Dyspepsia in pregnancy
Indigestion and heartburn in pregnancy
Indigestion – also known as dyspepsia – in pregnancy is partly caused by hormonal changes, and in later pregnancy by the growing womb pressing on your stomach.
As many as eight out of 10 women experience indigestion at some point during their pregnancy. The symptoms of indigestion can include feeling full, feeling sick or nauseous, and burping. The symptoms usually come on after eating food.
Heartburn is a strong, burning pain in the chest caused by stomach acid passing from your stomach into your oesophagus (the tube that leads from your mouth to your stomach).
You can help ease the discomfort of indigestion and heartburn by making changes to your diet and lifestyle, and there are treatments that are safe to take in pregnancy. Talk to your midwife, GP or pharmacist. You can also find out more by reading this page or clicking on the links to go directly to the relevant information.
Symptoms of indigestion
Causes of indigestion in pregnancy
Treatment for indigestion and heartburn in pregnancy
Self-help tips for indigestion and heartburn
Symptoms of indigestion in pregnancy
Symptoms of indigestion and heartburn in pregnancy are the same as for anyone else with the condition. The main symptom is pain or a feeling of discomfort in your chest or stomach. This usually happens soon after eating or drinking, but there can sometimes be a delay between eating a meal and developing indigestion.
You may experience indigestion at any point during your pregnancy, although your symptoms may be more frequent and severe during later pregnancy, from 27 weeks onwards. As well as pain, indigestion may cause:
heartburn, a burning sensation caused by acid passing from the stomach into the oesophagus
feeling uncomfortable or heavy
regurgitation (food coming back up from the stomach)
nausea (feeling sick)
vomiting (being sick)
Causes of indigestion in pregnancy
The symptoms of indigestion (dyspepsia), including heartburn, are caused by stomach acid coming into contact with the sensitive protective lining (mucosa) of your digestive system.
The stomach acid breaks down the mucosa, which causes irritation and leads to the symptoms of indigestion. When you're pregnant, you are more likely to have indigestion due to:
hormonal changes that your body is going through
your growing womb (uterus) pressing on your stomach
the relaxing of the lower oesophageal sphincter (ring of muscle) that acts like a gate between your stomach and your oesophagus, allowing stomach acid to leak back up
You may be more likely to get indigestion in pregnancy if:
you had indigestion before you were pregnant
you have been pregnant before
you are in the latter stages of pregnancy
Your GP or midwife will usually be able to diagnose indigestion or heartburn from your symptoms and by asking you some questions. For example, they might ask:
how the symptoms are affecting your day-to-day life
what your usual eating habits are
if you have tried any treatments already
if you experienced indigestion or any other stomach conditions before you were pregnant
Your GP or midwife may also examine your chest and stomach. They may press gently on different areas of your chest and stomach to see whether this is painful.
Treatments for indigestion and heartburn in pregnancy
In some cases, changes to your diet and lifestyle may be enough to control indigestion, particularly if the symptoms are mild.
If you have severe indigestion, or if changes to your diet and lifestyle don't work, your GP or midwife may suggest using medication to help ease your symptoms. Several indigestion medicines are safe to use during pregnancy. However, check with your GP, midwife or pharmacist before taking anything they have not recommended.
The types of medicines that may be prescribed for indigestion and heartburn during pregnancy are:
Antacids are a type of medicine that can provide immediate relief from indigestion. They work by neutralising the acid in your stomach (making it less acidic) so that it no longer irritates the protective lining (mucosa) of your digestive system.
Some antacids are combined with another type of medicine known as an alginate. This helps relieve indigestion caused by acid reflux. Acid reflux occurs when stomach acid leaks back up into your oesophagus and irritates its protective lining.
Alginates work by forming a foam barrier that floats on the surface of your stomach contents. This keeps stomach acid in your stomach and away from your oesophagus. In most cases, antacids and alginates can effectively control the symptoms of indigestion during pregnancy.
Choice and dosage
A number of antacids are available over-the-counter from your pharmacist without a prescription. Ask your pharmacist for advice about which ones are suitable for you.
You may only need to take antacids and alginates when you start to experience symptoms. In other cases, your GP may recommend that you take these medicines before your symptoms are expected, such as:
before a meal
It is safe to use antacids and alginates while you are pregnant as long as you do not take more than the recommended dose. Follow the instructions on the patient information leaflet that comes with the medicine to ensure that you take it correctly. Side effects from antacids are rare, but can include:
If you are prescribed an antacid medicine and you are also taking iron supplements, do not take them at the same time. Antacids can prevent iron from being properly absorbed by your body. Take your antacid at least two hours before or after your iron supplement.
