Acid reflux (or heartburn) that recurs frequently during pregnancy is common because higher production of estrogen and progesterone causes the lower esophageal sphincter to weaken and causes stomach acid to rise up into the esophagus. In addition, the growing baby puts pressure on the stomach and pushes digestive acids into the esophagus, giving a pregnant woman a “double hit” effect. Both conditions improve after the baby is born, but learning how to combat heartburn during pregnancy is important for comfort and quality of life.
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Part 1 of 3: Prevent Acid Reflux Naturally
Step 1. Eat in small portions, but more often
Another suggestion for fighting heartburn is to eat smaller, timed meals throughout the day. Eating smaller meals every few hours instead of three larger meals over a longer distance prevents the stomach from becoming too full and compressing the diaphragm and pushing acid up the esophagus. Therefore, change the schedule of meals or snacks to 5-6 times with smaller portions which are arranged every 2 hours every day.
- The last meal or snack at the end of the day should be consumed early in the evening, at least 3 hours before bedtime. That way, the stomach gets enough time to properly digest the food and send it to the small intestine.
- Try to keep each serving of food/snack between 300-400 calories each. Gaining weight during pregnancy is necessary because you are eating for two, but excessive weight gain increases the risk of diabetes.
Step 2. Eat unhurriedly and chew your food well
Chew the food or snack slowly before swallowing it. That way, the food will be digested better. On the other hand, eating too fast without chewing properly reduces the production of saliva in the mouth and causes the stomach to work harder and increases the chances of indigestion and heartburn. In addition, eating slowly tends to prevent you from overeating because you feel full faster.
- Take small mouthfuls and chew each mouthful for 20-30 seconds so that more saliva is produced in your mouth before you swallow it.
- Chewing food well prevents you from drinking too much to “push food into the stomach”. Drinking too much with meals can dilute digestive enzymes and cause indigestion.
Step 3. Chew gum after eating
Chewing gum can help relieve heartburn because it stimulates the production of saliva, which contains acid-neutralizing bicarbonate. Swallowing more saliva can literally "put out the fire" because it neutralizes stomach acid that enters the esophagus. In this case, saliva becomes the body's natural antacid.
- Avoid mint or menthol-flavored gums, such as peppermint, because they can stimulate the production of gastric juices.
- Choose sugar-free gum with xylitol because artificial sweeteners can kill bacteria that cause cavities in the mouth and bacteria that cause stomach ulcers.
- Wait about 15-30 minutes after eating before chewing gum because food needs an acidic environment to be properly digested and broken down.
Step 4. Drink a small glass of milk after a meal
The stomach must be very acidic to digest food properly, but problems arise when too much acid is produced or when acid rises through the esophageal sphincter and irritates the esophagus. Therefore, wait about an hour or so after eating before drinking a small glass of milk. The minerals in milk (especially calcium) can neutralize any acid in the esophagus and help soothe irritation.
- Choose low-fat milk so that the animal fat in the milk doesn't worsen acid reflux.
- Sometimes the sugar (lactose) in milk and other dairy products can trigger heartburn. So experiment with drinking milk, but stop if the problem gets worse.
- Do not drink milk after meals if you are lactose intolerant (inability to produce enough of the enzyme lactase) as bloating and cramping can make acid reflux worse.
Step 5. Don't lie down after eating
The best way to eat food is to sit up straight, and fight the urge to lie down once you've eaten. Sitting upright supported by gravity will push digested food into the digestive system. Lying on the couch against the effects of gravity causes partially digested food and stomach acid to seep through the esophageal sphincter and into the esophagus.
- Irritation of the lining of the esophagus causes a burning sensation in the chest, aka heartburn. Other symptoms of acid reflux include: sore throat, difficulty swallowing, dry cough and hoarseness.
- Wait at least a few hours before laying down on the couch/bed. You can sit up and raise your legs to rest, but make sure your upper body remains straight.
- Avoid eating large meals to reduce fatigue (and the urge to lie down) due to the sudden secretion of the hormone insulin from the pancreas into the bloodstream.
Step 6. Try to stay active throughout the day
Doing moderate to vigorous exercise after eating can increase your risk of indigestion and heartburn, while light exercise (walking) can help promote gut motility by forcing undigested food and waste through the intestines so they can't go back up into the esophagus. After washing the dishes, go for a slow 15-20 minute walk or do some light household chores at home.
- Excessive exercise diverts blood from the digestive system to the muscles of the legs and arms, disrupting digestion.
- If you want to increase the portion of exercise, focus on doing it during the day, not at night so it doesn't affect the quality of sleep.
- Moderate exercise encourages regular bowel movements thereby avoiding "blockages" in the intestines and the increased pressure due to gas.
Step 7. Pay close attention to your sleeping position
If you experience acid reflux attacks during pregnancy (or at any time), pay attention to your position at night. To prevent heartburn, try positioning your upper body and head higher with a pillow to allow gravity to work, although pillows are not always effective because they are too soft. If this position is uncomfortable for you, try lying on your left side, making it difficult for stomach acid to flow back into your esophagus.
- Foam wedges are designed for upper body support and can be purchased at drug and medical supply stores.
- Avoid lying on your side when your upper body is supported by a pillow or wedge as this can irritate the upper spine (mid-back) and ribs.
