Mar 23, 2023 • 7 min read

Heartburn & Acid Reflux During Pregnancy: Symptoms, Causes, Treatment, & More

Medically Reviewed by Kim Langdon, MD on 3/23/2023
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You fall asleep easily and expect a normal night’s sleep—until you wake up with nagging pain in your chest and a sour taste in your mouth. What’s going on and why is this the fourth night this month that you’ve suffered from these distressing symptoms?

The common disorder that explains these symptoms is Gastroesophageal Reflux Disease (GERD)—and being pregnant is one of its leading causes. GERD affects about two-thirds of women at some point in pregnancy and, fortunately, passes for most sufferers after the baby is born.

While it’s often referred to as “heartburn,” the intense burning pain located in the middle of the chest is unrelated to your heart. GERD and its symptoms stem from the rise of stomach acid into the esophagus, or “acid reflux.”

There are hormonal and physical reasons why GERD is more common in pregnancy. One is that the growing baby takes up abdominal space, causing more pressure than usual in the abdomen. This forces stomach acid up into the esophagus, especially when you’re reclining.

Luckily, there are things you can do to both prevent and treat GERD. This guide will go over the causes and symptoms of heartburn and acid reflux during pregnancy and explain why it’s so common during this time. You’ll also learn safe treatments that relieve symptoms without risk to you or your baby.    

What is heartburn & acid reflux during pregnancy?

Heartburn and acid reflux are so common during pregnancy that nearly all women experience the symptoms at least once while pregnant. It is more common after a large meal and as the baby gains weight, taking up more space in the abdomen.

Reflux is the result of unequal pressure between the abdominal cavity and the chest cavity. When you eat, food travels through the chest cavity and sits in your stomach. When you have a large meal and a growing baby both adding pressure to the abdominal cavity, it is normal for some of your meal (and stomach acid) to back up.

Pregnancy hormones also exacerbate heartburn. There is a muscle called the lower esophageal sphincter, or LES, that keeps stomach contents in place. Pregnancy hormones like progesterone cause the LES to weaken, allowing stomach acid to enter the esophagus. This is unique to pregnancy and partly explains why heartburn is so common among pregnant women.  

Is there any difference between having heartburn and having acid reflux? Yes and no.

Heartburn is the irritation you get when acid coats the esophagus. Without the same protection against acidity that exists in the stomach, the esophagus is quickly irritated, resulting in heartburn pain. Acid reflux is the cause of heartburn, but it can also cause other symptoms.

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What are the symptoms of heartburn & acid reflux during pregnancy?

Heartburn is just one symptom of acid reflux. Others you might experience include:

  • Throat burning. Acid in the throat burns just as it does in the esophagus. It can feel like irritation in the throat or like having a viral infection or “sore throat.”
  • Wheezing. Tiny droplets of acid can reach the trachea where it connects to the esophagus. When you inhale them, the acid causes your bronchial tree to become irritated. This creates wheezing similar to that seen in asthmatics. If you already have asthma, GERD will likely worsen your asthma symptoms.
  • Chronic cough. Even if you don’t wheeze, the acid in your bronchial tree and trachea can lead to a dry, irritating cough.
  • Sour taste in the back of the throat. Acid is sour-tasting. If it reaches the back of your mouth, you can taste a sourness or even notice some of the liquid in the throat. Doctors call this symptom “water brash.”
  • Sharp chest pain. The esophagus can suddenly spasm, leading to sharp pain in the area of the heart. While it is uncomfortable, the spasm should pass within a few minutes.
  • Laryngitis/hoarse voice. If your larynx/voice box becomes too irritated by stomach acid, you can lose your voice or have difficulty talking or singing without hoarseness.
  • Dental caries. The enamel of your teeth is very sensitive to acidity. If you have frequent cavities in the back teeth, it might be due to acid reflux.

How common is heartburn & acid reflux during pregnancy?

Heartburn and acid reflux are very common. Almost all pregnant women experience heartburn at least once; about two-thirds have it regularly.  As mentioned, pregnancy is a risk factor for GERD. 

GERD and acid reflux can happen at any time in pregnancy, even if the baby hasn’t grown much. Pregnancy hormones are quite elevated as soon as you become pregnant, so you can get heartburn even in the first trimester.

Because the space inside the abdominal cavity is diminished the most in the third trimester, this is when you should most expect these symptoms. If you have other risk factors, including obesity, previous heartburn, and eating large meals before bedtime, your symptoms will be more frequent.

What causes heartburn & acid reflux during pregnancy?

