Heartburn in Pregnancy

Why does it happen?

Heartburn is incredibly common and will plague between 17%-45% of pregnant people (Vazquez JC. Heartburn in pregnancy. BMJ Clin Evid. 2015;2015:1411. Published 2015 Sep 8.).

This happen because of two hormones: progesterone and relaxin. They are responsible for relaxing the muscles in your body during pregnancy to allow for growth and stretching in order to accommodate your baby. This causes your esophagus and the sphincter that keeps it closed to relax as well. Also, as your baby grows your “real estate” gets smaller and smaller.

With this change, your stomach gets squished which forces stomach acid back up into your esophagus. Not pleasant, but there are ways to combat this physical change and discomfort!

First, what not to do!

• - Do not stop eating. Your baby needs to be nourished. Not eating will actually increase your stomach acid making your heartburn worse.
  
  
• - Do not munch on antacids (TUMS, Rolaids) like candy as this has been linked to calcification of the placenta*. This means your placenta will begin to develop these very hard, rocklike spots and obviously this is not healthy for your baby. Also too much calcium can block iron absorption so be mindful of that. Many actiacids use aluminum as an active ingredient such as aluminum hydroxide or aluminum carbonate and should be avoided in pregnancy. Antiacids can cause constipation and due to the high sodium bicarbonate in some formulas, it can elevate your blood pressure which is not great for anyone at risk for preeclampsia.
  
  

What to do? (Please check with your provider before using/adopting these remedies): 

• - Begin with eating smaller meals. I recommend also snacking every hour with just a handful of something light, but filling like almonds, popcorn, 3-5 crackers, a handful of grapes or blueberries, a bowl of strawberries or watermelon, a hard-boiled egg, etc. Eating smaller meals will benefit you in several ways: it will allow your belly to digest before adding more since the space is limited, it will provide you and your baby consistent fuel (and energy), and it will support stable blood sugar. Along with eating small meals is eating slow. Do not scarf down your dinner in 10 minutes flat and be shocked that your heartburn is out of control. Your tummy just can’t digest that amount of food consumed in a matter of minutes at once anymore.
  
  
• - Drink a glass of milk. Milk can coat the inside of your stomach and help dilute the stomach aid. Yogurt can do the same thing for you! You can also try a shot of Apple Cider Vinegar, eating ginger or sipping ginger tea, a spoonful of honey or chamomile tea with honey.
  
  
• - Papaya Enzymes. Caution here because papaya FRUIT (vs. the extracted enzyme) is contraindicated as a possible cause of pre-term labor. The caveat here is that it’s UNRIPE papaya fruit but since you don’t ever really know the ripeness of fruit you purchase in the store, it’s best to stay away altogether (unripe papaya has also been linked to miscarriage in a few studies when consumed in the first trimester).
  
  
• - Orange Peel Extract: I have never heard of this and have never recommended this, but this is a very interesting article and the sources are provided at the bottom. 
  
  
• - Stay hydrated. Rather than downing a glass of water once an hour, it’s better to consume liquids consistently throughout the day. The recommended amount of water for an average pregnancy and average sized female is 8-10 cups (equal to 65-80 ounces or 2-2.4 liters).
  
  
• - Avoid laying down after eating. You should not lie down for at least 45-60 minuets after eating. This is most difficult after dinner so I say find an activity that requires you to be upright—either standing or sitting. If you lie down too soon, the stomach acid that is working to digest the food in your stomach will slip right up and you might even feel nauseas or find yourself throwing up.
  
  
• - Avoid eating right before bed. I always say if you can eat 2 hours before bed, then that’s enough, but some doctors would say you shouldn’t eat anymore than 3 hours before bed. I believe this truly depends on your body and only you will know what that time is for you. However, try not to eat super hearty meals before bed because this will have your stomach working in overdrive. If you need to eat right before bed (trust me, I feel you), I recommend something water based like grapes, watermelon, or celery. These are easy things to digest, but be mindful that the sugar from the grapes and watermelon may spike your blood sugar or make your baby have a dance party.
  
  
• - Sleep Elevated. You can achieve this several ways. You can purchase a wedge pillow or you can stuff rolled up towels (or a yoga mat) under the top of your mattress to create an angle at your head. This will prevent stomach acid from going back into your esophagus while you’re lying flat.
  
  
• - Chew sugarless gum after eating dinner (or any large meal). This is a very interesting one, but it works similarly to giving a baby with acid reflux (or just really bad spit up) a pacifier after feeding them (before burping) to keep them sucking. This continuous sucking, despite not eating, keeps their gastrointestinal system activated which keeps them digesting longer and we generally see a decrease in spit up. Same with adults, but our gastrointestinal system is activated by chewing since we are not infants anymore. The chewing gum will keep your stomach activated. The increased saliva might also help to neutralize the stomach acid.
  
  
• - Speak with your doctor. They may suggest a H2 blocker like Tagamet or Zantac. Be mindful that long term use of these have been linked to pH unbalance in your stomach and gut.
  
  

*CALCIFICATION OF THE PLACENTA

• - This is a condition where the placenta begins to harden (calcify) in specific spots. These spots are indicators of the “age” or “ efficiency” fo the placenta meaning the more calcification the “older” and less efficient your placenta is considered to be. 
  
  
• - This is a great informational article but provides no evidence-based citations or any real sources. 
  
  
• - It’s not regulated by the FDA nor has it been evaluated by any formal study that it is safe to consume daily TUMS during pregnancy. 
  
  
• - The Placenta is in charge of filtering all calcium that crosses the blood-brain barrier. If there is too much, your placenta will actually hold the extra calcium —causing calcification of the placenta. Calcification of the placenta has been associated with pre-term labor. TUMS should never be taken at the same time as prenatal vitamins due to a possible adverse interaction between the two. 
  
  
• - Calcium Carbonate is the active ingredient in antacids and too much calcium has been shown to block iron absorption. Iron is extremely important in pregnancy. Your body uses iron to make hemoglobin, a protein in the red blood cells that carries oxygen to your tissues. During pregnancy, you need up to double the “normal” recommended dose to increase the red blood cells to in-turn increase the oxygen levels reaching your baby. 
  
  
• - There are a few studies that show (one of these is as a journal of veterinarian medicine—not too far off as we generally test on rats, pigs, or rabbits for pregnancy related research) an almost toxic level of calcium in fetal blood compared to mothers. Read more about these studies  here or here.
  
  
• - Another product similar to TUMS, called Tame the Flame, is provided by Healthy Mama. 
  
  
• - It is possible that magnesium or Vitamin D can help offset the potential “overdose” of calcium.
  
  

Calcium During Pregnancy:

• - It is needed for bone development in the fetus. It is especially important in the third trimester as this is when your baby’s bones truly begin to form and fill in. Women should be mindful that they are consuming enough, but not too much, calcium beginning in the second trimester. 
  
  
• - A healthy calcium intake has been linked to fetal birth weight. 

Remember: It is not our job to tell clients what they should and shouldn’t take during pregnancy. Our responsibility is to share with them the potential risks, the sources we have available, and alternatives choices they have as options to consider.

If you are looking for more resources and support surrounding diet and nutrition in pregnancy - join us in The Birth Lounge to have an informed pregnancy and confident birth experience!