Heartburn in pregnancy: Difference between revisions
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{{Infobox medical condition | {{Infobox medical condition | ||
| name = | | name = Heartburn in pregnancy | ||
| synonyms = Indigestion in pregnancy, acid reflux in pregnancy<ref name=NHS2026/> | | synonyms = Indigestion in pregnancy, acid reflux in pregnancy<ref name=NHS2026/> | ||
| specialty = [[Family medicine]], [[obstetrics and gynecology]] | | specialty = [[Family medicine]], [[obstetrics and gynecology]] | ||
| symptoms = [[heartburn|Burning in the chest or throat]]<ref name=BMJ2015/> | | symptoms = [[heartburn|Burning in the chest or throat]]<ref name=BMJ2015/> | ||
| complications = [[esophagitis|Inflammation of the esophagus]], cough, [[asthma]]<ref name=BMJ2015/><ref name=Dun2022/> | | complications = [[esophagitis|Inflammation of the esophagus]], cough, [[asthma]]<ref name=BMJ2015/><ref name=Dun2022/> | ||
| causes = Pressure from the baby, [[hormone]] changes<ref name=NHS2026/> | | causes = Pressure from the baby, [[hormone]] changes<ref name=NHS2026/> | ||
| risks = Fatty or spicy food<ref name=Dun2022/> | | risks = Fatty or spicy food<ref name=Dun2022/> | ||
| Line 20: | Line 12: | ||
| treatment = Small frequent meals, avoiding eating before sleeping, sleeping with head raised, reducing [[caffeine]]<ref name=NHS2026/><ref name=BMJ2015/> | | treatment = Small frequent meals, avoiding eating before sleeping, sleeping with head raised, reducing [[caffeine]]<ref name=NHS2026/><ref name=BMJ2015/> | ||
| medication = [[Antacids]], [[sucralfate]], [[H2 blockers]], [[proton pump inhibitors]]<ref name=BMJ2015/><ref name=Dun2022/> | | medication = [[Antacids]], [[sucralfate]], [[H2 blockers]], [[proton pump inhibitors]]<ref name=BMJ2015/><ref name=Dun2022/> | ||
| prognosis = Generally resolves after [[delivery]]<ref name=Dun2022/> | | prognosis = Generally resolves after [[childbirth|delivery]]<ref name=Dun2022/> | ||
| frequency = 17 to 45%<ref name=BMJ2015/> | | frequency = 17 to 45%<ref name=BMJ2015/> | ||
}} | }} | ||
<!-- Definition and symptoms --> | <!-- Definition and symptoms --> | ||
'''Heartburn in pregnancy''' is | |||
'''Heartburn in pregnancy''' is a common physiological symptom of [[heartburn|burning in the esophagus or throat]] during [[pregnancy]].<ref name="BMJ2015" /><ref name=":0" /> There may also be associated [[regurgitation (digestion)|regurgitation]].<ref name="Dun2022">{{cite journal |last1=Dunbar |first1=K |last2=Yadlapati |first2=R |last3=Konda |first3=V |title=Heartburn, Nausea, and Vomiting During Pregnancy. |journal=The American Journal of Gastroenterology |date=1 October 2022 |volume=117 |issue=10S |pages=10–15 |doi=10.14309/ajg.0000000000001958 |pmid=36194028 |pmc=10782592 }}</ref> It does not appear to affect pregnancy outcomes; however, it affects [[quality of life]] during pregnancy.<ref name="Dun2022" /> Complications may include [[esophagitis|inflammation of the esophagus]], cough, or [[asthma]].<ref name="BMJ2015" /><ref name="Dun2022" /> In those who are affected, it usually starts near the end of the first trimester or in the second trimester, becomes more frequent by the time of the third trimester, and resolves on its own soon after delivery.<ref name=":0">{{Cite Q |Q28277056}}</ref><ref>{{Cite Q |Q140536310 |page=258 |url=https://books.google.com/books?id=m3iiEAAAQBAJ&pg=PA258}}</ref> | |||
<!-- Cause and diagnosis --> | <!-- Cause and diagnosis --> | ||
Risk factors may include fatty or spicy food.<ref name=Dun2022/> The underlying mechanism involves | Risk factors may include fatty or spicy food.<ref name="Dun2022" /> The underlying mechanism involves [[hormone|hormonal]] changes, but the size of the baby may also contribute.<ref name="NHS2026" /><ref name="BMJ2015" /> This results in [[stomach acid]] entering the [[esophagus]].<ref name="BMJ2015" /> Diagnosis is generally based on symptoms; though it may rarely be supported by [[upper endoscopy]].<ref name="BMJ2015" /><ref name="Dun2022" /> [[Esophagitis]], on the other hand, is uncommon and usually occurs in those who had the disease before the pregnancy.<ref name=":0" /> The diagnosis of [[gastroesophageal reflux disease]] (GERD) can be considered if heartburn is troublesome or has complications.<ref name=":1">{{Cite Q|Q140540930}}</ref> If a person had the disease before the pregnancy, heartburn can be considered an [[exacerbation]] of GERD.<ref name=":0"/> | ||
