OK you’ve survived the first trimester and your N and V has settled down so everything should be fine. Right?

Well unfortunately most women suffer from Heartburn or Acid Reflux during their pregnancy. This can occur during the first trimester (and if it does it tends to make your N and V worse) but usually kicks in towards the end of the first trimester.

Our stomachs are filled with acid because acid helps us digest our food. The stomach wall is especially reinforced to resist the effects of acid – only a very few people ever acquire a stomach ulcer due to the effects of acid. However the oesophagus (or gullet) does not have a reinforced lining so acid in the oesophagus causes pain – or heartburn. We have a sphincter muscle at the bottom end of our oesophagus that normally prevents acid from escaping the stomach and affecting the oesophagus.

Heartburn is a problem in pregnancy for two reasons:

• Some pregnancy hormones – especially progesterone and relaxin – relax smooth (involuntary) muscles including the gastro – oesophageal sphincter so it is easier for acid to escape your stomach and cause heartburn.
• The second reason is very simple. The expanding uterus simply presses on the stomach and tends to force stomach contents – including acid – up through the already weakened sphincter to cause heartburn. Unfortunately this is the reason women with multiple pregnancies usually suffer from heartburn more severely than women carrying just one baby.

So how should you manage Heartburn during pregnancy?

There are quite a few simple things you can do to help with symptoms of heartburn. These include:

• Using gravity. Most Heartburn is worst at night when laying down makes it even easier for acid to escape your stomach. If it is possible to sleep in a slightly semi recumbent position this can reduce your symptoms.
• Eating frequent smaller meals. Avoiding a massive evening meal may help night time symptoms of reflux.
• Avoiding spicy foods or anything that increases stomach acid. Some women find their iron supplements increase heartburn so perhaps taking any iron supplements in the morning rather than the evening may help.
• Drinking milk. Apart from the benefits of providing you and your baby with calcium a glass of milk in the evening may help your symptoms of heartburn
• Simple antacids such as Mylanta, “Tums”, “Rennies” or Gaviscon can significantly help your symptoms without posing any risk to you or your baby. Milk and antacids interfere with your body’s absorption of iron so – again – it’s best to take your pregnancy vitamin and / or iron supplement at a different time to when you are drinking milk or taking antacids.

Finally – as with Nausea and Vomiting in pregnancy – there is a small group of women whose heartburn is so severe they need medications to manage their symptoms. For example if you are vomiting fresh blood you need medications to reduce your acid levels and protect the lining of your oesophagus. We only use medications that have been around for a long time and have been proven to be safe in pregnancy.