Reflux in pregnancy

Healthylife Pharmacy21 March 2023|3 min read

Reflux can be hard to avoid in pregnancy as the growing foetus takes up room normally available for your stomach, whilst hormonal changes, a slow digestive system and weight gain also contribute. Feeling nauseous, sleep disturbances and not knowing what to eat can make this normally joyous time distressing. However, symptoms can be reduced by employing some lifestyle and dietary changes, and supplements for use in pregnancy.

Reflux (gastroesophageal reflux disease (GERD)), also known as indigestion or heartburn, can occur at any time during pregnancy and most commonly occurs after the 27th week.

Causes of reflux in pregnancy

Increased levels of progesterone may interfere with gastrointestinal motility and contribute to reflux, nausea and vomiting. Increased pressure from the growing uterus on the stomach, slower gastrointestinal transit time (time it takes for food to leave the stomach), and weight gain as pregnancy progresses, are the common causes of acid reflux [1,2,3].

Symptoms of reflux

  • Burping
  • Burning sensation or pain in chest
  • Feeling full or bloated
  • Feeling nauseous
  • Regurgitating foods and acid

These symptoms occur soon after eating or drinking or may arise at a later stage. Some women can continue to experience reflux after giving birth, and safe treatments whilst breastfeeding should be considered. Along with the impact of eating and drinking restrictions and limitations, reflux can interfere with sleep, impact physical functioning, social life and emotions. Effective treatments alleviating
symptoms can improve quality of life.

Avoiding and treating reflux in pregnancy

Lifestyle and dietary modifications are the first consideration in the management of reflux. Non-pharmaceutical remedies and non-systemic therapies (alginate/antacid combinations) may be suggested. For severe symptoms pharmaceutical medications may be prescribed by a doctor who will take into consideration suitability during pregnancy and lactation [1,2,3].

Simple tips

  • Consume smaller size meals through the day rather than 3 large meals
  • Take smaller bites and chew foods slowly and thoroughly 
  • Eat when hungry 
  • Maintain an upright posture whilst eating and for 2 - 3 hours after eating

What to eat

Reflux can occur to anyone especially if they consume large meals or eat certain foods. Focus on eating foods which are wholesome, healthy and nourishing. 

Specific foods which may help acid reflux include almonds and almond milk (low acid, nutritive), bananas (alkaline, high in potassium and fibre), apples (high in fibre), chicken and fish (low in acid), oatmeal (high in fibre), brown rice (high in fibre), and reduced-fat dairy.

What to avoid

  • Spicy foods, fatty foods and cooking with fats (steam, poach, air fry or grill is best)
  • Fatty cuts of mean and processed meats like hot dogs, sausages and luncheon meats
  • Chocolate/cocoa products which may be high in caffeine and fat
  • Caffeine drinks, carbonated drinks and citrus juices (or using citrus such as lemon with fish), carbonated drinks
  • Onions, garlic, tomato and tomato-based foods
  • Drinking during whilst eating (consume beverages between meals, or only consume small amounts with meals)

A diet diary recording trigger foods can help identify foods best avoided.

Lifestyle modifications

  • Elevating the head-end of the bed or sleep slightly sitting up
  • Sleep on your left side
  • Avoid cigarettes and alcohol
  • Exercise to support healthy digestion and weight maintenance
  • A gentle walk after eating may benefit digestion
  • Wear loose clothing

Breastfeeding mums with reflux should follow the guideline set out for pregnancy and reflux. Weight loss is recommended for over-weight breast feeding mums under the guidance of your healthcare provider.

Reflux symptom relief

Ginger

Ginger (Zingiber officinale) is a safe alternative therapy for treating indigestion, nausea and vomiting in pregnancy. Ginger helps by accelerating gastric emptying and is a carminative (helping expel gas from the gastrointestinal tract) [3].

Slippery elm

Slippery elm bark is a nutritive demulcent, rich in mucilaginous polysaccharides which, when combined with water, becomes a gel offering an emollient action. The gel coats and soothe inflamed tissue and can act as a barrier against acidity. Its high calcium content may have an antacid effect.

Slippery elm is available as a tablet, capsule or powder and can be added to a meal (such as chia, oats or yoghurt), or taken after meals. Avoid combining with medication.

Evidence for slippery elm is drawn from traditional use and is considered a nutritional food. There is no known toxicity from use [4].

Probiotics

Probiotics can support a healthy digestive system and help with reflux, constipation and haemorrhoids. Probiotics are also beneficial for the  immune health of the of the newborn baby. Choose a probiotic suitable for pregnancy [5,6].