<!-- Treatment and epidemiology --> | <!-- Treatment and epidemiology --> | ||
Initial efforts often include eating small frequent meals and avoiding eating before sleeping.<ref name=NHS2026/> Sleeping with the head raised and reducing [[caffeine]] may also be tried.<ref name=BMJ2015/> Medications that may help include [[antacids]], [[sucralfate]], [[H2 blockers]], and [[proton pump inhibitors]].<ref name=BMJ2015/><ref name=Dun2022/> Magnesium, aluminum, and calcium-containing antacids appear safe.<ref name=Dun2022/ | Initial efforts often include eating small frequent meals and avoiding eating before sleeping.<ref name=NHS2026/> Sleeping with the head raised and reducing [[caffeine]] may also be tried.<ref name=BMJ2015/> Antireflux medications can be potentially [[Teratogenicity|teratogenic]], so lifestyle modifications may be preferable in mild cases.<ref name=":0" /> Medications that may help include [[antacids]], [[sucralfate]], [[H2 blockers]], and [[proton pump inhibitors]].<ref name=BMJ2015/><ref name=Dun2022/> Magnesium, aluminum, and calcium-containing antacids appear safe.<ref name=Dun2022/> Heartburn in pregnancy is common, particularly after 12 weeks of [[gestation]].<ref name=NHS2026>{{cite web |title=Indigestion and heartburn in pregnancy |url=https://www.nhs.uk/pregnancy/common-symptoms/indigestion-and-heartburn/ |website=nhs.uk |access-date=9 July 2026 |language=en |date=3 December 2020 |archive-date=8 July 2026 |archive-url=https://web.archive.org/web/20260708102024/https://www.nhs.uk/pregnancy/common-symptoms/indigestion-and-heartburn/ |url-status=live }}</ref> About 17 to 45% of pregnancies are affected at some point.<ref name=BMJ2015>{{cite journal |last1=Vazquez |first1=JC |title=Heartburn in pregnancy. |journal=BMJ Clinical Evidence |date=8 September 2015 |volume=2015 |pmid=26348641 |pmc=4562453 }}</ref> | ||
== Causes == | |||
The sensation of heartburn appears when [[stomach acid]] passes from the [[stomach]] into the [[esophagus]].<ref>{{Cite Q|Q141535128|pages=426|url=https://books.google.com/books?id=2y6zOSQcn14C&pg=PA426}}</ref> In pregnancy, [[progesterone]] and [[estrogen]] levels are elevated in the [[blood]], increasing throughout pregnancy.<ref>{{Cite Q|Q141537292}}</ref> Progesterone and estrogen affect the [[lower esophageal sphincter]] by relaxing its smooth muscles and decreasing its pressure, which holds stomach contents from going up into the [[Oesophagus|oesophageal lumen]].<ref name="BMJ2015" /><ref>{{Cite Q|Q141537957}}</ref> On the other hand, the growing baby may also play a role by creating additional pressure to the stomach and increasing intragastric pressure.<ref name="BMJ2015" /><ref>{{Cite Q|Q141537957}}</ref> Another possible contributing factor is the displacement of the lower esophageal sphincter up into the [[thoracic cavity]] during pregnancy.<ref name="BMJ2015" /> The thoracic cavity has negative pressure, so it can decrease lower esophageal sphincter pressure.<ref name="BMJ2015" /><ref>{{Cite Q|Q51002982}}</ref> | |||
== Treatment == | |||
{{See also|Gastroesophageal reflux disease#Pregnancy}} | |||
Mild heartburn in pregnancy can be treated by lifestyle modifications.<ref name="NHS2026" /> Avoiding eating too much food at a time can help prevent [[indigestion]], so smaller meals several times a day might be preferable during pregnancy than three large meals.<ref name="NHS2026" /> Avoiding spicy food, fatty food, and caffeine prevents symptoms from worsening.<ref name="NHS2026" /> Chewing gum stimulates saliva production, which can neutralize stomach acid, so chewing gum is also often recommended, but it is not known whether it is effective.<ref name=":2">{{Cite Q|Q24187104}}</ref> Avoiding lying down for some time after eating and sleeping with the head and shoulders elevated can stop [[stomach acid]] from going up the [[esophagus]].<ref name="NHS2026" /> Drinking alcohol and smoking [[tobacco]] can lead to indigestion and can also harm the baby, so cessation is the common advice.<ref name=":2" /><ref name="NHS2026" /> Also, medications that cause heartburn may be avoided.<ref name=":2" /> | |||
