and your stomach takes longer to empty.

This gives your body more time to absorb nutrients for the fetus, but it can also result in heartburn.

During the third trimester, the growth of your baby can push your stomach out of its normal position, which can lead to heartburn.

However, each woman is different. Being pregnant doesn’t necessarily mean you’ll have heartburn. It depends on many factors, including your physiology, diet, daily habits, and your pregnancy.

Relieving heartburn during pregnancy typically involves some trial and error. Lifestyle habits that can reduce heartburn are often the safest methods for mother and baby. The following tips may help relieve your heartburn:

• Eat smaller meals more frequently and avoid drinking while eating. Drink water in between meals instead.
• Eat slowly and chew every bite thoroughly.
• Avoid eating a few hours before bed.
• Avoid foods and beverages that trigger your heartburn. Typical culprits include chocolate, fatty foods, spicy foods, acidic foods like citrus fruits and tomato-based items, carbonated beverages, and caffeine.
• Stay upright for at least one hour after a meal. A leisurely walk may also encourage digestion.
• Wear comfortable rather than tight-fitting clothing.
• Maintain a healthy weight.
• Use pillows or wedges to elevate your upper body while sleeping.
• Sleep on your left side. Lying on your right side will position your stomach higher than your esophagus, which may lead to heartburn.
• Chew a piece of sugarless gum after meals. The increased saliva may neutralize any acid coming back up into the esophagus.
• Eat yogurt or drink a glass of milk to quell symptoms once they start.

Alternative medicine options include acupuncture and relaxation techniques, such as progressive muscle relaxation, yoga, or guided imagery. Always check with your doctor before trying new treatments.

Over-the-counter antacids such as Tums, Rolaids, and Maalox may help you cope with occasional heartburn symptoms. Those made of calcium carbonate or magnesium are good options.

However, it may be best to avoid magnesium during the last trimester of pregnancy. Magnesium could interfere with contractions during labor.

Most doctors recommend avoiding antacids that contain high levels of sodium. These antacids can lead to a buildup of fluid in the tissues.

You should also avoid any antacids that list aluminum on the label, as in “aluminum hydroxide” or “aluminum carbonate”. These antacids can lead to constipation.

Finally, stay away from medications like Alka-Seltzer that may contain aspirin.

Ask your doctor for the best option. If you find yourself downing bottles of antacids, your heartburn may have progressed to gastroesophageal acid reflux disease (GERD). In that case, you may need a stronger treatment.

If you have heartburn that often wakes you up at night, returns as soon as your antacid wears off, or creates other symptoms (such as difficulty swallowing, coughing, weight loss, or black stools), you may have a more serious problem that requires attention.

Your doctor may diagnose you with GERD. This means that your heartburn needs to be controlled to protect you from complications such as damage to the esophagus.

Your doctor may prescribe certain acid-reducing medications to reduce your symptoms. Research indicates that medications called H2 blockers, which help block the production of acid, appear to be safe.

Another type of medication, called proton pump inhibitors, is used for people with heartburn that doesn’t respond to other treatments.

If you’re concerned about the effects of medications, be sure to talk to your doctor. Doctors can help you control your symptoms while keeping your unborn child safe.