Managing Heartburn During Pregnancy: Causes, Safe Relief, and When to Seek Help

For many expectant mothers, the joy of pregnancy is accompanied by an unwelcome companion: persistent heartburn. This burning sensation in the chest, along with indigestion and frequent burping, is one of the most common discomforts during pregnancy—particularly in the second and third trimesters. While often dismissed as a minor annoyance, understanding why it happens and knowing how to manage it safely can make a significant difference to a mother's quality of life.

Why Does Pregnancy Trigger Reflux?

The increase in reflux symptoms during pregnancy is not coincidental; it is driven by a combination of hormonal and physical changes.

Hormonal Relaxation: The body produces higher levels of hormones like progesterone to support the pregnancy. However, progesterone also relaxes smooth muscles throughout the body, including the lower esophageal sphincter (LES)—the muscular valve that acts as a barrier between the stomach and the esophagus. When this sphincter relaxes, it becomes less effective at preventing stomach acid from flowing back up into the esophagus. Studies have shown that LES pressure progressively decreases during pregnancy, reaching its lowest point around 36 weeks^【1】.

Physical Pressure: As the baby grows, the expanding uterus increases intra-abdominal pressure, pushing against the stomach and digestive tract. This mechanical pressure can force stomach contents upward, contributing to reflux, especially in the later stages of pregnancy^【2】.

The prevalence of heartburn reflects this progressive burden. Research indicates that symptoms increase with gestational age: affecting approximately 22% of women in the first trimester, rising to 39% in the second, and peaking at 72% in the third trimester^【2】. A 2025 systematic review and meta-analysis confirmed this trend, reporting a pooled prevalence of GERD symptoms during pregnancy of 40.96%, with rates climbing from 26.12% in the first trimester to 55.93% in the third^【1】.

First-Line Management: Lifestyle and Dietary Adjustments

For many women, mild to moderate reflux symptoms can be effectively managed through simple changes to diet and daily habits.

Eating Habits: Consuming smaller, more frequent meals can prevent the stomach from becoming overly full and putting pressure on the LES. It is also advisable to avoid eating within three hours of going to bed to reduce the likelihood of nighttime reflux.

Posture: Sitting upright while eating and for a period afterward can help gravity keep stomach contents down.

Dietary Choices: Limiting or avoiding known trigger foods—such as spicy, fatty, or acidic items—can help reduce the frequency and severity of episodes.

For many women, these adjustments are sufficient, and symptoms often resolve naturally after the baby is born. However, when symptoms persist or become more problematic, additional interventions may be necessary^【3】.

Medication Options: What Is Safe During Pregnancy?

When lifestyle modifications are not enough, several medication options are available that are considered safe for use during pregnancy.

Antacids: These work by neutralizing stomach acid and increasing the pH of gastric juice, thereby reducing the potential for irritation when reflux occurs. They provide rapid, short-term relief^【2】.

Alginates: Alginate-based formulations offer a different mechanism of action. They form a gel-like "raft" that floats on top of the stomach contents, creating a physical barrier that prevents acid and other gastric contents from refluxing into the esophagus^【3】. Importantly, alginates are not absorbed into the bloodstream; they work locally in the stomach^【3】.

A systematic review on the use of raft-forming agents in pregnancy confirmed that alginate-based formulations are allowed with no restrictions during pregnancy^【3】. Their safety profile makes them a very valid option, considering the risk-benefit ratio for both the mother and the unborn baby, with no particular risks shown even when administered throughout all pregnancy trimesters^【3】. A prospective clinical evaluation of an alginate raft-forming suspension licensed for use in pregnancy found it to be both safe and highly efficacious in treating heartburn and GER symptoms^【3】.

Proton Pump Inhibitors (PPIs): If antacids and alginates do not provide sufficient relief, a healthcare professional may prescribe a PPI, such as omeprazole. PPIs work by reducing the production of stomach acid.

The safety of PPIs during pregnancy has been a subject of study. A meta-analysis found that PPIs are not associated with an increased risk for major congenital birth defects, spontaneous abortions, or preterm delivery^【4】. However, a 2018 study published in Pediatrics reported that women taking PPIs during pregnancy had a 34% increased risk of having children who developed asthma, compared to women who did not take these drugs^【4】. Consequently, some experts prefer not to recommend PPIs during pregnancy, as they are systemically acting drugs, whereas alginates are not absorbed and are considered safer for the unborn baby^【3】.

The Importance of Objective Diagnosis

While heartburn is common in pregnancy, persistent or severe symptoms can significantly impact quality of life. For women who are unsure whether their symptoms are due to reflux or another condition, objective testing can provide clarity. A non-invasive saliva test called Pepfast that detects pepsin—a stomach enzyme that serves as a marker for reflux—can offer a simple way to confirm the presence of reflux. This can help guide conversations with healthcare providers and inform the choice of the most appropriate and safest management strategy.

❓Frequently Asked Questions

1. Why is heartburn so common in the third trimester?
Heartburn becomes more frequent and severe as pregnancy progresses due to two main factors: rising levels of progesterone relax the lower esophageal sphincter, and the growing baby increases pressure on the stomach, both of which promote reflux^{【1】【2】}. Studies show the prevalence peaks at around 72% in the third trimester^【2】.

2. Are alginate-based reflux treatments safe to use throughout pregnancy?
Yes. Alginate-based formulations are considered safe for use during pregnancy with no restrictions^【3】. They work locally in the stomach to form a physical barrier and are not absorbed into the bloodstream, making them a very safe option for both mother and baby^【3】.

3. What is the difference between antacids and alginates for pregnancy heartburn?
Antacids work by neutralizing stomach acid, providing quick but short-lived relief. Alginates form a gel-like "raft" that sits on top of the stomach contents, creating a physical barrier that prevents acid from refluxing into the esophagus^【3】. Alginates offer longer-lasting protection and are often preferred during pregnancy.

4. Should I be concerned about taking PPIs during pregnancy?
While PPIs are not linked to a significant increase in major birth defects, some studies have associated their use during pregnancy with a higher risk of childhood asthma^【4】. Many experts recommend trying lifestyle changes, antacids, or alginates first, and reserving PPIs for cases where symptoms are intractable^{【3】【4】}.

5. Will my heartburn go away after I give birth?
For the vast majority of women, reflux symptoms disappear once the baby is born. The hormonal and physical changes of pregnancy reverse, and the lower esophageal sphincter regains its normal tone^【2】. However, if symptoms persist, it is worth discussing with a healthcare provider.

References

【1】Global prevalence and risk of gastroesophageal reflux disease symptoms in pregnancy: a systematic review and meta-analysis. BMC Pregnancy and Childbirth. 2025.

【2】Gastroesophageal reflux in pregnancy: a systematic review on the benefit of raft forming agents. European PMC. 2013.

【3】Review of recent evidence on the management of heartburn in pregnant and breastfeeding women. PubMed. 2022.

【4】Acid-Suppressive Drug Use During Pregnancy and the Risk of Childhood Asthma: A Meta-analysis. Pediatrics. 2018.

Medical Review by: Prof. Peter Dettmar, world‑renowned expert in reflux disease and the original developer of pepsin detection technology. Published July 2026.

About Maxhealth Innovative

Maxhealth Innovative Meditech (Wuxi) Co., Ltd. provides end‑to‑end diagnostic and therapeutic solutions for GERD and LPR, including Pepfast (rapid non‑invasive pepsin test), Peptest (lab‑based confirmatory test), and Gasrelief (alginate physical barrier therapy). All products hold CE, FDA, and NMPA clearances. For distribution inquiries, please contact our commercial team.