Heartburn in pregnancy

Symptoms of heartburn can include an uncomfortable feeling in the center of the chest; some say it feels like burning. This can be worse after eating, especially with spicy or acidic foods, hot food and drink.

Other symptoms include bloating and feeling full, burping, farting, and feeling sick or vomiting. The feeling often comes on after eating, especially if you lie down, and lasts for several minutes up to an hour or two.

To understand symptoms better, let's think about the anatomy and why we don't all get heartburn all of the time.

Your stomach has acid that helps break down and digest food – the acid increases with every meal. This acid burns if it goes up a muscular tube called the esophagus, otherwise known as the food pipe or gullet.

To prevent this, the esophageal sphincter is a one-way valve that sits at the bottom of the esophagus, closing the entrance to the stomach. And gravity helps acid go up the esophagus, which is why lying down makes it worse.

During pregnancy, this sphincter tends to relax, causing reflux of stomach acid and contents and the sensation of heartburn. This can be due to hormonal changes or the pressure of the growing baby on the stomach, forcing the contents back up.

Although the symptoms can be very uncomfortable, you should feel reassured that it causes no harm to your baby. If your symptoms are sudden or severe and you are worried, it's always best to talk to your midwife or doctor.

It's true to say that being rested and happy will make your pregnancy feel a bit easier. As heartburn symptoms can often come on as you go to bed, it's worthwhile taking measures to ease these symptoms and get a good night's rest.

The good news is that for most, symptoms improve shortly after giving birth.

It's important to take small meals more often and avoid large heavy meals or late-night snacking and feasts. Give it a couple of hours after eating before you lie down or go to bed, and you could keep your head raised at night.

Certain foods can trigger symptoms, so it's easiest to keep a food diary and avoid these. Common ones are spicy foods, acidic food, fizzy drinks, or hot food and liquid. If you can sleep with some elevation, that may help, and avoid meals within a couple of hours of going to sleep.

If you are overweight or obese, weight loss can help, but this may be difficult to achieve as you navigate pregnancy – you could set it as a goal sometime after birth, if it applies.

Avoid smoking and drinking alcohol as they can both worsen the symptoms, but these are a must-avoid in any healthy pregnancy, anyway.

If simple measures haven't stopped the pain, pharmacy products may help for short-term relief. Let's talk you through the three main groups of pregnancy-safe products and how they work.

Antacids provide quick relief by neutralizing excess acid in the stomach. Effects last for a couple of hours at best, which may be sufficient for most people. Tums is one such product. Remember that antacids can prevent iron tablets from being absorbed, which may be important if you need them in pregnancy, so avoid taking them at the same time.

Alginates provide quick relief of symptoms, and additionally form a protective layer on top of the stomach contents that helps prevent stomach acid moving upwards to the esophagus and causing pain. Protection lasts for several hours. Gaviscon Suspension is one suggestion.

Proton pump inhibitors (PPIs) decrease the amount of acid produced in the stomach, but it's not an instant effect - you need to take it daily for a few days to build effect. But it gives much longer protection - for up to 24 hours. Prilosec OTC is one example, containing omeprazole.

This is widely used for heartburn and acid reflux and can be taken by pregnant and breastfeeding women over 18 years of age.

Natural treatment options include medications containing mastic gum, or mineral mixtures that can also balance excess acidity.

If your symptoms persist for more than two weeks or are particularly severe, you should speak to your doctor. It's important not to overlook a stomach ulcer or other causes of severe pain.