Reflux, also referred to as indigestion or heartburn, is incredibly common in pregnancy. In fact, a study has reported that up to 80% of pregnancies are affected so you may well end up struggling to eat in the day and struggling to sleep at night because of the discomfort. If you are having trouble, there are a number of dietary and lifestyle changes you can make before having to resort to medication.
As someone who's suffered a lot with heartburn before pregnancy, and then particularly during pregnancy, I've personally tried almost all of these suggestions.
What is reflux?
Reflux, or GERD (gastroesophageal reflux disease, using the American English spelling) is caused when the acid in your stomach irritates the lining of the stomach or the oesophagus. You experience the irritation as a pain or burning sensation. You'll also be very likely to feel extra nauseous and you might even vomit when it's particularly severe.
Natural remedies, dietary, lifestyle & at-home solutions for reflux
REMEDIES WITH STRONG MEDICAL EVIDENCE
Try these remedies first. They've got really good scientific backing and have been proven in strong medical to help prevent and relieve reflux. But there are lots of personal factors in heartburn, so have a read through all the suggestions as you might hit on something that really works for you!
What's important to bear in mind as you read through is that I'm definitely not suggesting you cut out every food that's listed here. That would be miserable and very hard to do. Instead, have a play around with your diet and eating pattern and see what works for you and what doesn't. Pregnancy is hard enough as it is and you want to make sure you get plenty of variety and vitamins in your food.
There's good data to show that sleeping in a more upright position helps to keep pregnancy reflux symptoms at bay during the night. The recommendation is that you buy or make a foam wedge and put it underneath your mattress to elevate the head end. It's very likely though that while you're pregnant, you're uncomfortable at nights and you're already sleeping in myriad pillows (is your husband complaining about being squashed out of the other side of the bed, perhaps..?!). Why not save the money on buying a wedge and instead stack a few up behind you and sleep in a slightly upright position.
Losing weight isn't something you can do in pregnancy, but if you're still suffering from heartburn after pregnancy (as I was), you might find that losing some of that baby weight reduces your symptoms. A 2006 study provides 'good evidence' that there's a link between weight gain and reflux. Higher pressure on your stomach from that extra weight you're carrying on your stomach leaves less space for food to sit comfortably in your abdomen. And hormonal changes associated with obesity reduce the effectiveness of your oesophageal sphincter, again meaning that food and acid can escape the stomach more easily and irritate your oesophagus.
Antacids can block the absorption of iron for your prenatal vitamins, so always try to take your vitamins at a different time. From my own experience, I know this can be hard to find a time when you haven't just taken, or are about to take antacids, so just make sure you do get your vitamins in at some point.
Sometimes taking your prenatal vitamins on an empty stomach seems to upset your tummy too. So you could try taking them with some of the calming anti-acid foods mentioned below.
Antacids are expected to be very safe during pregnancy, and many even mention on their packaging or leaflets that they're suitable for pregnant and breastfeeding women. Of course you should always check this out and consult your midwife or GP for your specific circumstances.
Alginates form a floating 'raft' or layer of medicine on top of the contents of your stomach. That helps to keep them down. But also if anything does escape upwards, it's going to be the 'raft' first so it's not going to irritate your oesophagus.
REMEDIES WITH SOME MEDICAL EVIDENCE
Avoid caffeinated coffee
The NHS recommends that you avoid drinking caffeine when you're suffering from pregnancy reflux. It's a good idea as you have to limit the amount of caffeine you drink anyway while you're pregnant. However, there isn't a huge amount of evidence to prove that caffeine worsens reflux.
But a very small 1994 study on just 16 (non-pregnant) volunteers found that caffeinated coffee did increase the acidity in their oesophagus after drinking. Decaffeinated coffee, caffeine-infused water, or a cup of tea (which also contains caffeine) didn't have the same effect and didn't worsen reflux. Therefore the negative effect of coffee was put down to another agent in the coffee that was removed during the decaffeination process.
