Heartburn

Heartburn in pregnancy is one of the most common discomforts of the second and third trimesters, affecting a large share of pregnant people — by some estimates more than half by the final weeks, with rates climbing as the due date nears. It's a burning feeling behind the breastbone, sometimes rising into the throat, and despite the name it has nothing to do with the heart. It's almost always benign, it tends to resolve after delivery, and a layered set of food, posture, and (when needed) medication strategies usually brings real relief. This guide reflects mainstream obstetric guidance and covers what's happening, what helps, and the less common situations where that burning sensation deserves a call to your provider.

Why pregnancy causes it

Heartburn (acid reflux) happens when stomach acid flows back up into the esophagus, the tube connecting your mouth to your stomach. Pregnancy makes this far more likely for two reasons. First, rising progesterone relaxes smooth muscle throughout the body — including the valve (the lower esophageal sphincter) that normally keeps acid down — so it doesn't seal as tightly. Second, as your uterus grows, it crowds the stomach and increases pressure that can push acid upward. That's why heartburn often starts or worsens in the second and third trimesters and tends to be at its most stubborn in the final weeks before delivery.

Signs and symptoms

The classic symptom is a burning sensation behind the breastbone, often after eating or when lying down, that may travel up toward the throat. Other common signs include a sour or bitter taste in the mouth, regurgitation of food or liquid, burping, bloating, nausea, a feeling of fullness, or a persistent cough or hoarseness. Symptoms frequently flare in the evening, at night, or after large or spicy meals. The intensity varies widely from person to person and from day to day — some feel only occasional twinges, others a near-constant burn.

Caring for it at home

Start with eating patterns: eat smaller, more frequent meals rather than three large ones, eat slowly, and stop while you're comfortably full rather than stuffed. Avoid common triggers — fried and fatty foods, spicy dishes, citrus and tomato-based foods, chocolate, caffeine, and carbonated drinks — though triggers are individual, so note your own. Don't lie down right after eating; finish your last meal or snack about 2 to 3 hours before bed, and sip fluids between meals rather than gulping them with food. At night, raise the head of the bed by about 6 inches using blocks or a wedge under the mattress (not just pillows under your head), and wear loose clothing around the waist. If lifestyle steps aren't enough, several over-the-counter options — calcium- or magnesium-based antacids for quick relief, and certain acid reducers for more persistent symptoms — are generally considered compatible with pregnancy. Avoid antacids containing sodium bicarbonate or magnesium trisilicate, and talk to your obstetric provider or pharmacist before starting or regularly using any medication.

When to call your provider

Routine heartburn doesn't need a visit, but reach out if symptoms are severe, frequent, or not controlled by lifestyle changes and over-the-counter remedies, if you're losing weight, vomiting persistently, having trouble or pain swallowing, vomiting blood or material that looks like coffee grounds, or passing black, tarry stools. Seek urgent care for chest pain or pressure — especially if it spreads to the arm, jaw, neck, or back, or comes with shortness of breath, sweating, or lightheadedness — since heart problems can mimic heartburn and need to be ruled out. One pregnancy-specific red flag deserves special attention: upper-right or upper-middle belly pain or new, intense pain under the ribs, particularly with a severe headache, vision changes, or sudden swelling of the face or hands, can be a sign of preeclampsia rather than reflux and should be evaluated promptly. The bottom line: pregnancy heartburn is common, usually harmless, and manageable with smaller meals, trigger avoidance, staying upright after eating, head-of-bed elevation, and provider-approved remedies, and it typically eases soon after delivery — but treat severe or worsening symptoms, anything that mimics heart trouble, or signs that point toward preeclampsia as reasons to check in promptly rather than wait. When in doubt, it's always reasonable to call your obstetric provider.