A common pregnancy problem

Indigestion (known as dyspepsia) is general pain or discomfort in the stomach. Heartburn (or reflux) is the “burning” discomfort felt behind the breastbone when acid moves from the stomach into the gullet.

Indigestion and heartburn are very common in pregnancy, with up to 8 in of every 10 women experiencing symptoms at some time during their pregnancy. You may experience indigestion or heartburn at any time during your pregnancy, however it is most common during the last 13 weeks (known as the last trimester) of pregnancy. As your uterus gets larger, it increases the pressure on the stomach, which may lead to indigestion or heartburn. The increased and changing hormone levels during pregnancy can also contribute to the development of these symptoms. Normally, the symptoms of indigestion settle completely after you have delivered your baby.

Symptoms

The symptoms of indigestion and heartburn are the same whether you are pregnant or not. Common symptoms include pain or discomfort at the top of your stomach below the breast bone (and sometimes behind the lower breast bone), a burning sensation in the same area, belching or burping, nausea, and regurgitated food or acid coming back into your mouth. These symptoms most commonly occur after food, but are also common when lying down flat, or bending forward.

There are two main explanations for these symptoms:

• Acid, which your stomach produces to help to digest food, can irritate the lining of the stomach, causing inflammation and discomfort.
• A muscle (called the lower oesphageal sphincter) between the bottom of the oesophagus (gullet) and the stomach. This muscle prevents the acid moving from the stomach up into the oesophagus. During pregnancy, the sphincter muscle is more relaxed, allowing acid to enter the more delicate oesophagus, leading to inflammation and burning discomfort.

If you experience any of these symptoms of indigestion in pregnancy, it is advisable to talk to your doctor or midwife so that they can confirm they are due to indigestion and/or reflux and advise appropriate treatment.

Dietary and lifestyle changes

There are several dietary and lifestyle changes which can help to improve your symptoms of indigestion in pregnancy:

• eat small amounts of food more frequently, rather than three larger meals a day.
• avoid caffeine (including caffeine in some fizzy drinks and dark chocolate) and alcohol, as well as spicy or fatty food.
• avoid eating a meal within three hours of going to bed.
• smoking will worsen the symptoms and smoking is strongly discouraged during pregnancy.
• a glass of skimmed milk may be helpful.
• Avoid lying flat by sleeping with an extra pillow.

Medications

If dietary and lifestyle changes aren’t enough, there are over the counter medicines called antacids and alginates that can help the symptoms of indigestion and reflux. Antacids (such as Maalox) neutralise the acid in the stomach, while alginates (such as Gaviscon Advance) form a layer on the top of the stomach, reducing acid reflux into the oesophagus. These are usually fine for short term use but extended use can sometimes affect your bowels, e.g. they may result in diarrhoea or constipation. It is advisable to consult your doctor or midwife who can safely advise the correct medication for you and continue to review you to ensure you remain well.

If your symptoms persist despite the above, there are other medications which are available on prescription in pregnancy. The most commonly used one is raniditine. Although it is not licensed for use in pregnancy, it has been used for many years without any reports of harm to the developing baby. It is routinely used and recommended by NICE during labour in women who have received any opioid analgesia or who have risk factors where a general anaesthetic might be needed. Another option is omeprazole, which works via a different mechanism to reduce acid production.  Your doctor will be able to discuss these options with you to choose the right treatment for you, and your unborn baby.

Main points

• Indigestion is also called dyspepsia and is felt as pain or discomfort in the stomach.
• Heartburn is also called reflux and is felt as a ‘burning’ discomfort, which is experienced as acid moves from the stomach into the gullet.
• 8 to 10 women experience heartburn or indigestion during pregnancy.
• Symptoms are generally at their worst in the third trimester and are a result of hormonal changes and increased pressure on the stomach from the enlarged uterus.
• You should discuss any symptoms you experience with your doctor or midwife.
• Certain dietary and lifestyle changes may improve symptoms. For example, avoid caffeine, don’t eat before bed and eat small amounts frequently.
• Antacids and alginates can ease the symptoms of indigestion and reflux.
• Discuss your options with your GP, pharmacist or midwife before commencing any course of medication, even over-the-counter medication.