It was heartburn that got me in the end. I could take the swelling, the back pain, the constant trips to the bathroom, the itchy skin, the fatigue, the sweating, the sleeplessness and even the psychological shock of seeing the scale tip 200 pounds. But the constant, searing pain of heartburn made the miracle of pregnancy seem more like a curse—by the middle of my third trimester, my mantra had changed from "Please, let him be healthy!" to "Just get him OUT!"
That fiery sensation known as heartburn happens when the lower esophageal sphincter (LES), a muscle responsible for keeping stomach contents in their place, begins to relax or leak. This allows stomach acids to flow upward into the esophagus, explains Suzanne Trupin, M.D., CEO of Women's Health Practice of Champaign, Ill. Also known as acid indigestion or reflux, heartburn shows up in about 50% of pregnancies in the 2nd and 3rd trimesters, typically after meals or at bedtime. The feeling can range from uncomfortable to agonizing.
Pregnant women are prime candidates for two reasons: First, the hormone relaxin—busy limbering up your joints and connective tissue for an easier delivery—slows your digestion, meaning food stays in your stomach longer and triggers more acid production. Second, your growing baby exerts pressure on both the stomach and the LES, increasing the chance that acids will be pushed up into the esophagus.
So how does an expectant mother relieve heartburn during pregnancy? Follow these five tips to ease the pain:
Overeating exacerbates heartburn, says Rachel Brandeis, M.S., a registered dietitian in Atlanta who specializes in prenatal nutrition. "When you're pregnant, there's less room for your stomach to expand," she explains. Maintaining a sensible diet will not only stave off heartburn in the short term, but throughout your pregnancy as well, because gaining more than the recommended weight puts more pressure on your abdomen, which can trigger the condition. Instead of three meals a day, aim for six mini-meals (See "Meal Plan" below) of no more than 1½ cups of food each, Brandeis recommends. Smaller meals are easier for your body to digest, helping to relieve the symptoms of heartburn during pregnancy.
Identify the foods that intensify your heartburn and banish them from your diet. While there are no universally "banned" foods, common heartburn triggers include acidic foods, such as citrus fruits and tomatoes, greasy or fried foods, spicy foods, chocolate, coffee and carbonated beverages and alcohol (which, as you well know, you should eliminate anyway!).
"Liquid-y foods are less likely to cause problems than solids, since they move through the stomach more quickly," Brandeis says. Soups, smoothies, yogurt, milkshakes, protein shakes, and puddings are good choices. Look for liquids that offer plenty of protein, such as milk and drinkable yogurt. and aim to make solids a little less so: "chew solid foods slowly and extremely well, until they're almost liquefied," Brandeis adds. Keep in mind, however, that drinking large quantities of fluids with meals can aggravate heartburn, because drinking can cause you to swallow more air. If you feel thirsty during a meal, take small sips between bites of food.
To avoid nighttime heartburn during pregnancy, don't eat anything for at least three hours before bedtime. Elevate the head of your bed by placing books under the legs, and if you're not already sleeping on your left side, start now; stomach acids will have to travel uphill to reach the esophagus—no easy feat! Pregnant women also shouldn’t lie down or bend over right after eating.
It's fine to find relief in a bottle of Tums or Rolaids or other calcium-containing antacids. However, "too much calcium can block iron absorption, so don't take Tums at the same time you take your prenatal vitamin," Brandeis advises. Also, avoid antacids that list aluminum (such as aluminum hydroxide or aluminum carbonate) as an ingredient; it can cause constipation and can even be toxic in large doses. Remedies containing aspirin (such as Alka-Seltzer) should also be avoided during pregnancy; look for salicylate or acetylsalicylic acid in ingredients lists. You don't want an antacid containing sodium bicarbonate (baking soda) or sodium citrate, either. Both are high in sodium, which causes water retention.
Here's a sample of what a day's worth of small, healthful meals looks like:
1 cup of oatmeal with nonfat milk and 1 apple
1 cup of yogurt with fruit
½ peanut butter and jelly sandwich and 1 cup of vegetable soup
1 handful of whole-grain crackers and 1 ounce of your favorite hard cheese
2 ounces of chicken, ½ cup of mashed sweet potatoes and ½ cup of cottage cheese with fruit