Which of the following is one of the recommendation to treat pregnancy associated heartburn?

More than half of pregnant women get serious heartburn, particularly during their second and third trimesters. Heartburn, also called acid indigestion, is an irritation or burning sensation of the esophagus (the tube that carries food and liquid to your stomach when you swallow). It’s caused by stomach contents that reflux (come back up).

Symptoms of Heartburn During Pregnancy

If you have heartburn while you’re pregnant, you may:

• Feel burning or pain in your chest or throat, especially after you eat
• Have sensations of fullness, heaviness, or bloating
• Burp or belch
• Have a sour or bitter taste in your mouth
• Cough or have sore throat

Causes of Heartburn During Pregnancy

Heartburn in pregnancy may happen because of changing hormone levels, which can affect the muscles of the digestive tract. 

Pregnancy hormones can cause your lower esophageal sphincter (the muscular valve between the stomach and esophagus) to relax, allowing stomach acids to flow back up into your esophagus. Also, as your baby grows, your enlarged uterus can crowd the abdomen, pushing stomach acids upward. Although it's rare, gallstones can also cause heartburn during pregnancy.

Prevention of Heartburn During Pregnancy

Some tips that may help you cut down on heartburn during your pregnancy include:

• Eat several small meals each day instead of three large ones.
• Eat slowly.
• Avoid fried, spicy, or rich (fatty) foods or any foods that seem to cause relaxation of the lower esophageal sphincter and increase the risk of heartburn.
• Don’t smoke tobacco or drink alcohol, which can make heartburn symptoms worse.
• Drink less while eating. Drinking large amounts while eating may increase the risk of acid reflux and heartburn.
• Don't lie down directly after eating.
• Keep the head of your bed higher than the foot of your bed. Or place pillows under your shoulders to help prevent stomach acids from rising into your esophagus.
• Wear loose-fitting clothing. Tight-fitting clothes can increase the pressure on your stomach and abdomen.
• Try to avoid constipation.

Treatment of Heartburn During Pregnancy

If your heartburn won’t go away, see your doctor. They may prescribe or recommend OTC medications that are safe to take during pregnancy. Heartburn usually disappears following childbirth.

Medications may include:

Over-the-counter antacids such as calcium carbonate or magnesium hydroxide. These are generally safe to use during pregnancy. You may find that liquid heartburn relievers are more effective in treating heartburn, because they coat the esophagus.

H2 blockers. These medications block chemical signals that produce stomach acid. They include cimetidine (Tagamet) and famotidine (Pepcid, Zantac 360), and they’re available in over the counter and prescription strengths.

Proton pump inhibitors (PPIs). Like H2 blockers, these drugs help cut down on stomach acid. PPIs, which include lansoprazole (Prevacid) and omeprazole (Prilosec), are available over the counter and by prescription.

If you take iron supplements, talk to your doctor before you take a PPI or H2 blocker. These medications can make the supplements less effective.

Heartburn Medication to Avoid During Pregnancy

Talk to your doctor before taking any antacids. Some contain ingredients that may harm you or your baby. Be sure to not to take these medications:

Ranitidine. In 2020, the FDA stopped sales of an H2 blocker called ranitidine (the ingredient in older Zantac products) because it was contaminated with a cancer-causing agent. If you take OTC ranitidine, stop your use. If you have a prescription for ranitidine, talk to your doctor about other options before you stop your medication.

Despite its name, heartburn has nothing to do with the heart. (Some of the symptoms, however, are similar to those of a heart attack or heart disease.) Heartburn is an irritation of the esophagus that is caused by stomach acid and is a common pregnancy complaint, especially in the third trimester when the growing uterus places pressure on the stomach.

With gravity's help, a muscular valve called the lower esophageal sphincter, or LES, keeps stomach acid in the stomach. The LES is located where the esophagus meets the stomach -- below the rib cage and slightly left of center. Normally it opens to allow food into the stomach or to permit belching; then it closes again. But if the LES opens too often or does not close tight enough, stomach acid can reflux, or seep, back into the esophagus and cause a burning sensation.

Occasional heartburn isn't dangerous, but chronic heartburn can indicate serious problems, such as gastritis or gastroesophageal reflux disease, also called GERD. Heartburn is a daily occurrence for 10% of Americans and 50% of pregnant women. It's an occasional nuisance for another 30% of the population.

If you didn't have heartburn before you were pregnant, it will probably go away when your baby is born.

Symptoms of Heartburn During Pregnancy

Common heartburn symptoms reported by pregnant women include:

• A burning feeling in the chest just behind the breastbone (the sternum) that occurs after eating and lasts a few minutes to several hours
• Chest pain, especially after bending over, lying down, or eating
• Burning in the throat -- or hot, sour, or salty-tasting fluid at the back of the throat
• Belching
• Chronic coughing
• Hoarseness
• Wheezing or other asthma-like symptoms

Prevention and Treatment of Heartburn During Pregnancy

To ease heartburn during pregnancy without medications, you should try the following:

• Eat several small meals each day instead of three large ones.
• Avoid fatty, fried, spicy, or rich foods.
• Avoid chocolate, coffee, caffeine, and mint.
• Drink less fluid while eating. Drinking large amounts while eating may increase the risk of acid reflux and heartburn.
• Don't lie down right after eating.
• Keep the head of your bed higher than the foot of your bed.
• Wear loose-fitting clothing. Tight-fitting clothes can increase the pressure on your stomach and abdomen.
• Try to sleep on your left side. Your stomach is on the left, so it's harder for acids to get into the esophagus at this angle.
• Chew a piece of gum. This creates more saliva with bicarbonate, which neutralizes the acid in the esophagus when swallowed.

If your heartburn persists, see your doctor. They may recommend over-the-counter antacids or prescribe drugs that are safe to take during pregnancy. Pregnancy-related heartburn usually disappears after childbirth.

When to Call Your Doctor

Reach out to your doctor if you:

• Want to take an antacid. Some are not recommended during pregnancy
• Have severe hoarseness, wheezing, vomiting, or a hard time swallowing
• Have trouble sleeping because of heartburn