When I was pregnant, I did find that avoiding caffeine helped overall. Even decaffeinated tea was better for my symptoms than normal tea. So as this expert recommends, as there isn't a lot of evidence one way or another, you should try things and see what works for you. Stick with the things that work.
Avoid spicy foods, chillies & peppers
People who have reflux report that spicy foods and any kind of pepper - even bell peppers - can make their symptoms worse. Doctors will sometimes recommend that you avoid chilli and spice. There isn't a good body of evidence to support this. But if you find that peppers make your symptoms worse or they make you burp a lot after eating them, it makes sense to cut down on them slightly while you're pregnant.
A Korean study in 2017 of foods and reflux symptoms reports that spicy foods and red pepper were particular problems for people's self-reported reflux symptoms. It's thought that red bell peppers cause a problem because they contain a neurotoxin that slows down the stomach and prevents it from emptying as quickly as usual.
Avoid rich & fatty foods
Again, this is one you need to test out for yourself. There isn't strong medical evidence that creamy, fatty or fried foods make your heartburn worse. But there also isn't enough evidence to say that they definitely don't. The same study in Korea found that fatty foods were among the top trigger foods among their 120+ sufferers.
Fill up on oats
Oatmeal is continually being proven to be good for us in lots of different ways. It's high in fibre and good for filling you up, and it turns out that this is, in a roundabout way, good for your reflux. A randomised controlled trial into the full-feeling effects of oats on patients with inflammatory bowel disease discovered as a byproduct that patients who had reflux also reported a significant improvement in those symptoms. It is thought that oats make you feel fuller for longer as you digest them (even after they've moved on from your stomach into your intestines) and that leads you to eat smaller portions in following meals. And it's that which helps the reflux.
If you make them up into porridge, you can get a double whammy of anti-heartburn goodness by mixing them with milk.
I'm so sorry about this one...! But there has been a tentatively proven link between chocolate and heartburn. Chocolate can cause your lower oesophageal sphincter to relax so that food and acid can escape out of your stomach. I'm not saying you have to cut out chocolate. I'd never say that to a pregnant lady! Chocolate was probably my main food group when I was pregnant. I'm just saying you might want to see if cutting down helps and then you can decide whether you need the chocolate or the heartburn relief more.
Chewing sugar-free gum after a meal helps to encourage you to keep swallowing. You're also producing lots of saliva. That means that you're keeping a regular downwards flow into the stomach, rather than allowing acid to come back up. A small study (of 31 people) found that chewing gum reduced the length of time the patient's oesophagus experienced acidity.
But maybe avoid mint
There has been a small study into the effects of mint, but none have been proven. Again, avoiding it is something you can try and see if it works for you personally. I've found that a cup of mint tea (often recommended for calming upset lower digestives tracts) has repeatedly made my reflux symptoms worse immediately after drinking and for a couple of hours.
Eat broccoli, radish and kale
Who would have thought that these veg might be able to help reflux? A 2017 study on an 'artificial stomach model' found that these naturally alkaline foods were naturally particularly effective at lowering the acidity in the stomach model. They weren't trialled on humans, but it's always worth adding some good veg to your diet, so you won't lose anything by giving these a go.
Cucumber's a tricky one. The same study found that cucumber was also more effective at reducing hyperacidity than plain water. But...
Or don't eat cucumber
Me and a number of other heartburn sufferers I've spoken to all report that we avoid cucumber. Why? It repeats on us for hours and hours afterwards. So many cucumber burbs... The Functional Gut Clinic claims that 'cucumber is well known for causing acid reflux symptoms'.
I can only speculate as there isn't any medical research I've found into why cucumber gives you such an unpleasant experience. But perhaps if it is effective at neutralising the acid, it releases carbon dioxide as a byproduct and this has to escape as burps. Why this side effect isn't so pronounced over the hours after you take an acid-neutralising medication, I'm not sure. Let me know in the comments if you know the answer to this!
