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Heartburn in pregnancy

Also known as Acid reflux in pregnancy, GERD in pregnancy, Indigestion. Any time, most common in the third trimester.

That burning behind the breastbone, the sour taste, the sense that dinner is coming back up: heartburn is among the most common and most miserable discomforts of pregnancy. It is not dangerous to you or your baby, and it is very treatable, the work of pregnancy hormones and a growing uterus ganging up on the valve that keeps stomach acid down. This page covers what helps, which remedies are safe, and the one upper-belly pain in later pregnancy that is not heartburn and needs checking.

Know the warning signs When to call a provider
How common
Up to 80% of pregnancies
Estimates range from 30% to 80%, rising through the trimesters.
When
Peaks in the third trimester
Can start any time; most common when the uterus is largest.
Urgency
Routine
Uncomfortable but not harmful; managed with lifestyle and safe medicines.
Outlook
Resolves after birth
Symptoms typically disappear once the baby is delivered.

Understanding it

What is heartburn in pregnancy?

Heartburn in pregnancy is the burning that rises from the stomach up behind the breastbone, often after eating or lying down, sometimes with a sour taste at the back of the throat. Despite the name it has nothing to do with the heart: it is acid reflux, stomach contents washing back up into the esophagus, which is not built for acid.

Two things make pregnancy prone to it. Progesterone relaxes smooth muscle, including the lower esophageal sphincter, the valve that keeps acid down, so acid escapes upward. And the growing uterus crowds the stomach and pushes contents up. That is why heartburn worsens as pregnancy progresses, from about a quarter of people in the first trimester to more than half by the third.

Unpleasant as it is, heartburn does not harm your baby or signal anything wrong. It is a plumbing problem of hormones and anatomy, and it resolves after delivery, once the valve regains its tone and the uterus no longer presses on the stomach.

There is a lot you can do, from how and when you eat up to safe medicines. One caution: in the second half of pregnancy, severe pain in the upper belly, especially on the right side under the ribs, is not always heartburn. Paired with a bad headache, vision changes, or new nausea, it can be a sign of preeclampsia, and that needs prompt evaluation.

Symptoms

What are the symptoms?

The classic symptom is a burning feeling behind the breastbone, often after meals or lying down. It is uncomfortable but, on its own, not dangerous.

Early signs

  • A burning feeling in the chest, often after eating or at night
  • A sour or bitter taste at the back of the throat
  • Regurgitation, food or liquid coming back up
  • Bloating, fullness, and frequent burping
  • Symptoms that worsen when lying down or bending over

Emergency signs — call 911

  • Severe pain in the upper belly, especially under the ribs on the right side, in the second half of pregnancy, which can be preeclampsia rather than heartburn
  • Upper-belly pain with a bad headache, vision changes, or new nausea and vomiting after mid-pregnancy
  • Vomiting blood or material that looks like coffee grounds
  • Black, tarry stools
  • Trouble or pain with swallowing, or unintentional weight loss
  • Chest pain with shortness of breath, sweating, or pain spreading to the arm or jaw

Why it matters

Risks to you and baby

It does not harm the baby

Heartburn is uncomfortable for you, but it does not affect your baby's health or the pregnancy itself.

Sleep and quality of life

The real toll is on rest and comfort. Nighttime reflux disturbs sleep and constant discomfort wears on you, reason enough to treat it.

Being mistaken for something serious

In the second half of pregnancy, the upper-belly pain of preeclampsia or HELLP can feel like heartburn. Unlike heartburn, it usually does not burn or ease with antacids, and may come with headache or vision changes. When in doubt, get it checked.

Rarely, esophagus irritation

Long-standing, untreated reflux can irritate or inflame the esophagus lining. This is uncommon in pregnancy and another reason to treat persistent symptoms rather than endure them.

How it's found

How is it diagnosed?

Heartburn in pregnancy is diagnosed from your description of the symptoms. Tests are rarely needed and usually avoided in pregnancy unless there are warning signs.

Clinical history

The pattern of burning after meals or lying down, with a sour taste, is enough to diagnose most cases. No scan or scope is needed.

Checking for red flags

Your provider makes sure it is not something else: trouble swallowing, vomiting blood, black stools, or weight loss would prompt further evaluation.

Blood pressure and labs when pain is high up

For severe upper-belly pain in the second half of pregnancy, blood pressure and blood tests check for preeclampsia or HELLP rather than treating it as reflux.

Whenever symptoms are bothersome. Investigation is reserved for warning signs or symptoms that do not respond to treatment.

Treatment

How is it managed?

Treatment climbs a ladder, from how and when you eat to antacids and, if needed, stronger acid-reducing medicines safe in pregnancy.

Treatment paths

The foundation is lifestyle: smaller, more frequent meals; eat slowly and sit up; avoid fatty, fried, spicy, and acidic foods and your triggers; do not eat within two to three hours of lying down; and raise the head of your bed. When that is not enough, antacids such as calcium carbonate (Tums) are the first-choice medicine. Beyond that, alginates and sucralfate are safe add-ons, and acid-reducing medicines can be added with your provider.

