When Does Heartburn Start in Pregnancy: 16 Tips To Manage It

Heartburn during pregnancy typically starts in the second or third trimester.

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Pregnancy comes with many bodily changes that affect the way people move, feel, and eat.

Sometimes, pregnancy can cause symptoms like heartburn that are uncomfortable or even painful.

It’s common for people to wonder when heartburn starts in pregnancy — this guide is here to help fill you in, and provide some additional tips that can provide some relief.

What Is Heartburn?

Heartburn, sometimes referred to as acid reflux, is the feeling of a burning sensation in the chest that occurs behind the sternum.

The pain is caused by stomach acid that rises into the esophagus, which can contribute to burning in the chest and a bitter or acidic taste in the mouth. 

Some foods and drinks are more likely to contribute to heartburn than others, including spicy foods, citrus, fatty or fried foods, chocolate, large meals, onions, tomato products, peppermint, alcohol, carbonated drinks, and caffeinated beverages. 

heartburn pregnancy

Most people experience heartburn occasionally over the course of their lifetimes, but some people experience the condition on a chronic basis.

People are also more likely to experience heartburn during pregnancy.

Why Do People Experience Heartburn During Pregnancy?

Heartburn is a well-known symptom of pregnancy, with many women experiencing the pain and discomfort at some point over the course of nine months. 

One surprising aspect of heartburn during pregnancy is that many women who experience the condition have never suffered from heartburn before getting pregnant.

Doctors aren’t sure exactly why heartburn is so common during pregnancy, but hormones are thought to play a role.

During pregnancy, a woman’s hormone levels spike considerably, including a hormone called progesterone.

Progesterone is critically important during pregnancy, as it encourages the uterus to grow, and also prevents it from contracting too early, which could contribute to a miscarriage or premature birth.  

Progesterone’s relaxing effect also extends to the esophageal sphincter, a band of muscles between the stomach and the esophagus that prevents stomach acid and food from flowing backwards into the esophagus. 

During pregnancy, rising levels of progesterone relax the esophageal sphincter, increasing the likelihood of food and stomach acid rising into the esophagus and causing heartburn.

Higher levels of pregnancy hormones and increases in progesterone can also slow down the digestive process, meaning food takes longer to digest.

In turn, food sits in the stomach for longer after a meal, increasing the risk of experiencing the burning feeling of heartburn. 

In addition, the growing fetus begins to exert upward pressure on the stomach and esophagus in the later months of pregnancy, which can force food and stomach acid into the esophagus, which causes heartburn.

When Does Heartburn Start in Pregnancy?

When heartburn starts during pregnancy varies depending on the person and their previous susceptibility to the condition.

Women who have experienced heartburn outside of pregnancy are more likely to experience symptoms while pregnant and may experience symptoms in the first trimester. 

Women who do not experience heartburn outside of pregnancy may still struggle with the condition, which typically begins during the second or third trimester.

Pregnancy heartburn often gets worse as the growing baby presses upward as they grow. 

How Can You Manage Heartburn During Pregnancy?

While it may not be possible to completely avoid symptoms, there are a number of lifestyle changes women can take to reduce the effects of heartburn. 

Dietary Changes

Dietary changes are often very helpful in preventing and managing heartburn in pregnancy. 

Suggestions include:

  • Chew your food thoroughly and eat slowly
  • Avoid fried foods
  • Avoid fatty foods
  • Avoid spicy foods
  • Eat several small meals throughout the day instead of just a few large meals (smaller meals means less crowding in your stomach)
  • Limit your caffeine intake
  • Avoid citrus fruits and juices
  • Avoid foods containing tomato, onion, or garlic
  • Try not to eat several hours before bedtime.

Positional Changes

The position of your body can also play a role in heartburn during pregnancy. Some positions can help you avoid or minimize symptoms of heartburn. 

Suggestions include:

  • Eat when sitting upright rather than while reclined or laying down
  • Stay upright after eating and wait before lying down
  • Elevate the head of the bed when going to sleep — this can be done by placing pillows under your shoulders or propping up the head of the mattress. Elevating your upper body helps to reduce the amount of acid that can move from the stomach into the esophagus.

Natural Remedies

Some over-the-counter remedies can also help manage heartburn in pregnancy.

Because a growing fetus is exposed to everything a mother takes in during pregnancy, pregnant women need to be careful about using different medications and over-the-counter remedies. 

Some natural remedies for heartburn in pregnancy include:

  • Eating yogurt
  • Drinking a glass of milk
  • Warming some milk and adding a tablespoon of honey

Over-the-Counter Treatments

Pregnant women may also be able to use over-the-counter heartburn medications to relieve their symptoms. 

Medications like Tums and Maalox, which contain calcium carbonate and bismuth salicylate, respectively, can effectively help treat heartburn symptoms. 

However, these products may contain inactive ingredients, such as sodium or aluminum, that can be harmful during pregnancy when consumed in excess.

Therefore, pregnant women should always speak to their healthcare provider before using any medication. 

The Bottom Line

Heartburn in pregnancy typically starts in the second trimester or the third trimester, but some women who experienced heartburn before pregnancy may start to have symptoms sooner.

Heartburn during pregnancy is thought to occur as a result of an increase in the hormone progesterone, which causes the esophageal sphincter to relax and digestive processes to slow. 

Heartburn pregnancy symptoms can be managed with dietary changes, such as eating several small meals a day instead of big meals, and cutting out foods that contribute to acid reflux (and the burping or bloating that can go with it).

Other changes include positional changes, such as sleeping with your head elevated and eating when sitting straight up, as well as over-the-counter treatments, such as eating yogurt or using over-the-counter medications like antacids with your OB-GYN’s approval.

References and Sources:

Pregnancy and Heartburn | Stanford Children's Health 

Progesterone treatment to help prevent premature birth | March of Dimes 

Pregnancy and Heartburn: Causes & Management | Cleveland Clinic 

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