Heartburn
HEARTBURN & GERD (Gastroesophageal Reflux Disease)
Defined: Gastroesophageal reflux (GERD, or heartburn) is reported by 40-85% of women during pregnancy and although it can be caused by many things-hormone changes play the largest role. Heartburn can show up at any point within 9 months, but symptoms worsen as baby grows, since the stomach is displaced by your growing uterus. To complicate matters more, protein needs increase from the 1st into the 2nd and 3rd trimester, and a protein rich meal alters lower esophageal sphincter tone-so the more protein you eat (and need to eat!) the worse your heartburn can be. Increased gastric pressure, caused by slowed stomach emptying as well as compression from your pregnant uterus, along with reduced resting muscle tone of the lower esophageal sphincter, sets the stage for GERD in pregnancy. In pregnancy, the rise in progesterone leads to delayed gastric emptying and prolonged small bowel transit time, by ~30–50%. This equates to an increase from about 1.5-2 hours up to 3-4 hours until gastric emptying, which can feel really uncomfortable and increase the prevalence of heartburn.
Standard of Care: Avoid dietary triggers like caffeine, alcohol, fatty foods, spicy foods, chocolate, carbonated beverages and peppermint. Antacids are used in the setting of mild GERD. Antacids begin to provide relief of heartburn within five minutes, but have a short duration of effect of 30-60 minutes. Antacids containing sodium bicarbonate and magnesium trisilicate should be avoided in pregnancy. Histamine 2 receptor antagonists (H2Ras) are in the FDA pregnancy category of B – safe to use.
GrowBaby Care
→ Remove the triggers or assess frequency of dietary intake
Gluten
Dairy
Sugar
Spicy
Caffeine (even if only 200 mg)
→ Add the healing
More veggies (colorful-like a rainbow!)
More fruit (skin on, seeds in)
Alkaline food and fluids (spices and herbs, olive oil, citrus, dark leafy greens)
Mucilaginous foods (flaxseeds, chia seeds, figs, nopal or cactus, plantain, okra, seaweed)
Foods high in digestive enzymes (papaya, mango, pineapple, ginger, honey)
Address adequate clear fluid intake (1/2 your growing body weight (lbs) in fluid ounces daily)
→ Nutrients
Protein is a crucial part of a healthy pregnancy. Focus on this macronutrient is particularly important in the 2nd and 3rd trimester when heartburn hits. Emphasize plant-based protein like nuts and seeds, lentils, or yogurt. Animal based protein is a dense source of protein, but eating too much at one time can be uncomfortable and hard for your stomach to breakdown quickly. Eat small meals frequently to decrease the feeling of being over-full.
GrowBaby Heartburn Smoothie (O/Veg/V)
By Emily Rydbom, CN, BCHN, CNP
½ cup coconut milk from a can
1 cup of coconut water
½ cup+ of water
2 tsp of apple cider vinegar
½ cup pineapple (frozen)
½ cup papaya (frozen)
½ lime squeezed in
Blend!
Science Corner - Why Heartburn or GERD matters for long-term health, diagnoses & birth outcomes
Associations to consider – prolonged exposure to acid reflux causes negative cellular changes in the esophagus, and exposure to H2 blockers and PPIs impairs absorption of B12, Folic acid, Vitamin D, iron, calcium, and zinc
Risk factors to consider – obesity
Sources
Cappell M., Garcia A. (1998). Gastric and duodenal ulcers during pregnancy. Gastroenterol. Clin. North Am. 27 169–195 10.1016/S0889-8553(05)70352-6
Costantine MM. Physiologic and pharmacokinetic changes in pregnancy. Front Pharmacol. 2014;5:65. Published 2014 Apr 3. doi:10.3389/fphar.2014.00065
DeValle, James B, Consequences of Cardiovascular Drug-Induced Nutrient Depletion, Chapter 16, p 369-404 in Sinatra, Stephen T, Houston, Mark C, Nutritional and Integrative Strategies in Cardiovascular Medicine, CRC Press, Boca Raton, FL 2015