Heartburn and Indigestion During Pregnancy

Once the nausea of early pregnancy wanes, many women look forward to enjoying their meals again. However, around the middle of pregnancy, heartburn and indigestion may spoil the party. These discomforts can happen at any time, but are more common in the second and third trimesters. Fortunately, they're rarely serious and are easily treatable.

What are heartburn and indigestion?

Heartburn -- which actually has nothing to do with your heart -- is marked by a burning sensation after meals in your throat or in your chest behind the breastbone. It's caused by stomach acid coming in contact with the esophagus (the pipe your food travels down). A valve at the bottom of that pipe seals off the top of the stomach when you're not eating, but when valve is overly relaxed, partially digested food and stomach acid sometimes make their way back up into the esophagus, irritating its sensitive lining.

The chief symptom of heartburn is a burning feeling in the chest. You may also experience a sour taste in your mouth or the unpleasant feeling that vomit is rising in your throat.

Indigestion, also known as dyspepsia, is a general term for digestion-related pain or discomfort in the abdomen. Symptoms of indigestion include heartburn, excess gas, bloating, burping, and feeling too full after a normal meal.

Both heartburn and indigestion are common conditions during pregnancy and rarely require medical attention.

What causes heartburn and indigestion during pregnancy?

When you're expecting, the hormones coursing through your body make the muscles of the digestive system relax, which slows down digestion. The valve in your esophagus may open or leak, allowing acid from the stomach to flow upward. In addition, as your uterus grows, it pushes against the stomach, increasing pressure on the valve.

The slowdown in digestion can also cause more gas, which is the culprit in flatulence and bloating. Your stomach has less room due to your expanding uterus, and so feels fuller than normal.

How can I prevent heartburn?

Avoid eating or drinking things that encourage the valve in the esophagus to relax further. These include greasy or fatty foods, chocolate, caffeine, carbonated drinks, tomato products, citrus juice, peppermint and spearmint, alcohol, onion, garlic, and spicy foods.

Here are some other tips:

  • Sit up straight while eating.
  • Remain upright for several hours after eating.
  • Take a leisurely stroll after dinner to get digestion going.
  • Keep your weight gain within reasonable limits.
  • Wear loose-fitting clothing.
  • Incorporate healthy sources of fiber in your diet to help the digestive system do its job.
  • Reduce your stress level by taking time out for something you enjoy, such as a warm bath, a good book, or a chat with a friend.
  • Eat frequent, light meals. The fuller your stomach is, the more pressure on the valve in your esophagus. For the same reason, avoid filling up on liquids while eating -- consume your fluids between meals.
  • Commit to not smoking or drinking alcohol. Smoking can increase the acidity in your stomach and is linked to premature birth, and drinking during pregnancy -- especially binge or heavy drinking -- can cause permanent brain damage to the fetus. If necessary, seek help from friends, support groups, or professionals.
  • Raise the head of your bed by placing wooden wedges under the legs.
  • Talk with your doctor about which antacids are safe during pregnancy, such as calcium carbonate (Tums).

If you are on medications, be sure to check whether heartburn is one of the possible side effects. Your doctor may want to adjust your treatment or dosage.

How can I prevent indigestion?

One of the best ways to minimize indigestion is to reduce the amount of gas in your body. Gas enters your system when you swallow air or forms inside your body when bacteria work on undigested food in your intestine. Although there is no way to eliminate gas altogether, here are some helpful tips to keep it in check:

  • Avoid foods that cause you gas. These may include beans, cabbage, cauliflower, brussels sprouts, broccoli, asparagus, and carbonated drinks. Don't rule out whole classes of healthy foods, however, as beans and cruciferous vegetables are very nutritious. Instead, keep track of your body's reactions to different foods -- meals that give your friend indigestion may sit just fine with you -- and avoid foods that cause you problems.
  • Stay away from high-fat, fried foods. These take longer to digest and thus contribute to bloating.
  • Graze throughout the day rather than filling up at mealtime.
  • Chew your food thoroughly (try counting how many times you actually chew each bite) and don't rush through meals. The same goes for beverages. Take your time drinking and avoid gulping, which can introduce more air into your system. Never drink through a straw.
  • Drink most of your fluids between meals, rather than when you eat.
  • Practice good posture at the dinner table.
  • Stay away from gum and hard candy, particularly those that are artificially sweetened. (These can cause significant gas in some people.)
  • Get plenty of exercise, best done before a meal or at least one hour afterwards.
  • Take steps to prevent or treat constipation. Drink lots of water, take daily walks, and try wheat bran for fiber, which will help speed up your digestive system. This source shouldn't result in more gas, as many other fiber-rich foods do.
  • Don't smoke or drink alcohol.
  • Practice relaxation and deep breathing. If you're having trouble doing so, consider taking a class on prenatal yoga or meditation.