Medication

Calcium carbonate antacids are effective and safe on demand, best kept under about 1,000 mg of elemental calcium a day. Avoid sodium bicarbonate and magnesium trisilicate antacids. If antacids are not enough, famotidine, an H2 blocker, is commonly used, and proton pump inhibitors are added when symptoms persist.

Can it recur?

Heartburn typically eases and resolves after delivery. It commonly returns in a later pregnancy, especially if you had it before, but it is managed the same way and is not a sign of any lasting problem.

What you can do

Can it be prevented?

  • Eat small and often

    Smaller, more frequent meals keep the stomach from getting overfull, one of the main triggers. Eat slowly and sit upright while you do.

  • Time your meals and lie down later

    Finish eating two to three hours before lying down, and stay upright afterward. Raising the head of your bed helps overnight reflux.

  • Learn your triggers

    Fatty, fried, and spicy foods, citrus, tomato, chocolate, caffeine, and carbonated drinks are common culprits. Cut the ones that bother you.

  • Use antacids wisely

    Calcium carbonate antacids taken as needed are a safe first-line remedy. Keep them handy for after meals and at bedtime, and check with your provider if you use them often.

Who is more at risk

Risk factors

Heartburn before pregnancy
A history of acid reflux or GERD makes heartburn in pregnancy more likely and often more pronounced.
Later in pregnancy
The bigger the uterus, the more pressure on the stomach, so heartburn is most common in the third trimester.
Prevalence rises from about 26% in the first trimester to more than half in the third.
Having been pregnant before
Multiparity, having had prior pregnancies, is associated with a higher chance of heartburn.
Eating patterns
Large meals, eating late, and trigger foods make reflux worse, which is why lifestyle changes help so much.

Do not wait

When to call your provider or 911

  • Call your provider about severe pain in the upper belly, especially under the ribs on the right side, in the second half of pregnancy, which can be preeclampsia rather than heartburn.
  • Seek urgent care if upper-belly pain comes with a bad headache, vision changes, or new nausea and vomiting after mid-pregnancy.
  • Go in for vomiting blood or coffee-ground material, or black, tarry stools.
  • Call for trouble or pain swallowing, or losing weight without trying.
  • Reach out if heartburn is severe, wakes you at night, or is not helped by antacids and lifestyle, so a safe medicine can be added.

Talking to your team

Questions to ask your provider

  • Which antacid is best for me, and how often can I safely take it?
  • If antacids are not enough, what medicine would you add?
  • Are any of my usual remedies not safe in pregnancy?
  • How can I tell heartburn from something more serious?
  • What upper-belly pain should send me in right away?
  • Will this go away after the baby is born?

Keep reading

More on heartburn in pregnancy

All pregnancy guides articles

Good to Know

Heartburn in pregnancy FAQs

Common questions about heartburn in pregnancy, answered.

Is heartburn harming my baby?

No. It is uncomfortable but does not affect your baby or the pregnancy: hormones relax the valve at the top of the stomach and the uterus presses on it. A comfort problem, not a danger.

Are Tums safe in pregnancy?

Yes. Calcium carbonate antacids like Tums are a safe, effective first choice, as needed. Stay under about 1,000 mg of elemental calcium a day. Avoid sodium bicarbonate and magnesium trisilicate antacids.

What can I do besides medicine?

A lot. Smaller, more frequent meals; eat slowly and stay upright; avoid fatty, fried, spicy, and acidic foods and your triggers; do not eat within two to three hours of lying down; and raise the head of your bed.

Is it true heartburn means my baby will have hair?

There is an old wives' tale, and one small study did find a weak association. But heartburn is fully explained by hormones and the growing uterus, so read nothing into it.

Can I take famotidine or omeprazole?

Often yes, under guidance. If antacids are not enough, famotidine, an H2 blocker, is commonly used, and proton pump inhibitors such as omeprazole when symptoms persist.

When is upper-belly pain not heartburn?

In the second half of pregnancy, severe pain high in the belly, especially under the ribs on the right, can be a sign of preeclampsia or HELLP syndrome rather than heartburn. The tell: it does not burn or ease with antacids and comes with headache, vision changes, or new nausea. That pain needs prompt evaluation.

Will it go away after I deliver?

Yes, almost always. Once the baby is born, the valve regains its tone and the uterus no longer presses on the stomach, so it typically resolves within days to weeks.

Why is it worse at night?

Lying flat removes gravity's help keeping acid down, so reflux comes more easily. Finishing meals two to three hours before bed and raising the head of your bed both help.

Medically Reviewed · Updated

Reviewed by Dr. Grace Lin, MD, FACOG · OB-GYN

Obstetrician-gynecologist focused on reproductive and sexual health for women: pregnancy, BV, yeast, trichomoniasis and HPV/cervical screening. Our editorial guidelines →

6 Sources

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