Step 8. Manage your stress
Stress and anxiety often increase the production of acid in the stomach and reduce the blood flow around the intestines needed for the absorption of food, making acid reflux worse. Therefore, try to manage stress with relaxation therapies, such as deep breathing, meditation, progressive muscle relaxation, guided imagination, yoga or tai chi.
- A variety of techniques to reduce stress and anxiety can relieve the signs and symptoms of acid reflux/heartburn.
- Practice various relaxation techniques after you get home from work or school, but before eating any food. This relaxation technique can also be done right before bed to improve sleep quality.
Part 2 of 3: Avoiding Trigger Foods
Step 1. Avoid consuming fatty foods
Fatty or fried foods tend to trigger heartburn or acid reflux because they take longer to digest, and require more stomach acid to make it easier for acid to flow back into the esophagus. Therefore, choose lean meats and poultry, consume low-fat dairy products and it will be better to grill food than fry it.
- Foods to avoid include: French fries, almost any type of fast food, potato chips, bacon, sausage, heavy sauce, regular ice cream and milk shakes.
- Several types of fat are needed for the baby to develop normally. So, focus on avocados, coconut products and nuts/seeds that have healthier fatty acids.
Step 2. Avoid spicy and sour foods
Another food group that should be avoided is spicy and acidic foods because they can irritate the esophagus when swallowed, then will trigger acid reflux once it reaches the stomach. Therefore, avoid spicy chili sauce, red chili, hot chili, raw chili sauce, tomato sauce, onions, garlic and pepper.
- It's best to avoid Padang and Manado foods even though they are delicious and beneficial for your health if you have an acid reflux attack.
- Be careful with citrus fruits, such as oranges and grapefruit. Choose freshly squeezed fruit and don't drink it on an empty stomach to prevent heartburn.
Step 3. Reduce consumption of caffeinated drinks
Caffeine is known as a trigger for acid reflux because it stimulates the production of stomach acid. In addition, most caffeinated drinks are also acidic, creating a double attack situation for heartburn. Therefore, limit or avoid coffee, black tea, hot chocolate, cola drinks, soda and all energy drinks.
- Coke and soda can actually be considered a “fourfold attack” for heartburn because they are acidic, caffeinated, sugary and carbonated. The bubbles will make the stomach dilate and allow acid to be pushed through the esophageal sphincter.
- You should also avoid caffeinated drinks as they can reduce blood flow and limit the nutrients your baby receives.
Step 4. Stop drinking alcohol
Alcohol is considered a trigger for heartburn because of its acidity and its relaxing effect on the esophageal sphincter. However, pregnant women are asked to avoid alcohol altogether because of the negative effects it has on the baby. Alcohol can cause fetal alcohol syndrome. Alcohol is not safe to consume even in small amounts or during pregnancy. So, get rid of the habit of drinking alcohol from your life immediately.
- All types of alcohol are equally harmful to babies, including all types of wine and beer.
- If you still want to go to a cafe or bar with friends and family, opt for non-alcoholic cocktails, grape juice or non-alcoholic beer.
Part 3 of 3: Preventing Acid Reflux with Medication
Step 1. Take antacids after meals
Antacids are the safest heartburn medications for pregnant women mainly because they are not absorbed into the bloodstream and that means they circulate only in the digestive system and are not passed on to the growing baby. Common antacids that can relieve heartburn quickly include: Maalox, Mylanta, Gelusil, Gaviscon, Rolaids and Tums. Take an antacid about 30-60 minutes after eating a meal or snack.
- Antacids can not cure inflammation of the esophagus damaged by digestive acids. So, use antacids only to relieve symptoms.
- Some antacids are combined with a compound called alginate, which works by forming a foam barrier in the stomach to prevent acid reflux.
- Excessive use of antacids can trigger diarrhea or constipation. So, do not consume it more than 3 times per day.
Step 2. Try an H2 antagonist (H2 blocker)
Over-the-counter drugs that reduce acid production are called histamine-2 (H2) receptor antagonists and include: cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR) and ranitidine (Zantac). In general, H2 antagonists do not act as rapidly as antacids in relieving heartburn, but they usually provide longer-lasting comfort and can reduce gastric acid production for up to 12 hours.
- Over-the-counter H2 antagonists are considered safe for pregnant women even though they are absorbed into the bloodstream and affect the baby to some extent.
- Stronger H2 antagonists must be obtained by prescription, but talk to your doctor about the pros and cons if you are pregnant as there is a risk of vitamin B12 deficiency.
Step 3. Consider a proton pump inhibitor (PPI)
Other drugs that can block acid production are called proton pump inhibitors. In addition, PPIs can heal the lining of the esophagus. PPIs are more effective gastric acid antagonists than H2 antagonists and allow the inflamed esophagus to heal itself.
- Over-the-counter PPIs include: lansoprazole (Prevacid 24 HR) and omeprazole (Prilosec, Zegerid OTC).
- Taking a PPI right before a meal still allows stomach acid to digest food, but prevents overproduction.
Tips
- Avoid smoking as it can increase the risk of acid reflux. However, you should not smoke while pregnant because of the negative effects on the baby.
- Avoid eating chocolate as a snack because it contains caffeine, sugar and fat. All that trigger heartburn.
- Don't wear tight clothing as this will put pressure on your stomach and can make acid reflux worse. It's best to wear loose maternity clothes.
- Do not take antacids at the same time as iron supplements because iron will not be absorbed in the intestines.
