Heartburn

INFORMATION FOR WOMEN WHO HAVE HEARTBURN DURING PREGNANCY OR BREASTFEEDING

The information provided below is for readers based in the United States of America. Readers outside of the United States of America should seek the information from local sources.

What is heartburn during pregnancy?

Heartburn is a colloquial term for what doctors call gastroesophageal reflux disease (GERD), in which contents from the stomach move backward into the esophagus. This leads you to feel a burning sensation in the chest or throat, so it actually has nothing to do with the heart. Special cells within the lining of the stomach, called parietal cells, secrete hydrochloric acid, which helps in the digestion of food, so the problem is not that the stomach makes acid, but that the acid comes up. This can happen to anybody, but pregnant women are particularly prone to GERD, because of a combination of weight gain and the growing womb, both of which cause pressure increase on the stomach, and also because the lower esophageal sphincter (LES, a ring-shaped muscle that normally keeps stomach contents from entering the esophagus) tends to relax in pregnancy.

How common is heartburn during pregnancy?

GERD has been reported to occur with a prevalence ranging from 30 percent to as much as 80 percent of pregnancies (depending on which report you read). Various factors increase your chances of developing GERD. Gaining too much weight during pregnancy, for instance, increases the chances, as does eating within about three hours of going to bed, and consuming caffeine, chocolate, alcohol, mint, onions, garlic, foods that are fatty or spicy, and consuming large meals, rather than dividing your food into smaller meals and eating more frequently. Smoking also stimulates GERD, but avoiding heartburn is one of the least important reasons to avoid smoking.

How is heartburn during pregnancy diagnosed?

Reporting symptoms of heartburn will be a big clue to the doctor that you may have GERD, especially if you are pregnant. Once that happens, you may be sent to a gastroenterologist for a procedure called upper endoscopy to rule out other conditions that can cause similar symptoms, such as a gastric ulcer. In upper endoscopy, a flexible tube is inserted down your throat, with a bright light and camera to view the lining of your esophagus and stomach, and if needed to obtain a sample.

Does heartburn cause problems during pregnancy?

If you are experiencing GERD frequently, you will have a burning sensation, and often a sore throat. Typically, these symptoms are worse in the morning (due to reflux while you sleep) and after large meals. Usually, the condition resolves after you deliver and return to your normal weight. If GERD is frequent and continues for a long time, however, it can cause changes in the lining of the esophagus that, over time, can lead to cancer.

Does heartburn cause problems for the baby?

GERD in a pregnant woman does not harm the baby.

What to consider about taking medications when you are pregnant or breastfeeding:

  • The risks to yourself and your baby if you do not treat the heartburn
  • The risks and benefits of each medication you use when you are pregnant
  • The risks and benefits of each medication you use when you are breastfeeding

What should I know about using medication to treat heartburn during pregnancy?

The first medical treatment that you can try is antacid, which you can use as directed on the package. If this is not enough, an H2-blocker, a drug that prevents histamine from stimulating the parietal cells from making acid, may be used. A popular H2-blocker is ranitidine, which you can obtain over-the-counter (no prescription needed in the United States). Recently, this drug has been the subject of controversy related to the concern that it may have the potential to cause cancer, but the jury is out on this issue, and ranitidine is thought to be very safe in pregnancy, so it may be an option for you. If an H2-blocker does not relieve your symptoms, the next step is to use a proton pump inhibitor (PPI) drug. The flagship PPI is called omeprazole, but it is in a higher pregnancy risk category than the other PPIs. Most of these other PPIs also end with the suffix prazole, and your doctor or pharmacist can help you select one based on price and other considerations.

Who should NOT stop taking medication for heartburn during pregnancy?

You can stop taking an H2-blocker or a PPI, but your symptoms are likely to return if you do stop.

What should I know about choosing a medication for my heartburn during pregnancy?

It is important to stay in communication with your health care provider as the release of new studies over time can change the outlook on the role of specific medications during pregnancy.

You may find Pregistrys expert reports about the medications to treat this condition here. Additional information can also be found in the sources listed below.

What should I know about taking a medication for my heartburn when I am breastfeeding?

Ranitidine is considered safe in nursing mothers, and PPIs are probably safe since secretion into breastmilk is very low.

What alternative therapies besides medications can I use to treat my heartburn during pregnancy?

One important measure against GERD is the management of weight gain during pregnancy. Doing this requires knowing your body mass index (BMI) at the onset of pregnancy. If you start underweight (BMI below 18.5), you can gain up to 40 pounds by the end of pregnancy. If you are of normal weight (BMI 18.524.9), you should gain 25-35 pounds. If you are overweight (BMI 2529.9), you should gain 1525 pounds at most (or perhaps a little less), and if you are obese (BMI >30), you should not gain any weight during pregnancy. Other strategies against GERD include not eating within about three hours of going to bed, and avoiding caffeine, chocolate, alcohol, mint, onions, garlic, and foods that are fatty or spicy. Instead of eating three large meals, you should divide your food into 5-6 smaller meals throughout the day. Avoid smoking. Chewing sugarless gum after meals and before going to bed also can be helpful, because it stimulates saliva, which is alkaline, to run down your esophagus. One other thing that you can do is elevate the head side of your bed.

What can I do for myself and my baby when I have heartburn during pregnancy?

Be assured that heartburn is extremely common during pregnancy and that it most likely will go away in the weeks after you deliver. Follow the instructions of your physician regarding medications and lifestyle.

Resources for heartburn in pregnancy:

For more information about heartburn during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or contact the following organizations:

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General information

It is very common for women to worry about having a miscarriage or giving birth to a child with a birth defect while they are pregnant. Many decisions that women make about their health during pregnancy are made with these concerns in mind.

For many women these concerns are very real. As many as 1 in 5 pregnancies end in a miscarriage, and 1 in 33 babies are born with a birth defect. These rates are considered the background population risk, which means they do not take into consideration anything about the health of the mom, the medications she is taking, or the family history of the mom or the baby’s dad. A number of different things can increase these risks, including taking certain medications during pregnancy.

It is known that most medications, including over-the-counter medications, taken during pregnancy do get passed on to the baby. Fortunately, most medicines are not harmful to the baby and can be safely taken during pregnancy. But there are some that are known to be harmful to a baby’s normal development and growth, especially when they are taken during certain times of the pregnancy. Because of this, it is important to talk with your doctor or midwife about any medications you are taking, ideally before you even try to get pregnant.

If a doctor other than the one caring for your pregnancy recommends that you start a new medicine while you are pregnant, it is important that you let them know you are pregnant.

If you do need to take a new medication while pregnant, it is important to discuss the possible risks the medicine may pose on your pregnancy with your doctor or midwife. They can help you understand the benefits and the risks of taking the medicine.

Ultimately, the decision to start, stop, or change medications during pregnancy is up to you to make, along with input from your doctor or midwife. If you do take medications during pregnancy, be sure to keep track of all the medications you are taking.


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