What Helps with Heartburn in Pregnancy? Easing It with Food and Habits

What helps most with heartburn in pregnancy is eating smaller, more frequent meals, finishing eating at least 3 hours before bed, cutting back on fatty, fried and spicy foods, and sitting upright after eating. For mild complaints these changes are often enough; if the burning does not go away, you should talk to your obstetrician about medication options.

Heartburn is quite common in pregnancy. Under the influence of hormones the muscle between the stomach and the oesophagus relaxes, and the growing womb also presses on the stomach; together these make it easier for stomach acid to rise. The complaint can start at any point in pregnancy, but it becomes more frequent particularly after week 12 and in the final months.

What Causes Heartburn in Pregnancy?

There are two main causes of heartburn in pregnancy: hormonal changes and the pressure of the growing baby on the stomach. The hormone progesterone relaxes the muscle at the lower end of the oesophagus, which normally stops the contents of the stomach from rising up.

As pregnancy progresses, the womb grows and pushes the stomach upwards. The stomach has to hold the same volume of food in less space. For this reason, in the last trimester, burning, sourness, belching and a feeling of fullness increase, especially after a large meal. The complaint is more common in women who had reflux before pregnancy and in those who have been pregnant before.

Which Foods and Habits Can Help with Heartburn?

The most useful approach is to control how full the stomach gets and when. How and when you eat matters as much as what you eat.

• Small, frequent meals: Dividing three large meals into 5 or 6 small ones reduces stretching of the stomach.
• Eating slowly: Taking small bites and chewing well helps to avoid swallowing air and filling up too fast.
• Drinking between meals: Instead of a large glass of water with the meal, spreading your water between meals eases things for some pregnant women.
• Sitting upright: Sitting upright during and after meals reduces the pressure on the stomach.
• A gentle walk: Instead of lying down straight after eating, a short, calm walk helps digestion.

Not skipping meals matters as much as portion size. Going hungry for a long time and then eating a big meal makes the stomach fill all at once and increases the burning. In my work, one of the patterns I see most often is not eating enough during the day and trying to make up for it with one large meal in the evening; this pattern also brings night-time heartburn. Small meals at set times spread across the day keep both your stomach and your energy levels steadier.

Foods cooked by boiling, baking or steaming; grains such as oats, wholegrain bread, rice and bulgur; low-acid fruits such as banana, apple and pear; and reduced-fat yoghurt and cheese are tolerated comfortably by most pregnant women. I have described in more detail how to build a balanced plate in pregnancy on my page on nutrition in pregnancy.

Which Foods Make Heartburn Worse?

Fatty, fried and heavily sauced foods, very spicy dishes and caffeinated drinks are the most common triggers of heartburn. However, triggers vary from person to person; a food that bothers one pregnant woman may not cause a problem for another.

Noting briefly for a week what you eat and at what times the burning occurs is the most practical way to find your own triggers. That way you avoid cutting many foods from your list unnecessarily. Foods that you really should avoid in pregnancy are a separate subject; I have summarised them in my article on what not to eat in pregnancy.

Do Milk, Almonds and Other Home Remedies Work?

Cold milk, yoghurt or a few almonds may give a short-lived feeling of relief to some pregnant women, but there is no strong scientific evidence that these treat heartburn. So they should be thought of not as "medicine" but as part of a meal plan.

Full-fat milk and large amounts of dairy can make the complaint worse for some people. Almonds are a nourishing snack, but more than a handful can be hard on the stomach because of their fat content. Baking soda is not something you should use on your own in pregnancy; before using any product or medicine for heartburn, ask your doctor or pharmacist, telling them that you are pregnant.

What Can You Do About Night-Time Heartburn?

The two most important steps for night-time heartburn are to finish dinner at least 3 hours before bed and to lie with your head and shoulders raised. When you lie down, stomach contents rise more easily without the help of gravity.

• Do not make dinner the biggest meal of the day; make lunch a little bigger and dinner lighter.
• If you get hungry before bed, choose a light snack such as a few crackers, a small banana or a few spoonfuls of yoghurt.
• Raising the head of the bed slightly, or supporting your head and shoulders with an extra pillow, may help.
• Lying on your left side brings relief to some pregnant women.
• Smoking and alcohol make heartburn worse; both should be avoided completely in pregnancy.

When Should You See Your Doctor About Heartburn?

If heartburn does not go away despite changes in eating and lifestyle, or if it affects your daily life, you should see your obstetrician. Your doctor will assess the medication options that can be used in pregnancy according to your situation.

Some symptoms may not be simple heartburn. In the following cases, see a doctor or go to the maternity unit straight away:

• Burning that does not go away with heartburn medication, or pain just under the ribs
• A severe headache that does not go away, blurred vision or flashing lights in the eyes
• Sudden swelling of the face, hands or feet
• Vomiting and feeling very unwell
• Difficulty swallowing, weight loss, or swelling and pain in the abdomen

These symptoms, particularly after week 20, can be linked to conditions that need urgent assessment, such as pre-eclampsia, which comes with high blood pressure in pregnancy. If your doctor has recommended a stomach medicine along with supplements such as iron or folic acid, be sure to ask at what intervals they should be taken.

How Can You Plan a Sample Day for Heartburn in Pregnancy?

The plan below is a general example of how meals might be spread for a pregnant woman who has heartburn; your energy and nutrient needs vary according to your week of pregnancy, your weight and your health.

• Breakfast: Boiled egg, reduced-fat white cheese, wholegrain bread, cucumber; lightly brewed tea or warm water.
• Snack: A banana or apple with a few walnut kernels.
• Lunch: A vegetable dish made with little olive oil, bulgur pilaf, yoghurt.
• Snack: Yoghurt with oats and fruit.
• Dinner (at least 3 hours before bed): Baked chicken or fish, boiled vegetables, a small portion of rice.
• If needed at night: A few crackers or a small bowl of yoghurt.

For a personal plan that supports both your complaints and your baby's growth throughout pregnancy, we can work together in line with your obstetrician's advice through nutrition counselling in pregnancy. If you do not eat meat, my article on vegetarian eating in pregnancy may also be a useful guide.

Sources

• NHS – Indigestion and heartburn in pregnancy
• ACOG – Problems of the Digestive System
• Thélin CS, Richter JE. The management of heartburn during pregnancy and lactation. Aliment Pharmacol Ther, 2020 (PubMed)
• NHS – Pre-eclampsia

This article is for general information only; please consult your doctor and dietitian about your own situation.