Many women experience indigestion, acid reflux, or heartburn during pregnancy. Most believe that it’s just a part of pregnancy–that there’s nothing to do but grin and bear it. But when should you talk to your doctor, and when does it cross from just occasional upset to GERD? Most importantly, is there anything that can be done to minimize the discomfort? Let’s take a look at GERD during pregnancy.
What is GERD?
GERD stands for gastroesophageal reflux disease (1). The esophagus is the tube that connects your mouth and stomach. There is a valve at the bottom of the esophagus that separates esophagus from stomach. This valve opens to let food pass through when you swallow, but should otherwise be closed. Sometimes, though, this valve opens and allows stomach acid and other stomach contents to flow back into the esophagus. GERD occurs when stomach acid frequently flows back up into your esophagus (2). It’s a fairly common diagnosis, and is experienced by 30 – 50% of pregnant women (3).
GERD vs Heartburn vs Acid Reflux
These terms often seem to be used interchangeably, and they are related. But how do you distinguish between them? Well, acid reflux is what we just described above — when the valve that should keep stomach acid, digestive juices, and food in your stomach allows them to back up into the esophagus instead. Sometimes this happens for short periods of time without any symptoms. When it does cause a feeling of burning in your chest, that’s heartburn. (We discuss heartburn more in our Week 32 Pregnancy post.) And GERD is when acid reflux happens more often — mild reflux that happens at least twice a week or more severe reflux that occurs at least once a week (2).
All of these are common when you’re expecting. We’ll focus on GERD during pregnancy, but the tips apply to all of these related conditions.
Why Does GERD Happen During Pregnancy?
As we’ve discussed in previous posts, one of progesterone‘s jobs during pregnancy is to relax the muscles in your body. This causes the entire digestive process to slow down. And remember that valve that’s supposed to keep things in your stomach? It can also be affected by progesterone.
Additionally, your abdomen gets more and more crowded as pregnancy progresses. The increased pressure on your stomach from the growing baby can also contribute to its contents being pushed back upward where they don’t belong. (4)
GERD is more likely to occcur in pregnancy if mom experienced reflux before pregnancy. Older moms and moms who gain more weight during pregnancy also have a higher risk of developing GERD (3).
GERD Symptoms During Pregnancy
If you have GERD during pregnancy, you may experience some or all of these symptoms (1):
- Heartburn (burning feeling in the middle of your chest)
- Sour or bitter taste in your mouth
- Difficulty swallowing
- Persistent cough
- Upset stomach
If you experience these symptoms twice a week or more, your healthcare provider may diagnose you with GERD.
How Can I Help Minimize Symptoms?
Lifestyle Changes for GERD
The good news is that you don’t need to just suffer and wait for pregnancy to pass. Your doctor or midwife will likely recommend lifestyle changes as the first line of defense. It is suggested that you:
- Eat smaller meals to avoid filling the stomach too much (3)
- Don’t eat within three hours of bedtime (3)
- Avoid foods that are spicy, highly acidic, or fatty (1)
- Don’t smoke or chew tobacco (4) which is of course true during pregnancy, with or without GERD
- If symptoms are worse when lying down, elevate your upper body with a wedge pillow. (3)
Medications for GERD
If none of these things help, there are medications that are generally considered safe for severe GERD during pregnancy, though they should always be used with caution. Of course, you should never begin taking any medication without talking to your doctor or midwife first. (For example, some over-the-counter antacids contain aspirin, which isn’t recommended during pregnancy.)
Antacids, Pepcid, & Tagmet
Many health care providers begin treatment with antacids or H2 receptor blockers, which can help decrease excess stomach acid. Common H2 receptor blockers include medications like famotidine (Pepcid) or cimetidine (Tagamet).
CAUTION!! Please note that in April 2020, rantidine (Zantac) was removed from sale due high carcinogen levels found in the medication (5). Do not use any rantidine products that you may already have in your medicine cabinet.
Prevacid & Nexium
Proton pump inhibitors (PPIs) may be considered to treat more severe cases of GERD during pregnancy. PPIs target the proton pumps in the stomach, which produce stomach acid. The medications work by decreasing the amount of acid that the pumps can produce. Most PPIs are category B drugs, which means that there were no risks to the fetus shown in animal studies, yet studies have not been done on humans. Omeprazole, one popular PPI, is a category C drug, and may pose greater risk to baby.
Common PPIs include lansoprazoe (Prevacid) and esomeprazole (Nexium). Note that this is some concern about the use of PPIs pre-conception and in the first trimester, though research is still inconclusive.
GERD During Pregnancy: Conclusion
GERD can be uncomfortable at best and painful at worst. But you don’t need to live with the symptoms of GERD throughout your pregnancy. Consult with your healthcare provider. You should be able to find a lifestyle change, over-the-counter medication, or prescription medication to bring you the relief you need to be able to get back to enjoying your pregnancy.
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1. Curtis, G. B., & Schuler, J. (2016). Your pregnancy week by week. Cambridge, MA, MA: Da Capo Life Long.
2. Gastroesophageal reflux disease (GERD). (2020, May 22). Retrieved July 16, 2020, from https://www.mayoclinic.org/diseases-conditions/gerd/symptoms-causes/syc-20361940
3. Gerson, L. (2012, November). Treatment of gastroesophageal reflux disease during pregnancy. Retrieved July 16, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3966174/
4. Gastroesophageal Reflux Disease (GERD) During Pregnancy. (n.d.). Retrieved July 16, 2020, from https://www.uofmhealth.org/health-library/aa130363
5. FDA. (2020). FDA Requests Removal of All Rantidine Products (Zantac) from the Market. Retrieved at https://www.fda.gov/news-events/press-announcements/fda-requests-removal-all-ranitidine-products-zantac-market