Heartburn in the third trimester

By trimester

Weeks 28–birth

3rd trimester

Sleep positioning matters: try sleeping on your left side with the head of your bed raised 6 to 8 inches, which often brings real relief. Eat earlier and smaller meals in the evening. If you're using antacids every day, or they're not controlling your symptoms, talk with your provider about a scheduled H2 blocker or PPI instead.

What does the evidence show for heartburn in the third trimester?

• Heartburn is one of the most common third-trimester complaints, caused by pregnancy hormones plus the growing uterus physically pushing up on the stomach. 1
• Raising the head of the bed and avoiding meals in the 2 to 3 hours before lying down are effective non-medication steps for pregnancy reflux, ACOG notes. 2
• H2 blockers like famotidine are widely used in pregnancy for reflux and have a reassuring safety profile at standard doses. 3
• Calcium-carbonate antacids are supported for on-demand use alongside stepped therapy, though it's worth tracking your total daily calcium if you're using them often. 4
• Reflux that goes beyond typical heartburn and needs medical attention includes chest pain, pain or difficulty swallowing, vomiting that won't stop, vomit that contains blood or looks like coffee grounds, black or tarry stools, and unexplained weight loss. 5
• Pain in the upper right area of the belly, especially together with a severe headache or vision changes, is a preeclampsia warning sign rather than typical reflux. 6

When should I call my provider about heartburn in the third trimester?

Call your provider the same day for chest pain, pain or difficulty swallowing, vomiting that won't stop, vomit that contains blood or looks like coffee grounds, or stool that is black and tarry: these go beyond typical third-trimester reflux and need prompt evaluation. Unexplained weight loss alongside heartburn is also worth flagging rather than assuming it's just reflux. Severe or persistent pain under your right ribs, especially together with a headache or vision changes, is a different pattern that can point to preeclampsia and calls for same-day contact with your provider. If you are ever unsure which side of the line you are on, make the call. Obstetric teams handle these check-ins as routine, not as overreacting.