How to treat heartburn during pregnancy before it gets worse

• Heartburn during pregnancy can worsen if you don't take steps to manage it.
• Keep a diary to track common foods that cause heartburn, like spicy and fried foods.
• Also eat smaller, more frequent meals and talk to your doctor about an antacid or H2 blocker.

When you first become pregnant, the prospect of "eating for two" certainly seems pretty grand. However, for most women, amidst the moments of liberated eating also comes some less savory times: morning sickness, nausea, constipation, and last - but certainly not least - heartburn.

You know the feeling. Heartburn is that burning sensation in your chest that runs from your stomach up to your throat and sometimes comes with a sour or bitter flavor in the back of your mouth. And it's one of the most common digestive symptoms that women experience at some point during their pregnancy.

"About 85% of women experience heartburn or other forms of gastroesophageal reflux in pregnancy," says Aparna Sridhar, an OB-GYN and associate professor in Obstetrics and Gynecology at UCLA. "I discuss this with almost all of my patients at least once in pregnancy. With the majority of them, I keep discussing this problem at least every trimester."

It's hard enough to cope with heartburn when you're not pregnant. But pregnancy takes it to a whole new level, because heartburn during pregnancy can actually get worse with each trimester unless you learn how to manage it.

Pregnancy itself ups your risk of heartburn

Normally, there are certain factors - like your weight, whether you smoke, and your genes - that can increase your likelihood of heartburn. But when you're pregnant, it's the pregnancy itself that makes you more susceptible.

"There are two main factors," says Renee Wellenstein, DO, who is a double board-certified OB-GYN. One that's hormonal and one that's physical.

Heartburn is caused by acid reflux, when food and digestive fluids, which contain acids, back up in your esophagus and create that uncomfortable burn. That backup can happen when you're pregnant because you have higher-than-usual progesterone levels, which can - one - slow digestion and - two - relax the muscle, called the esophageal sphincter, that separates your esophagus and stomach.

Combined, these two factors create the perfect storm for heartburn because the slow digestion can lead to more backup in your esophagus and the relaxed muscle makes it easier for acid to creep through.

"The other factor is the growing uterus that physically pushes up on the stomach as it grows," says Wellenstein.

As a result, heartburn does tend to get worse throughout pregnancy. Fortunately, all those changes to your body that cause heartburn during pregnancy quickly disappear after you give birth. So, at least that's something you can look forward to leaving behind at the hospital when you bring your newborn home.

How to treat pregnancy heartburn naturally

While you can't completely prevent heartburn during pregnancy, there are ways you can minimize how often it happens and reduce the severity when it strikes.

Below are seven tips from Wellenstein, Sridhar, and experts from the American College of Obstetrics and Gynecology.

1. Avoid food triggers. Keep a food diary to track the foods that cause heartburn for you. Common triggers include spicy and fried foods, processed deli meats, mint, chocolate, caffeine, and carbonated beverages. Some people are also affected by acidic foods like citrus, tomatoes, vinegar, and mustard.
2. Adjust your environment and your body. Elevate your head on a couple of stacked pillows or a wedge pillow, and lie on your left side, which is generally advised during pregnancy anyway after 20 weeks gestation. This is important because it allows gravity to help keep digestion moving in the right, downward, direction and away from the esophagus where you feel the pain.
3. Eat smaller, more frequent meals: You can digest smaller meals faster and more easily, which may lead to less acid reflux.
4. Watch your timing: Eat two to three hours before going to bed, Wallenstein says. You want to be upright after eating so that gravity can help your food exit the stomach into the small intestines, thereby minimizing the chances for acids to escape up into the esophagus.
5. Neutralize it. You can try neutralizing the acid in a few different ways. First, try chewing gum to generate more saliva in your esophagus. Human saliva has a pH between 6.2 to 7.6 which can help neutralize any acidity. Milk has a similar pH to saliva - around 6.6 - so you can also try to find relief from drinking a little milk or a couple of tablespoons of yogurt. Baking soda is another remedy. Wellenstein says to mix 1 teaspoon of baking soda with a glass of water. Baking soda is a natural buffer that may neutralize the acid, not unlike some over-the-counter antacids.
6. Try acupuncture. There is a long history of the use of acupuncture to help with digestive symptoms like heartburn and minimal risk in trying. While the research is limited and insufficient in pregnant women, one small 2009 well-designed randomized control trial found acupuncture, combined with antacids and dietary counseling, to be more effective in alleviating heartburn symptoms during pregnancy than using antacids and dietary counseling alone.

7. Don't smoke. While this should go without saying during pregnancy for a number of reasons, it also increases the likelihood of heartburn.

OTC medications may also help

If changes to your lifestyle and diet don't work, that's when doctors may recommend medication.

• Antacids: "Most antacids are considered safe in pregnancy and are compatible with breastfeeding," Sridhar says. Antacids are OTC medications like Rolaids, Tums, and Maalox. And while they may be OTC, if you're pregnant, you should consult your doctor before taking them.
• H2 blockers: If antacids don't work, a doctor may prescribe H2 blockers like Pepcid. H2 blockers can relieve heartburn because they help you produce less hydrochloric acid in your stomach, thereby preventing heartburn before it even starts.
• Proton Pump Inhibitors: If antacids and H2 blockers don't work, your doctor may prescribe proton pump inhibitors like Nexium or Prevacid.

When you should see a doctor for heartburn

Wellenstein tells Insider that heartburn is "rarely a cause for major concern in pregnancy, especially if a woman didn't have an issue with it prior to pregnancy."

However, if symptoms become more frequent or severe despite lifestyle and dietary attempts, or "if she develops nausea and vomiting due to the severity of the heartburn, she should promptly alert her doctor. And it is a medical emergency if she begins vomiting blood, since this may indicate a more serious condition related to heartburn," Wellenstein says.

Insider's takeaway

While it can be frustrating and even worrisome to experience heartburn during pregnancy, know that you're certainly not alone and most women are able to manage it with a combination of lifestyle changes and OTC medications.

And the best news is that it's short-lived. Nine months may seem long at times, but soon your heartburn will be but a distant memory as you welcome your precious little one into your life.