Heartburn and reflux in pregnancy: what helps
Heartburn, also described as acid reflux or indigestion, is one of the most widely reported discomforts of pregnancy. More than half of all pregnant women experience it at some point, and for many the sensation becomes a daily occurrence during the second and third trimesters. While it is unpleasant, it is not harmful to the baby, and most people find that a combination of small dietary adjustments and safe over-the-counter remedies brings meaningful relief. This article draws on NHS guidance to explain why heartburn happens in pregnancy, what tends to trigger or worsen it, and what you can do to manage it.
Why heartburn is so common in pregnancy
The burning sensation in the chest or throat that characterises heartburn happens when stomach acid travels upward into the oesophagus. In pregnancy, two distinct factors make this more likely to occur than usual.
The first is hormonal. Progesterone, one of the key hormones that rises significantly during pregnancy, has a relaxing effect on smooth muscle throughout the body. This includes the lower oesophageal sphincter, the ring of muscle that sits between the oesophagus and the stomach and normally acts as a one-way valve. When this valve is more relaxed than usual, acid can slip upward more easily, particularly after meals or when lying down.
The second factor becomes increasingly significant as the pregnancy progresses. The growing uterus takes up more and more space in the abdominal cavity, and from around the second trimester onward it begins to press upward against the stomach. This physical pressure reduces the space the stomach has to expand after eating and pushes its contents closer to the oesophageal opening. The combination of a relaxed valve and a compressed stomach means that heartburn tends to get worse, not better, as pregnancy advances. Symptoms that are mild in the first trimester may become more frequent and more intense in the third.
Recognising the symptoms
The most common symptom is a burning feeling in the middle of the chest, sometimes extending up into the throat. Some people describe it as warmth or heat rather than a sharp pain. Other signs include an acidic or bitter taste at the back of the mouth, burping, and a general feeling of fullness or discomfort after eating. Nausea can also accompany heartburn, which sometimes makes it difficult to distinguish from the morning sickness that is common earlier in pregnancy.
Heartburn is generally worse after meals, particularly large ones, and when lying flat. For this reason, symptoms that were barely noticeable during the day can feel much more intrusive at night, making it harder to get comfortable and sleep well.
What makes heartburn worse
Certain foods and habits are consistently associated with worsening heartburn during pregnancy. The triggers vary from person to person, but the most commonly reported ones include:
- Spicy, fatty or rich foods
- Caffeine (found in tea, coffee, cola and some energy drinks)
- Chocolate
- Citrus fruit and fruit juices
- Fizzy drinks
- Large meals
- Eating shortly before lying down
Not everyone will be sensitive to all of these. It can be helpful to notice which foods or habits seem to precede your worst episodes so you can prioritise avoiding those specific triggers rather than eliminating everything at once. Some people find that eating quickly or gulping drinks also worsens symptoms, so slowing down at mealtimes is worth trying.
Practical steps that can help
There is a range of straightforward adjustments that many people find effective. None of them require any medication and they are safe to try at any point in pregnancy.
Eating smaller, more frequent meals rather than three large ones is one of the most consistently recommended changes. A smaller meal takes up less room in the stomach and produces less acid, giving the lower oesophageal sphincter an easier job. Eating slowly and chewing food thoroughly also tends to reduce the load on the digestive system.
Staying upright for at least an hour after eating gives the stomach time to begin emptying before gravity is no longer helping to keep the contents down. This means avoiding lying down or reclining on the sofa straight after meals, which can feel counterintuitive when you are tired, but makes a real difference for many people.
At night, sleeping with the head and shoulders slightly elevated can reduce the likelihood of acid travelling upward while you are lying flat. Propping up the head end of the mattress or using an extra pillow may help. Eating your last meal at least two to three hours before bed is also recommended, so that the stomach has more time to digest before you lie down.
Wearing loose, comfortable clothing around the waist and abdomen reduces external pressure on the stomach. Tight waistbands can push stomach contents upward, so choosing maternity-fit clothing or elasticated waistbands is a practical step that doubles as general comfort advice.
Antacids and medication in pregnancy
When lifestyle changes alone are not enough, antacids can provide additional relief. Gaviscon and calcium carbonate antacids are generally considered safe to use during pregnancy, but as with any medicine taken in pregnancy, it is worth checking with your pharmacist or midwife first.
Not all antacids are equally suitable. Products containing sodium bicarbonate or aspirin are best avoided in pregnancy. Sodium bicarbonate can affect the acid-base balance in both you and the baby, and aspirin is generally advised against during pregnancy unless prescribed for a specific reason at a specific dose. If you are unsure about an over-the-counter antacid, your pharmacist is the right person to ask before you buy.
For heartburn that is severe, not responding to antacids, or significantly affecting your ability to eat or sleep, there are prescription medicines that are considered safe in pregnancy. Your GP can discuss these with you and prescribe what is appropriate for your situation. You do not have to put up with heartburn that is making you miserable: it is a legitimate reason to contact your GP.
When to see a GP
Most heartburn in pregnancy can be managed at home without a GP appointment. However, there are situations where it is worth getting in touch with your doctor. See your GP if:
- Heartburn is severe and frequent
- Antacids are not providing relief
- Symptoms are regularly disturbing your sleep
- You have difficulty swallowing
- You are losing weight or finding it hard to eat enough
A GP can assess whether stronger medication is appropriate and rule out any other causes of your symptoms. Heartburn symptoms can occasionally overlap with other conditions, so if anything feels unusual or is accompanied by other symptoms, it is always worth seeking advice rather than assuming it is routine pregnancy discomfort.
Frequently asked questions
Is heartburn in pregnancy normal?
Yes. More than half of all pregnant women experience heartburn at some point. It is caused by pregnancy hormones relaxing the valve at the top of the stomach, and later by the growing uterus pressing upward. It is uncomfortable but not harmful to the baby.
Which antacids are safe in pregnancy?
Gaviscon and calcium carbonate antacids are generally considered safe to use in pregnancy. Always check with your pharmacist or midwife before taking anything new. Avoid antacids that contain sodium bicarbonate or aspirin.
What foods make pregnancy heartburn worse?
Spicy, fatty or rich foods, caffeine, chocolate, citrus fruit and fizzy drinks are common triggers. Large meals and eating shortly before lying down also tend to worsen symptoms.
When should I see a GP about heartburn in pregnancy?
See your GP if heartburn is severe, not responding to antacids, disturbing your sleep regularly, or if you have difficulty swallowing. A stronger medication can be prescribed that is safe to use in pregnancy.
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