march 2021

Heartburn in pregnancy - from first to third trimester

Heartburn, or indigestion, is a common pregnancy ailment. It is possible to manage and minimise symptoms with changes to diet and lifestyle

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heartburn in pregnancy


What causes heartburn in pregnancy?

Well, if you had “hormones” at the tip of your tongue, you’d be right – at least in part.

Your hormone progesterone, which does a wonderful job of protecting your early pregnancy, also relaxes smooth muscle, including the oesophageal sphincter - a ring of muscle that sits between your oesophagus (the tube that goes from your mouth to your stomach) and your stomach, sealing it to prevent your stomach contents from splashing back up. If the oesophageal sphincter relaxes a bit too much, acid from your stomach can move into your oesophagus and, even your throat, causing pain and burning.

Progesterone levels increase sharply at the beginning of pregnancy and can cause heartburn as early as in the first trimester. Not nice if you are also contending with nausea and vomiting.

As your pregnancy progresses and your baby grows, your growing womb puts pressure on your stomach, making heartburn symptoms worse.

What does it feel like?

As with everything in pregnancy, symptoms are individual to every woman. However, some of the most common symptoms of heartburn or indigestion in pregnancy are:

  • Pain or a feeling of burning behind your breast bone – most usually soon after eating, but can appear later
  • A sore throat or burning at the back of the throat, sometimes with a cough
  • A bitter, acidic or sour taste in your mouth
  • Feeling unusually full and heavy after food
  • Increased and/or repetitive burping
  • Feeling sick and, also, being sick

Most of these symptoms tend to appear soon after eating but can also appear at other times.

Does anything increase the risk of suffering with heartburn?

Yes. We know that women who have had a previous baby have higher chances of having heartburn than women who are expecting their first baby. This is also true for women that have a higher BMI before and during pregnancy.

Smoking in pregnancy, as well as having serious health risks for mum and baby, significantly increases the severity of heartburn symptoms.

Although not a risk factor per se, the frequency and severity of heartburn does increase as your pregnancy advances. It is estimated that around 20% of women will suffer with it in the first trimester, 40% during the second and over 70% in the third trimester.

Lastly, and despite its old wives’ tale status, a very small study showed that women who carried a baby with a good head of hair experienced more severe symptoms of heartburn than women pregnant with bald/less hairy babies. As this was such a small study, however, further research would be necessary to ascertain the relation between the severity of heartburn and a baby’s hair volume.

What makes heartburn worse?

Some dietary choices and lifestyle habits can trigger or worsen symptoms, for example:

  • Eating foods that are fatty, fried, rich or spicy
  • Having acidic foods like tomatoes (also tomato sauce, etc) and citrus fruit
  • Eating quickly
  • Having fizzy drinks and caffeinated beverages
  • Some fruit juices
  • Lying flat
  • Bending over, specially soon after you’ve eaten

What can help decrease the severity of symptoms?

You can help manage or reduce the severity of your symptoms by:

  • Favouring healthy and simpler foods
  • Avoiding rich or tomatoey sauces, foods with chilli, fatty and fried food
  • Chewing slowly
  • Taking pauses between mouthfuls
  • Sitting up straight whilst you eat
  • Only taking sips of your drink with food, or not drinking at all whilst you eat
  • Waiting until after you give birth to enjoy your favourite fizzy or caffeinated drinks and fruit juices
  • Propping yourself up in bed – try raising the head of your bed by putting one or two books under its legs, by placing a cushion under your mattress or, simply, by using one or two more pillows to raise your shoulders and head
  • Waiting at least 3 hours from when you have your evening meal until you get into bed
  • Sleeping on your side
  • Trying not to bend over or do much physical activity soon after you’ve eaten

When to see your midwife or doctor?

If you feel little or no relief after modifying aspects of your diet and lifestyle or feel that your quality of life is being seriously affected by heartburn symptoms, then you need to see your midwife or GP.

You can buy over the counter (OTC) antacids which can give you temporary relief. If you need to, you can also get these on prescription. If you experience little joy with OTC medication, a GP can prescribe stronger medication after a consultation.


Heartburn is a common pregnancy ailment which tends to worsen as your pregnancy progresses and can have a negative effect on your quality of life. There are many changes you can make to your diet and lifestyle to alleviate the severity of its