When should I see a doctor?

If these prevention techniques don't work and you want to try an antacid or an anti-gas medication, speak with your doctor or midwife. Your health care provider can prescribe the medication that is best for you or help you make a safe choice of over-the-counter remedies.

What if my symptoms are really those of a heart attack?

Call 911 if you suspect that a sensation similar to heartburn could be a heart attack instead. Because both conditions can cause burning chest pain, pay careful attention to your symptoms. Signs that discomfort may indicate a heart attack, rather than just heartburn, include:

  • A squeezing or crushing feeling in the chest
  • Pressure in the chest
  • Dizziness
  • Nausea
  • Hot flushing or cold sweat
  • Unusual fatigue
  • Shortness of breath
  • Weakness
  • A feeling of malaise and indigestion, particularly among women
  • Pain that spreads into your shoulder, arm or jaw

Fortunately, however, heart attacks among pregnant women are still very rare, although the rate has gone up slightly in recent years. In addition, pregnancy itself can increase a womans risk of heart attack 3- to 4- fold, according to a 2008 study published in the Journal of the American College of Cardiology. Because many symptoms of a heart attack are similar to those of common pregnancy discomforts, discuss heart attack awareness with your health care provider if you have any risk factors for heart problems. These include persistent high blood pressure, diabetes, eclampsia or preeclampsia, and getting pregnant later in life.

Armed with this toolbox of preventive tips, you should be able to indulge your food cravings without worrying about heartburn.

References

March of Dimes. Heartburn and Indigestion. http://www.marchofdimes.com

Mayo Clinic. Nonulcer stomach pain. http://www.mayoclinic.com

Mayo Clinic. Heartburn/GERD. http://www.mayoclinic.com/

Mayo Clinic. Early pregnancy: Morning sickness, fatigue and other common symptoms.

Pregnancy associated with increased risk of heart attack, Science Daily, July 8, 2008.

National Heartburn Alliance. Sufferers Point to Stress as an Aggravator of Heartburn. http://www.heartburnalliance.org/section3/1001.jsp

University of Pennsylvania Health System. Managing Heartburn with Diet. http://www.pennhealth.com/health_info/nutrition/heartburn.html

Journal of the American Medical Association. Smoking and Pregnancy. JAMA Patient Page. Vol. 293 No. 10, March 9, 2005. http://jama.ama-assn.org/cgi/content/full/293/10/1286

March of Dimes. Drinking Alcohol During Pregnancy. August 2010. http://www.marchofdimes.com/professionals/681_1170.asp

American Pregnancy Association. Pregnancy and Heartburn. http://www.americanpregnancy.org/pregnancyhealth/heartburn.html

Mayo Clinic. Heart Attack. March 2005. http://www.mayoclinic.com/

Black RA et al. Over-the-Counter Medications in Pregnancy. American Family Physician. Vol. 67 No. 12. http://www.aafp.org/afp/20030615/2517.html

National Digestive Diseases Information Clearinghouse. Gas in the Digestive Tract. http://digestive.niddk.nih.gov/ddiseases/pubs/gas/

Mayo Clinic. Intestinal Gas: The Inside Story. http://www.mayoclinic.com

American College of Obstetricians and Gynecology. Pregnancy-Related Heart Attack Incidence Increases Slightly. ACOG News Release. February 2005. http://www.acog.org/from_home/publications/press_releases/nr02-28-05-1.cfm

McSweeney JC et al. Women's Early Warning Symptoms of Acute Myocardial Infarction. Circulation. http://www.circ.ahajournals.org/cgi/content/full/108/21/2619

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