HEARTBURN IN PREGNANCY
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Heartburn is one of the most common discomforts experienced during pregnancy,
with up to 80% of all pregnant women experiencing it at some point. In many
women, heartburn is experienced for the first time during pregnancy. It can begin as
early as the first trimester, with symptoms coming and going with varying degrees of
discomfort until your baby is born. In many cases, the symptoms become
progressively worse as the pregnancy progresses.
Fortunately, it usually clears up after delivery. Although it can be worrying,
uncomfortable and even painful for you, heartburn is relatively harmless and cannot
affect your baby.
What is Heartburn?
Heartburn is described as a feeling of burning discomfort, usually localised behind the
breastbone. It also sometimes moves up towards the neck and throat.
This feeling is caused by gastro-oesophageal reflux, which means that digestive acids
from the stomach move upwards from the stomach, into the long muscular tube
(oesophagus) that transport food from the mouth to the stomach. The acids, causing
the discomfort we recognise as heartburn irritate the delicate lining of the oesophagus.
Symptoms of Heartburn
The common burning sensation of heartburn is experienced most often after meals.
Sometimes, the acid moves far enough up the oesophagus to reach the mouth and
throat, causing a bitter, sour or salty taste in the mouth, and possibly causing
hoarseness or laryngitis.
The symptoms of heartburn are the same in pregnant women as in anyone else.
However, pregnant women may experience heartburn more frequently, and often
experience it when lying down. Heartburn may also develop after movements that
increase pressure on the abdomen, such as straining, lifting, coughing or bending
over. It is often worse at night, and in the third trimester of pregnancy.
Causes of Heartburn in Pregnancy
Between the lower part of the oesophagus and the stomach is a valve called the lower
oesophageal sphincter (LOS). Normally, this is a “one way valve” that allows food to
enter the stomach, but does not allow the stomach again. However, if the LOS
relaxes, the stomach acids will pass upwards into the oesophagus, causing burning
discomfort.
Factors such as fatty foods, cigarettes, alcohol, chocolate and caffeine can relax the
LOS, increasing reflux. Reflux can also occur as a result of poor diet, hiatus hernia
and obesity.
During pregnancy, the LOS can also relax due to the effects of hormones-the placenta
produces the hormone progesterone, which relaxes the walls of the uterus.
Unfortunately, this hormone also relaxes other muscular tissue, including the LOS, as
well as slowing down the wavelike contractions of the stomach. This means that food
takes longer to digest and more acid builds up in the stomach at the same time as the
LOS is more relaxed than usual.
In later pregnancy, the growing baby and uterus take up more and more space,
cramping the stomach and making digestion even slower. This results in increased
acid in the stomach and more severe reflux, more often.
Diagnosing the Cause of Heartburn
If you experience heartburn for the first time during pregnancy, your doctor will
probably not order any further investigation, beyond taking a thorough look at your
medical history.
However, in highly exceptional cases, more tests might be needed to determine the
cause of the heartburn. These tests might include:
. Gastroscopy, using a flexible viewing tube passed through the mouth (you will
be sedated). This may show signs of gastro-oesophageal reflux, such as redness
or ulceration of the oesophageal lining.
. Barium swallow/meal – you swallow Barium, which shows up on special X-rays.
This is rarely if ever done in pregnancy because of the wish to avoid X-rays if
possible.
Avoiding Heartburn During Pregnancy
If you are prone to heartburn during pregnancy, there are steps you can take to
minimise the discomfort. Most of these involve improving the digestion process, and
so reducing the amount of acid in the stomach.
. Eat smaller meals. Two or three large meals will distend your stomach and
increase discomfort. Rather have five or six smaller meals and snacks during the
day.
. Break food into smaller, more manageable portions and take small bites. Eat
slowly, do not rush, and chew food properly. The more you chew, the less time
food needs to stay in your stomach for proper digestion.
. Drink only small amounts of water with meals. You may swallow air as you
drink, which makes heartburn worse.
. Avoid spicy, fatty or greasy foods, as these lower LOS tone.
. Stay away from drinks containing caffeine, such as coffee and colas.
. Avoid citrus food and drinks such as oranges, orange juice and tomato juice.
These may irritate the lining of the oesophagus.
. Avoid alcohol and cigarettes.
. Say no to chocolate, as this also lowers LOS tone.
. Try chewing a non-mint chewing gum. Chewing gum decreases the discomfort
of heartburn. However, peppermint can make it worse.
. Do not eat while lying down
. Wait two hours after eating before lying down, and do not eat immediately
before bedtime.
. Sleep at a slight incline. Prop your head and shoulders up on a pillow or two,
or elevate the head of the bed. This keeps your stomach below your diaphragm,
so that gravity will help to keep your stomach contents where they belong.
. Wear loosely fitting clothing especially in the third trimester
.
If you have any more questions regarding Heartburn in Pregnancy, please
consult your Doctor or Healthcare professional