Acid reflux can happen to anyone at any age—even babies can have acid reflux symptoms—but pregnancy increases the likelihood of symptoms for these reasons:

  • Esophageal sphincter relaxing. The lower esophageal sphincter relaxes during pregnancy under the influence of pregnancy hormones. Progesterone, in particular, causes relaxation of the muscle that should keep stomach acid inside the stomach, even when you lie down.
  • Changing hormone levels. Pregnancy hormonal changes are most rapid in early pregnancy. This explains why heartburn can occur very early in pregnancy.
  • Expanding uterus. The bigger the baby grows, the more pressure exists in the abdominal cavity. Simple things like bending over or eating a large meal can tip the scales toward increased symptoms.

How to prevent or soothe heartburn & acid reflux during pregnancy

Heartburn hurts, even if it’s just for a few minutes. If it’s a common occurrence throughout your pregnancy, those nine months may seem very long. Fortunately, there are first-trimester food choices and simple lifestyle modifications that can reduce the frequency and intensity of your symptoms:

  • Eat multiple, small meals throughout the day. Large meals will overfill the stomach, while smaller meals will be better tolerated, particularly before bedtime. This is especially important if you’re dealing with loss of appetite during pregnancy.
  • Take your time eating. Let your digestive system accommodate your eating by eating more slowly. When you eat slowly, you trigger your nervous system to recognize that you aren’t stressed. This improves digestive processes.
  • Avoid spicy foods. Spicy foods tend to be high in acidity. The spices themselves are not as problematic as the acidic foods, like tomatoes, that often accompany the spices.
  • Avoid fatty/greasy foods. Fatty or greasy foods slow your digestive processes so that you are more likely to have your meal still sitting in your stomach when you lie down at night. Learn about the best foods to eat for heartburn and acid reflux at night here.
  • Limit citrus fruits & juices. Citrus fruits and juices made from them (orange, grapefruit, and lemon) are acidic. If you drink too much, especially without food, the acidity can further irritate your esophagus.
  • Focus on alkaline foods. Alkaline foods can help GERD since they limit the amount of acid your stomach can produce.
  • Limit caffeine. Caffeine causes the lower esophageal sphincter to relax. This can cause stomach contents to rise up into the esophagus more easily.
  • Drink fewer fluids while eating. The more you put into your stomach (foods and fluids), the greater the pressure difference between the stomach and esophagus.
  • Wear loose clothes. Loose clothes allow your belly to expand and make room for both the baby and the rest of your abdominal contents.
  • Avoid tobacco and alcohol. Both of these relax the lower esophageal sphincter, causing more irritation of the esophagus.
  • If going to bed after eating, elevate your head. Placing a couple of blocks beneath the head of your bed or lying more upright in a recliner will allow gravity to help you avoid reflux.

If you’re looking for more help, you can learn about the ideal GERD diet for reducing acid reflux and heartburn here and supplements that can help with GERD here.

Also, here at Zaya Care, we can help you find a pregnancy nutritionist or find an acid reflux nutritionist that accepts your insurance and has your preferred visit type so you can get the help you need.

Which treatments for heartburn & acid reflux are safe & unsafe during pregnancy?

There are medications used outside of pregnancy to reduce stomach acid. These reduce symptoms by lowering the acid levels that enter the esophagus.

Can these medications be used while pregnant? Here’s what the research says:

  • Antacids. Antacids include Tums, Maalox, and Mylanta. These neutralize stomach acid fairly quickly and are not absorbed by the gut. This means that you can use them periodically for quick relief of heartburn. They are recognized as safe during pregnancy.
  • Histamine H2-receptor antagonists. These medicines, also known as H2-blockers, include cimetidine, famotidine, and nizatidine. These are also considered safe to take during pregnancy.
  • Proton pump inhibitors. Proton pump inhibitors lower stomach acid by blocking the mechanism that makes it. Most are labeled Category B, which means they are safe to take during pregnancy. One drug that is not recommended is omeprazole. Options considered safer include lansoprazole, pantoprazole, and esomeprazole.

When to seek medical attention for heartburn & acid reflux during pregnancy

In most cases, heartburn and acid reflux in pregnancy can be minimized enough to be tolerated, particularly if they don’t interfere with sleep. But you should talk to your healthcare provider if you are pregnant and have these symptoms:

  • Your sleep is interrupted regularly.
  • You want to begin taking medications for your symptoms regularly.
  • You have shortness of breath from wheezing or coughing because of reflux.
  • Your symptoms persist despite changing your eating habits and lifestyle.

You can also work with a prenatal nutritionist to make sure you are eating properly to reduce acid reflux and heartburn and have a healthier pregnancy, in general.

>> Download our printable 7-day GERD diet plan PDF here

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Christine Traxler MD is a family physician, lifelong writer, and author with a special interest in mental health, women’s healthcare, and the physical after-effects of psychological trauma. As a contributing writer and editor for numerous organizations, she brings a holistic focus to her work that emphasizes healing and wellness through daily self-care, connecting with others, and setting stepwise goals toward achieving more balanced and authentic lives.