Medications are often used when lifestyle changes are not effective.<ref name=":2" /> For symptomatic [[GERD]] in pregnancy, a step-up algorithm exists.<ref>{{Cite Q|Q141566770}}</ref><ref name=":0" /> According to a review published in 2022, it includes a few steps, each of which can be tried if the previous one did not help.<ref name=":1" /><ref name=":0" /> The algorithm involves lifestyle modifications, [[Antacid|antacids]], [[sucralfate]], [[H2 receptor antagonist|histamine-2 receptor antagonists]] and [[Proton-pump inhibitor|proton pump inhibitors]] (histamine-2 receptor antagonists and proton pump inhibitors were suggested to be used with antacids).<ref name=":1" /><ref name=":0" /> | |||
According to the 2015 Cochrane systematic review, medications seem to be effective in relieving heartburn during pregnancy, but the review couldn't determine which medication is the best.<ref name=":2" /> Another 2015 systematic review found that [[Antacid|antacids]] may be effective,<ref name="BMJ2015" /> and there is a consensus that they should be used if lifestyle changes did not work.<ref name=":1" /> | |||
== Prognosis == | |||
Heartburn in pregnancy can become more severe towards the end of pregnancy, but it usually resolves after delivery.<ref name="BMJ2015" /> During pregnancy, lifestyle changes may help improve the condition.<ref name="BMJ2015" /> In some women, heartburn can persist for some time after delivery and may require treatment.<ref name="BMJ2015" /> In addition, heartburn can be due to an exacerbation of pre-existing gastroesophageal reflux disease.<ref name=":0" /> Despite heartburn in pregnancy being thought to be a benign condition, some studies have reported that heartburn during pregnancy may increase the risk of developing gastroesophageal reflux disease in subsequent pregnancies, but the overall number of studies is small.<ref>{{Cite Q|Q40191102}}</ref> | |||
== See also == | |||
* [[Signs and symptoms of pregnancy]] | |||
* [[Physiological changes in pregnancy]] | |||
==References== | ==References== | ||
{{reflist}} | {{reflist}} | ||
[[Category:Health issues in pregnancy]] | |||
Latest revision as of 06:22, 29 September 2026
Template:Infobox medical condition
Heartburn in pregnancy is a common physiological symptom of burning in the esophagus or throat during pregnancy.[1][2] There may also be associated regurgitation.[3] It does not appear to affect pregnancy outcomes; however, it affects quality of life during pregnancy.[3] Complications may include inflammation of the esophagus, cough, or asthma.[1][3] In those who are affected, it usually starts near the end of the first trimester or in the second trimester, becomes more frequent by the time of the third trimester, and resolves on its own soon after delivery.[2][4]
Risk factors may include fatty or spicy food.[3] The underlying mechanism involves hormonal changes, but the size of the baby may also contribute.[5][1] This results in stomach acid entering the esophagus.[1] Diagnosis is generally based on symptoms; though it may rarely be supported by upper endoscopy.[1][3] Esophagitis, on the other hand, is uncommon and usually occurs in those who had the disease before the pregnancy.[2] The diagnosis of gastroesophageal reflux disease (GERD) can be considered if heartburn is troublesome or has complications.[6] If a person had the disease before the pregnancy, heartburn can be considered an exacerbation of GERD.[2]
Initial efforts often include eating small frequent meals and avoiding eating before sleeping.[5] Sleeping with the head raised and reducing caffeine may also be tried.[1] Antireflux medications can be potentially teratogenic, so lifestyle modifications may be preferable in mild cases.[2] Medications that may help include antacids, sucralfate, H2 blockers, and proton pump inhibitors.[1][3] Magnesium, aluminum, and calcium-containing antacids appear safe.[3] Heartburn in pregnancy is common, particularly after 12 weeks of gestation.[5] About 17 to 45% of pregnancies are affected at some point.[1]