This same study found that milk was incredibly effective at calming acid in the model stomach. Before I found out that I was dairy-intolerant, milk was always my go-to for some relief before bed time.
Avoid heavy, solid foods
I've included this one because it was definitely a factor when I was pregnant. Heavy, filling foods like breadsticks, pasta (OK, too much pasta) and corn chips (i.e. Doritos!) seemed to sit in my stomach for hours and hours, making me feel overly full and sick. They aren't foods that are traditionally recognised as causing heartburn, but a recent 2017 study has found that bread, noodles, rice and biscuits were second only to spicy food in causing the worst post-meal symptoms.
Eat little and often
Eating too much in one go means that you're more likely to overfill your stomach and food and acid are more likely to escape. Eat regular small meals and healthy snacks. If you eat foods with complex carbohydrates and healthy protein snacks that will give you long-lasting energy, you're less likely to want to binge a big meal or have an unhealthy snack. (Source).
Lie on your left-hand side
You're pregnant, so you're being advised to lie on your left-hand side at night anyway. Luckily, this is possibly a good position for avoiding reflux by increasing the effectiveness of your lower oesophageal sphincter, keeping your food in your stomach.
One study cited in a Cochrane review of evidence on treating heartburn in pregnancy found that pregnant women who suffered from reflux who were given acupuncture treatment suffered fewer symptoms and were better able to eat and sleep. The study didn't look into whether acupuncture has are any other effects on your pregnancy, the foetus or labour.
REMEDIES WITH ANECDOTAL EVIDENCE
These aren't necessarily any less effective or less likely to work for you. Frequently there just hasn't been enough research done to prove that they definitely do work. Or small studies haven't been able to find a link, but heartburn sufferers recommend that these ideas have worked for them. If you're not getting complete relief with any of the remedies above, it's definitely worth exploring these below.
Don't eat or drink acidic foods
There hasn't been enough work done to definitively prove a causal link between citrus fruits or high acid foods like tomatoes and reflux. Although if acid is your problem, it seems to make sense to choose foods that are less acidic.
Eat more alkali foods
So why not see if you can combat some of your stomach acid with some alkali foods. There isn't great information readily available on the pH of foods - just an awful lot of conflicting claims as to whether any particular food is alkali and how alkali it is. It's also tricky to filter out the information on which foods are alkali when you eat them vs. foods that are alkali once they're processed in your gut. There's a trend to eat foods that have an 'alkalising' effect on the body once they've been digested. That's not what you're looking for to treat your reflux.
The US FDA (Food & Drug Administration) is a reliable source as to the pH of foods. These foods are alkali at the point of consumption - without any dressings or anything else you add during cooking, which will, of course, affect the final pH. Most foods, being naturally produced, have a range of pHs, so you won't know exactly whether it will be gently acidic, neutral or gently alkali. That's why some foods are listed with 'some', as not all of them will be alkali, but at least you know they won't be strongly acidic.
All: tea, tofu, egg white, Graham crackers, cooked lobster (oh yes!), camembert, peanut soup, bird's nest soup, shrimp sauce
Sometimes: soda crackers, some olives, some clams, some coconut products, conch, some cooked sweetcorn, some cooked spinach
Some non-medical writers also suggest that foods that are only mildly acidic could help. Presumably, as most foods are acidic, they are thinking about diluting your very strong stomach acid with something that's not quite as acidic. Foods that are commonly recommended are bananas, melon, lettuce, onions, lean cuts of meat. However, almost all foods come with a supplementary warning that they do worsen reflux in some people. So, as usual, it's all about trying things and finding out what works for you!
Stick to still drinks
If the acidity in fizzy drinks causes you pain, or the bubbles make you burp and bring up stomach acid, then it's a good idea to avoid them. There isn't very strong evidence to suggest a link between carbonated drinks and reflux, but some pregnant ladies do find it's easier to avoid them. Other mum's can't face the idea of a fizzy drink when they're pregnant anyway!
