Indigestion (dyspepsia) in pregnancy
Introduction
Indigestion, also known as dyspepsia, is pain or discomfort in the upper abdomen (tummy).
If you have indigestion, you may experience a number of symptoms, including:
- heartburn, a burning sensation that is caused by acid passing from the stomach into the oesophagus (gullet)
- regurgitation (food coming back up from the stomach)
- bloating
- nausea (feeling sick)
- vomiting (being sick)
How common is indigestion in pregnancy?
Most people are affected by indigestion from time to time, but women are often affected by it while they are pregnant. As many as 8 out of 10 women experience indigestion at some point during their pregnancy. Indigestion tends to become more common as the baby develops.
Indigestion during pregnancy is mainly due to changes that occur in the body, such as rising levels of hormones and increased pressure on the abdomen (tummy).
These changes can often result in acid reflux, the most common cause of indigestion. Acid reflux occurs when stomach acid flows back up from the stomach into the oesophagus (gullet) and irritates the lining (mucosa).
Outlook
A number of lifestyle changes may help improve the symptoms of indigestion, such as eating smaller meals or cutting out certain foods. There are also medicines, such as antacids, that can be taken safely during pregnancy to treat indigestion.
Some women may find that their indigestion gets worse as their pregnancy progresses. However, in most cases, after giving birth, the symptoms disappear. Indigestion during pregnancy rarely causes complications.
^^ Back to top
Symptoms
If you are pregnant, your symptoms of indigestion (dyspepsia) will be the same as those of anyone else.
The main symptom is pain, or a feeling of discomfort, in your chest, or stomach. This usually comes on 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 your third trimester (weeks 27-40).
As well as pain, indigestion may cause:
- a burning sensation
- feeling uncomfortably full or heavy
- belching (burping)
- regurgitation (food coming back up from the stomach)
- bloating
- nausea (feeling sick)
- vomiting (being sick)
^^ Back to top
Causes
The symptoms of indigestion (dyspepsia) are caused by stomach acid coming into contact with the sensitive, protective lining (mucosa) of your digestive system.
Your stomach acid breaks down the mucosa, causing irritation. This brings on the symptoms of indigestion.
When you are pregnant, you are more likely to have indigestion due to:
- hormonal changes that your body is going though
- your growing uterus (womb) 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 (gullet), allowing stomach acid to leak back up
Risk factors
You may be more likely to get indigestion during pregnancy if:
- you experienced indigestion before you were pregnant
- you have been pregnant before
- you are in the latter stages of your pregnancy
^^ Back to top
Diagnosis
If you are pregnant, you should always see your GP or midwife if you experience indigestion (dyspepsia) that is severe or recurring.
Your GP will usually be able to diagnose indigestion from your symptoms and by asking you a number of questions. For example, they may 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.
^^ Back to top
Treatment
In some cases, changes to your diet and lifestyle may be enough to control your indigestion (dyspepsia), especially if your symptoms are mild. See the 'self help' section for more information on controlling indigestion without medicine.
However, if your indigestion is more severe, your GP or midwife may suggest or prescribe something to ease your symptoms.
Medicines for indigestion during pregnancy
There are several indigestion medicines that are safe to use during pregnancy, although you should always check with your GP, midwife or pharmacist before taking anything that they have not recommended. The types of medicine you may be prescribed are detailed below.
Antacids
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.
See the Encyclopaedia A-Z topic about Antacid medicines for more information about this type of medicine.
Alginates
Some antacids are combined with another medicine called an alginate. This helps to relieve indigestion caused by acid reflux. Acid reflux occurs when stomach acid leaks back up into your oesophagus (gullet) and irritates its protective lining (mucosa).
Alginates work by forming a foam barrier that floats on the surface of your stomach contents, keeping 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 (OTC) 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:
It is safe to use antacids and alginates while you are pregnant, as long as you do not take more than the recommended dosage. 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:
- diarrhoea (passing loose, watery stools)
- constipation (an inability to empty your bowels)
If you experience side effects, ask your GP or pharmacist about trying a different medicine.
Iron supplements
If you are prescribed an antacid and you are also taking iron supplements, you should not take them at the same time. This is because antacids can prevent iron from being properly absorbed by your body. You should make sure that you take your antacid at least two hours before or after you take your iron supplement.
Acid-suppressing medicines
If antacids and alginates do not improve your symptoms of indigestion, you may be prescribed a different medicine that works by suppressing the acid in your stomach.
There are two acid-suppressing medicines that are safe to use during pregnancy. They are called ranitidine and omeprazole. As with antacids and alginates, you should always follow the dosage instructions on the packet of your medicine.
Ranitidine
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
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:
- headaches
- diarrhoea
- nausea
- vomiting
Referral
If the medicines you are prescribed are not effective, your GP or midwife may refer you to a gastroenterologist (a doctor who specialises in treating conditions that affect the digestive system).
You may also be referred for specialist treatment if your GP or midwife thinks that your indigestion may be caused by an underlying condition, such as irritable bowel syndrome (a long-term condition that affects the digestive system).
^^ Back to top
Self Care
If you have indigestion (dyspepsia) while you are pregnant, you may not need medicine to control your symptoms.
Your GP or midwife may suggest some of the following simple changes to your diet and lifestyle. In many cases, these changes are enough to ease the symptoms of indigestion during pregnancy.
Stop smoking
Smoking while pregnant can cause indigestion and seriously affect your health and that of your unborn baby. Smoking during pregnancy increases the risk of:
- your baby being born prematurely (before week 37 of the pregnancy)
- your baby being born with a low birth weight
- cot death
When you smoke, the chemicals you inhale can contribute to your indigestion. These chemicals can cause the lower oesophageal sphincter (ring of muscle) that separates your oesophagus (gullet) from your stomach to relax. This allows stomach acid to leak back up into your gullet more easily (acid reflux).
If you smoke, giving up is the best thing that you can do for your own and your baby's health. See the Health A-Z topic about Quitting smoking for more information and advice, or speak to your GP, midwife or pharmacist.
If you want to give up smoking a good first step is to contact Smokers Helpline Wales on 0800 169 0 169 and Stop Smoking Wales on 0800 085 2219. Stop Smoking Wales hold details of local support services. These services offer the most effective support for people who want to give up smoking. Studies show you are four times more likely to give up smoking successfully if you do it with the help of the NHS.
Alternatively, your GP can provide help and advice about quitting.
Avoid alcohol
Drinking alcohol can contribute to the symptoms of indigestion. If you are pregnant, 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 altogether. However, if you choose to drink while you are pregnant, do not drink more than 1-2 units of alcohol once or twice a week, and avoid getting drunk.
One unit of alcohol is approximately half a pint of normal strength lager, cider or bitter, a pub measure (25ml) of spirits or a 50ml pub measure of fortified wine, such as sherry or port.
Eat healthily
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 much more than you would normally, but this may not be good for either you or your baby.
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 in order to get the right balance of nutrients that you and your baby need.
See the Pregnancy Book for more information about what you should be eating during your pregnancy.
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 gullet). You may want to keep a glass of milk beside your bed in case you wake up with heartburn in the night.
Avoid triggers
You may find that your indigestion is made worse by certain triggers, such as:
- drinking fruit juice
- eating chocolate
- bending over
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
Medicines
Speak to your GP if you are taking medication for another condition, such as antidepressants or non-steroidal anti-inflammatory medicines (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.
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 (gullet) while you are asleep.
^^ Back to top