Alginate

Alginates are considered acceptable for reflux during pregnancy and lactation [6,7]. Alginates are natural polysaccharide polymers which react with stomach acid to form a gel-like substance with a neutral pH. They occur naturally in brown algae (seaweed) or as alginate-based pharmaceutical formulations and have been successfully used for symptoms of reflux for decades.  A strong, raft-like barrier is formed preventing the reflux of acid and food back into the oesophagus [3,8].

  • Sodium bicarbonate, an antacid, is sometimes combined with alginates as it causes the gel-like substance to float. Sodium bicarbonate releases carbon dioxide gas which becomes trapped in the gel resulting in it floating to the surface of stomach.

Antiacids

Antacid should always be used under the care of a doctor. Although commonly prescribed for reflux during pregnancy, there are some concerns over their safe use. Antacids consist of a various salt of calcium, magnesium and aluminium. Their action is to neutralise stomach acid and inhibit pepsin (the main digestive enzyme).

Alginate/antacid combination work fast to reduce reflux symptoms after eating. The antacid component is quick-action whilst the alginate offers long-lasting action for suppressing reflux [5].

Key concerns

Helping mum-to-be have a comfortable and safe pregnancy is paramount. There are some key issues however with the use of antacids which your healthcare provider will consider before prescribing. 

  • Stomach acids is needed for the absorption of B12 and certain minerals (iron, calcium and magnesium) especially for those who are already deficient in these nutrients. (There are supplemental vitamins and minerals available which bypass this digestive process). 
  • Magnesium trisilicate has been associated with cardiovascular problems, respiratory issues, hypotonia, and kidney stone formation in long-term use.
  • Sodium bicarbonate antacids may lead to fluid overload and metabolic alkalosis in the mother and foetus.
  • Calcium in excess (more than 1000 mg elemental calcium/day) may cross the placenta. It may also lead to calcium-alkali syndrome [3].

Consultation through your healthcare provider is important to rule out other causes of reflux and if dietary and lifestyle modifications and non-pharmaceutical therapies have not offered symptom relief.

The information provided is not intended to be used for diagnosis or treatment. If you are experiencing any health concerns, please consult your doctor for advice.

References

  1. Management of heartburn in pregnancy https://www.ncbi.nlm.nih.gov/books/NBK573943/
  2. Reflux (heartburn) https://www.health.gov.au/resources/pregnancy-care-guidelines/part-i-common-conditions-during-pregnancy/reflux-heartburn
  3. Ali RAR, Hassan J, Egan LJ. Review of recent evidence on the management of heartburn in pregnant and breastfeeding women. BMC Gastroenterol. 2022 May 4;22(1):219. doi: 10.1186/s12876-022-02287-w. PMID: 35508989; PMCID: PMC9066781 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9066781/
  4. Romm, Aviva; 2010; Botanical Medicine of Women’s Health, Churchill Livingstone Elsevier, USA
  5. Cheng J, Ouwehand AC. Gastroesophageal Reflux Disease and Probiotics: A Systematic Review. Nutrients. 2020 Jan 2;12(1):132. doi: 10.3390/nu12010132. PMID: 31906573; PMCID: PMC7019778. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7019778/
  6. Baldassarre ME, Palladino V, Amoruso A, Pindinelli S, Mastromarino P, Fanelli M, Di Mauro A, Laforgia N. Rationale of Probiotic Supplementation during Pregnancy and Neonatal Period. Nutrients. 2018 Nov 6;10(11):1693. doi: 10.3390/nu10111693. PMID: 30404227; PMCID: PMC6267579. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6267579/
  7. Assessment of the Safety and Efficacy of a Raft-Forming Alginate Reflux Suppressant (Liquid Gaviscon) for the Treatment of Heartburn during Pregnancy https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3503308/
  8. Bor S, Kalkan İH, Çelebi A, Dinçer D, Akyüz F, Dettmar P, Özen H. Alginates: From the ocean to gastroesophageal reflux disease treatment. Turk J Gastroenterol. 2019 Sep;30(Suppl2):109-136. doi: 10.5152/tjg.2019.19677. PMID: 31624050; PMCID: PMC6836317. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6836317/
Spread the word

This article is for informational purposes only and does not provide medical advice, diagnosis, or treatment. Any information published on this website or by this brand is not intended as a substitute for medical advice. If you have any concerns or questions about your health you should consult with a health professional.