Don't drink alcohol
Obviously you're not meant to be drinking alcohol when you're pregnant anyway. But if you have indulged in an occasional tipple, or if you're postpartum and still suffering from reflux, you might have found that alcohol makes it worse. Anecdotally, heartburn sufferers sometimes find that alcohol exacerbates symptoms. Personally, I find that it does seem to make heartburn worse. But there haven't been enough medical trials to determine a definite causal link across the general population.
Three case-controlled trials (a case-controlled trial isn't as reliable as a well-executed randomised controlled trial) failed to show that alcohol worsens symptoms or oesophageal pH, or that avoiding alcohol alleviates them. But again, it's one of those things where you should try it and see if it works for you.
Again, I assume you're not smoking when you're pregnant but if you are the medical advice is the same as alcohol - stop! Similar to alcohol, there hasn't been a proven link between tobacco and reflux, but you might find that it's something that works for you.
Don't eat within 3 hours of bed
There's some evidence that not eating just before bed helps. It lets your food go down. Even though this hasn't been studied extensively, it's recommended by the NHS and doctors worldwide and it's described as 'common sense'.
The NHS tells us to sit upright when eating to take the pressure off our stomachs. It can only help. And you can practice good posture. Believe me... as you get more heavily pregnant, and then after you've given birth (when you suddenly discover that your previously-strong core has turned into jelly and you have to start carrying a 3kg+ weight around at all hours of day and night), you'll be grateful for that extra muscle tone!
Other suggestions that aren't backed up by medical evidence, but are frequently suggested are: Aloe vera, ginger tea, salad and parsley. Research the potential effects of aloe vera on pregnancy first - there's a recommended maximum limit on what you would consume per day.
If it's not letting up with any of these at-home remedies, you can visit your GP and they might prescribe you a pregnancy-safe medication to reduce the acid production in your stomach. Ranitidine and Omeprazole are considered to be safe, whereas Lanzoprazole has recently found to not be safe during pregnancy due to some serious potential cardiac side effects. But even if you have any some medication at home, always consult your doctor or midwife first because the latest advice may have changed since you were last prescribed it, it may interact with other medications that you're taking, and your own prenatal circumstances will be unique.
No doctor can guarantee that medication is 100% safe for you and your baby, and, of course, trials can't be carried out on pregnant women, so the NHS describes these medications as 'not known to be harmful'.
What are the symptoms of heartburn?
The NHS explains that the symptoms of heartburn tend to come on shortly after eating. They can last for hours, and include:
Symptoms of indigestion and heartburn include:
- a burning sensation or pain in the chest
- feeling full, heavy or bloated
- burping or belching
- feeling or being sick
- bringing up food
Why are pregnant women prone to indigestion?
You can get heartburn symptoms at any point in your pregnancy, but they're more common later on, particularly from week 27 according to the NHS.
When you're pregnant, you're more likely to have indigestion because of these medical changes in your body:
Your oesophageal sphincter relaxes
Your increased levels of oestrogen and progesterone lead to the lower oesophageal sphincter (the ring of muscle at the bottom of your oesophagus that keeps your food in your stomach) being more relaxed than usual. Without that forming a tight seal, food and acid can more easily move upwards out of your stomach.
Your digestive tract slows down
These same hormones also relax the muscles that move your food onwards out of your stomach. This is called 'lower gastric motility'. Food stays in your stomach for longer.
Your stomach is squashed by the baby
Your growing baby pushes your uterus up against your stomach. There's less space for your food and stomach acid to be contained safely within your stomach.
You may be more likely to get indigestion during pregnancy if:
- you had indigestion before you were pregnant
- you've been pregnant before
- you're in the later stages of pregnancy
- you have gained a large amount of weight during pregnancy
- you're an older mother