If antacids and alginates do not improve your symptoms of indigestion, your GP may prescribe a different medicine that suppresses the acid in your stomach. There are two acid-suppressing medicines that are safe to use during pregnancy:
As with antacids and alginates, follow the dosage instructions on the patient information leaflet or packet.
Ranitidine is usually prescribed as tablets to be taken twice a day. Follow the dosage instructions, as your medicine may not work if you only take it when you have symptoms. Ranitidine rarely causes any side effects.
Omeprazole is usually prescribed as a tablet to take once a day. After five days, your symptoms should have improved. If not, your dose may need to be increased. In some cases, omeprazole may cause side effects such as:
Self-help tips for indigestion in pregnancy
You may not need medicine to control your symptoms. Your GP or midwife may suggest some of the following changes to your diet and lifestyle. In many cases, these changes can be enough to ease your symptoms.
Stop smoking to banish indigestion
Smoking when you're pregnant can cause indigestion and seriously affect your health, as well as the health of your unborn baby. Smoking increases the risk of:
your baby being born prematurely (before week 37 of your pregnancy)
your baby being born with a low birth weight
cot death, or sudden infant death syndrome (SIDS)
When you smoke, the chemicals you inhale can contribute to your indigestion. These chemicals can cause the ring of muscle at the lower end of your oesophagus to relax. This allows stomach acid to leak back up into your oesophagus more easily (known as acid reflux).
If you smoke, quitting is the best thing that you can do for your own and your baby's health. You can speak to your GP or midwife for more information, or you can call the Smokefree Helpline, which offers support and encouragement to help you quit smoking.
Avoid alcohol to ease indigestion
Drinking alcohol can contribute to the symptoms of indigestion. During pregnancy, it can also put your unborn baby at risk of developing serious birth defects.
The Department of Health recommends that all pregnant women avoid drinking alcohol completely during pregnancy. It advises that if you do choose to drink while you're pregnant, to minimise risks to your baby you should not drink more than 1-2 units of alcohol once or twice a week, and should not get drunk.
The National Institute for Health and Care Excellence (NICE) recommends that pregnant women and women planning to become pregnant should avoid drinking alcohol in the first three months of pregnancy because there may be an increased risk of miscarriage.
One UK unit is 10ml (or eight grams) of pure alcohol. This is equal to:
half a pint of beer, lager or cider at 3.5% alcohol by volume (ABV: you can find this on the label)
a single measure (25ml) of spirit, such as whisky, gin, rum or vodka, at 40% ABV
half a standard (175ml) glass of wine at 11.5% ABV
You can find out how many units there are in different types and brands of drinks with the Drinkaware unit calculator.
If you have difficulty cutting down what you drink, talk to your midwife, doctor or pharmacist. Confidential help and support is available from local counselling services (look in the telephone directory or contact Drinkline on 0300 123 1110).
Eat healthily to avoid indigestion
You are more likely to get indigestion if you are very full, so regularly eating large amounts of food may make your symptoms worse. If you are pregnant, it can be tempting to eat more than you would normally, but this may not be good for you or your baby. You don't need to "eat for two".
During pregnancy you do not need to go on a special diet, but it is important to eat a variety of different foods every day to get the right balance of nutrients that you and your baby need.
Change your eating habits
In some cases, you may be able to control your indigestion by making changes to the way you eat. For example:
it may help to eat smaller meals more frequently, rather than larger meals three times a day
avoid eating within three hours of going to bed at night
sit up straight when you eat because this will take the pressure off your stomach
Drinking a glass of milk may relieve heartburn (the burning sensation from stomach acid leaking up into your oesophagus). You may want to keep a glass of milk beside your bed in case you wake up with heartburn in the night.
Avoid indigestion triggers
You may find that your indigestion is made worse by certain triggers, such as:
drinking fruit juice
Make a note of any particular food, drink or activity that seems to make your indigestion worse and avoid them if possible. This may mean:
eating less rich, spicy and fatty foods
cutting down on drinks that contain caffeine, such as tea, coffee and cola (find out more about caffeine and pregnancy)
Prop your head up
When you go to bed, use a couple of pillows to prop your head and shoulders up, or raise the head of your bed by a few inches by putting something underneath the mattress.
The slight slope should help prevent stomach acid from moving up into your oesophagus while you sleep.
Speak to your GP if you are taking medication for another condition, such as antidepressants or non-steroidal anti-inflammatory drugs (NSAIDs), and you think it may be contributing to your indigestion. Your GP may be able to prescribe an alternative medicine.
Never stop taking a prescribed medication unless you are advised to do so by your GP or another qualified healthcare professional who is responsible for your care.
Page last reviewed: 05/11/2014
Next review due: 05/11/2016
Dyspepsia in pregnancy