Heartburn, also known as acid indigestion or gastroesophageal reflux, is a common and often uncomfortable experience during pregnancy. This condition arises primarily due to the physiological and hormonal changes that occur in a pregnant woman’s body. Understanding the causes of heartburn during pregnancy and exploring effective relief methods is crucial for managing this discomfort and ensuring the well-being of both the mother and the developing fetus.
One of the primary causes of heartburn during pregnancy is the hormonal changes that the body undergoes. The hormone progesterone plays a pivotal role in pregnancy by relaxing smooth muscles, including those in the gastrointestinal tract. This relaxation can cause the lower esophageal sphincter (LES), which acts as a barrier between the esophagus and stomach, to become more lax. When the LES does not close properly, stomach acid can escape into the esophagus, leading to the burning sensation characteristic of heartburn. Additionally, progesterone slows down the motility of the stomach and intestines, prolonging the digestion process and increasing the likelihood of acid reflux.
Another significant cause of heartburn during pregnancy is the physical pressure exerted by the growing uterus. As the fetus grows, the uterus expands and exerts pressure on the stomach and other abdominal organs. This increased pressure can push stomach contents, including acid, back up into the esophagus. This mechanical factor becomes more pronounced as pregnancy progresses, especially in the third trimester, when the uterus is at its largest.
Dietary habits and certain foods can also contribute to heartburn during pregnancy. Foods that are spicy, fatty, or highly acidic can irritate the esophagus and relax the LES, exacerbating heartburn symptoms. Common culprits include citrus fruits, tomatoes, chocolate, caffeine, and carbonated beverages. Overeating or eating large meals, particularly before bedtime, can also increase the risk of acid reflux as the stomach becomes distended, leading to greater pressure on the LES.
Lifestyle factors play a role as well. Pregnant women who smoke or consume alcohol are at a higher risk of experiencing heartburn. Both smoking and alcohol can weaken the LES and increase stomach acid production. Moreover, stress and lack of sleep can exacerbate digestive issues, including heartburn, as they can affect the body’s ability to process food efficiently.
To alleviate heartburn during pregnancy, a combination of lifestyle modifications and, when necessary, medical interventions can be effective. One of the most straightforward and impactful changes is adjusting eating habits. Pregnant women are advised to eat smaller, more frequent meals rather than large, heavy ones. This helps prevent the stomach from becoming overly full and reduces the likelihood of acid reflux. Additionally, avoiding trigger foods and beverages can significantly decrease heartburn episodes. Keeping a food diary can help identify specific items that cause discomfort and should be avoided.
Elevating the head of the bed or using extra pillows to prop up the upper body during sleep can also provide relief. This position helps prevent stomach acid from rising into the esophagus by leveraging gravity. It is also beneficial to avoid lying down immediately after eating and to wait at least two to three hours before going to bed.
Chewing gum after meals can stimulate saliva production, which neutralises stomach acid and reduces acid reflux. Drinking plenty of water throughout the day, but avoiding large amounts during meals, can also help dilute stomach acid and improve digestion. Wearing loose-fitting clothing can prevent unnecessary pressure on the abdomen and stomach.
For some women, these lifestyle adjustments may not be sufficient, and medical treatments might be necessary. Over-the-counter antacids that contain magnesium or calcium can provide quick relief by neutralising stomach acid. However, it is crucial to consult a doctor before taking any medication during pregnancy to ensure it is safe for both the mother and the baby. In more severe cases, a doctor may prescribe medications such as H2 blockers or proton pump inhibitors, which reduce the production of stomach acid and can provide more long-term relief.
Heartburn during pregnancy is a multifaceted issue caused by hormonal changes, physical pressure, dietary habits, and lifestyle factors. While it is a common and often uncomfortable part of pregnancy, understanding the underlying causes and implementing effective relief strategies can significantly improve the quality of life for expectant mothers. By making dietary adjustments, adopting beneficial lifestyle habits, and seeking appropriate medical advice, pregnant women can manage heartburn symptoms and focus on the joyous experience of preparing for the arrival of their baby.
(The author, Dr. Pooja Choudhary, is a senior consultant (obstetrician and gynecologist) at Apollo Cradle & Children’s Hospital.)
