Heartburn in Pregnancy: Which Remedy, and When to Ask

Heartburn in pregnancy: how to think about it

NHS guidance describes indigestion and heartburn as common in pregnancy, caused by hormonal changes relaxing the valve at the top of the stomach and later by the growing uterus pressing upwards. It is uncomfortable rather than dangerous in itself, which is why the advice starts with diet, meal size, timing and sleeping position before medicines. Where medicines are needed, the guidance moves through classes: antacids neutralise acid directly, alginates form a barrier on top of the stomach contents, H2 blockers such as famotidine reduce acid production, and proton pump inhibitors such as omeprazole reduce it further. Each is used in pregnancy in the right circumstances, which is exactly why the choice belongs with a pharmacist or clinician rather than with the packaging. The one clinical caveat worth knowing is that pain in the upper abdomen late in pregnancy is also a feature of pre-eclampsia, so severe pain under the ribs with headache or visual changes is treated as urgent rather than as reflux.

Heartburn: safer choices

• Eating smaller meals more often, and not eating within about three hours of lying down, which are the first suggestions in NHS guidance.
• Propping the head and shoulders up in bed, which reduces reflux overnight when it is often worst.
• Antacids and alginates, which are the usual first medicines suggested in pregnancy. Gaviscon and calcium-based antacids such as Tums are common examples.
• Asking a pharmacist which product suits you, since antacids, alginates, H2 blockers and proton pump inhibitors are different classes with different considerations.
• Asking about acid-reducing medicines such as omeprazole or famotidine if simpler options are not controlling it. These are used in pregnancy when a clinician agrees.

Heartburn: what to avoid or double-check

• Do not take antacids at the same time as iron tablets. Antacids reduce iron absorption, so separate them by a couple of hours.
• Avoid trigger foods you have identified, commonly spicy, fatty or fried food, chocolate, citrus and caffeine.
• Do not self-start a proton pump inhibitor long term without advice. Short courses differ from ongoing daily treatment.
• Do not assume all heartburn is heartburn. Severe upper abdominal pain, especially under the ribs on the right after 20 weeks with headache or visual changes, can indicate pre-eclampsia and needs same-day contact.

How SafeMama helps

SafeMama can identify which class a heartburn product belongs to and what it contains, including calcium carbonate, alginates, famotidine and the proton pump inhibitors, plus sodium content and interactions with iron tablets.

Open the SafeMama app, scan the barcode or search the ingredient, then use the result as a starting point for a conversation with your healthcare provider.

Sources

• NHS indigestion and heartburn in pregnancy
• NHS medicines in pregnancy