Causes
The sensation of heartburn appears when stomach acid passes from the stomach into the esophagus.[7] In pregnancy, progesterone and estrogen levels are elevated in the blood, increasing throughout pregnancy.[8] Progesterone and estrogen affect the lower esophageal sphincter by relaxing its smooth muscles and decreasing its pressure, which holds stomach contents from going up into the oesophageal lumen.[1][9] On the other hand, the growing baby may also play a role by creating additional pressure to the stomach and increasing intragastric pressure.[1][10] Another possible contributing factor is the displacement of the lower esophageal sphincter up into the thoracic cavity during pregnancy.[1] The thoracic cavity has negative pressure, so it can decrease lower esophageal sphincter pressure.[1][11]
Treatment
Template:See also Mild heartburn in pregnancy can be treated by lifestyle modifications.[5] Avoiding eating too much food at a time can help prevent indigestion, so smaller meals several times a day might be preferable during pregnancy than three large meals.[5] Avoiding spicy food, fatty food, and caffeine prevents symptoms from worsening.[5] Chewing gum stimulates saliva production, which can neutralize stomach acid, so chewing gum is also often recommended, but it is not known whether it is effective.[12] Avoiding lying down for some time after eating and sleeping with the head and shoulders elevated can stop stomach acid from going up the esophagus.[5] Drinking alcohol and smoking tobacco can lead to indigestion and can also harm the baby, so cessation is the common advice.[12][5] Also, medications that cause heartburn may be avoided.[12]
Medications are often used when lifestyle changes are not effective.[12] For symptomatic GERD in pregnancy, a step-up algorithm exists.[13][2] According to a review published in 2022, it includes a few steps, each of which can be tried if the previous one did not help.[6][2] The algorithm involves lifestyle modifications, antacids, sucralfate, histamine-2 receptor antagonists and proton pump inhibitors (histamine-2 receptor antagonists and proton pump inhibitors were suggested to be used with antacids).[6][2]
According to the 2015 Cochrane systematic review, medications seem to be effective in relieving heartburn during pregnancy, but the review couldn't determine which medication is the best.[12] Another 2015 systematic review found that antacids may be effective,[1] and there is a consensus that they should be used if lifestyle changes did not work.[6]
Prognosis
Heartburn in pregnancy can become more severe towards the end of pregnancy, but it usually resolves after delivery.[1] During pregnancy, lifestyle changes may help improve the condition.[1] In some women, heartburn can persist for some time after delivery and may require treatment.[1] In addition, heartburn can be due to an exacerbation of pre-existing gastroesophageal reflux disease.[2] Despite heartburn in pregnancy being thought to be a benign condition, some studies have reported that heartburn during pregnancy may increase the risk of developing gastroesophageal reflux disease in subsequent pregnancies, but the overall number of studies is small.[14]
See also
References
- ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 Vazquez, JC (8 September 2015). "Heartburn in pregnancy.". BMJ Clinical Evidence 2015. PMID 26348641.
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 Template:Cite Q
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 Dunbar, K; Yadlapati, R; Konda, V (1 October 2022). "Heartburn, Nausea, and Vomiting During Pregnancy.". The American Journal of Gastroenterology 117 (10S): 10–15. doi:. PMID 36194028.
- ↑ Template:Cite Q
- ↑ 5.0 5.1 5.2 5.3 5.4 5.5 5.6 5.7 "Indigestion and heartburn in pregnancy" (in en). 3 December 2020. https://www.nhs.uk/pregnancy/common-symptoms/indigestion-and-heartburn/.
- ↑ 6.0 6.1 6.2 6.3 Template:Cite Q
- ↑ Template:Cite Q
- ↑ Template:Cite Q
- ↑ Template:Cite Q
- ↑ Template:Cite Q
- ↑ Template:Cite Q
- ↑ 12.0 12.1 12.2 12.3 12.4 Template:Cite Q
- ↑ Template:Cite Q
- ↑ Template:Cite Q