Heartburn is one of the most frequent complaints we get during prenatal visits – in fact, up to 45% of people experience heartburn in pregnancy (though I might argue that, anecdotally, we see a higher incidence.)

The reason that so many pregnant people have problems with heartburn is that the hormones of pregnancy cause the muscles of the digestive tract to relax (this is also why there is an increase in constipation), including the esophageal sphincter, which allows stomach acids to flow back up into the esophagus. Though this problem is often exacerbated late in pregnancy, when the growing uterus crowds the stomach, many women feel significant heartburn in the first trimester, when big hormonal shifts are happening.

So that’s the why – but what do we do about it? It may be tempting to take medication, but it is usually better in pregnancy to try non-pharmaceutical solutions first. Here is what we usually recommend:

• Eat smaller, more frequent meals
• Eat meals and snacks slowly
• Don’t drink liquids with your food, or keep it to a miminum (but make sure to stay well hydrated by drinking fluids between meals).
• Wait awhile after eating before you lie down, either for bed or even just on the couch to watch TV
• Prop yourself up on pillows to elevate the top half of your body when you sleep
• Keep bowel movements as regular as possible to avoid constipation, which can contribute to heartburn
• Some people have luck with chewing gum before a meal so that the saliva can neutralize stomach acids
• Papaya enzymes might help

If you do resort to over the counter medications such as Tums, be sure to take them sparingly and separate from iron supplements, as the calcium in Tums can interfere with iron absorption. And be sure to speak to your medical care provider about the pros, cons and safety of heartburn medications during pregnancy.