Heartburn during pregnancy

By trimester

Weeks 1–13

1st trimester

Heartburn can start early, as progesterone rises in the first trimester. Small, frequent meals and steering clear of trigger foods, like anything highly acidic, high-fat, or heavily spiced, often keep flares from happening.

Weeks 14–27

2nd trimester

Symptoms typically stick around and can get stronger as the uterus expands. Antacids like calcium carbonate can be added at provider-directed doses.

Weeks 28–birth

3rd trimester

This is when heartburn is usually at its worst. Sleeping with the head of the bed raised 6 to 8 inches, avoiding food for 2 to 3 hours before lying down, and stepping up medication under your provider's direction are the standard next steps.

What does the evidence show for heartburn?

• Small meals, staying upright after eating, and avoiding trigger foods are the first-line approach to pregnancy heartburn, which is driven by hormonal and mechanical changes in the body. 1
• Over-the-counter calcium-carbonate antacids are generally considered fine in pregnancy at standard doses, as long as you keep an eye on your total daily calcium intake. 2
• Famotidine (Pepcid) is a commonly used reflux medication in pregnancy with a reassuring safety record at standard doses. 3
• Proton-pump inhibitors like omeprazole or pantoprazole are a stepped-up option when antacids and H2 blockers aren't enough. 4
• Heartburn accompanied by gastrointestinal blood loss, persistent vomiting, difficulty swallowing, chest pain, or involuntary weight loss counts as an alarm symptom that may need further investigation beyond standard reflux management. 5

When should I call my provider about heartburn?

Reflux paired with difficulty or pain swallowing, signs of gastrointestinal bleeding, ongoing vomiting that will not let up, chest pain, or losing weight without trying goes beyond typical pregnancy heartburn and is worth a same-day call rather than another round of antacids. These are the alarm symptoms that call for your provider to look at the cause directly, rather than managing it as ordinary reflux. None of these signs are common, but they are specific enough to act on quickly when they show up. Whatever the pattern, any symptom that feels beyond your usual range is a reason to call: obstetric teams expect these questions and would rather hear early than late.