Ulcer and Heartburn in Pregnancy

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Note: The Pregistry website includes expert reports on more than 2000 medications, 300 diseases, and 150 common exposures during pregnancy and lactation. For the topic Stomach and Duodenal Ulcers and Erosive Esophagitis, go here. For the topic Heartburn, go here. For the topic Helicobacter Pylori Infection, go here. These expert reports are free of charge and can be saved and shared.

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Heartburn is more common during pregnancy. Ulcer disease is less common. Heartburn is caused by stomach acid seeping up out of your stomach into your esophagus. Your stomach has a thick mucous coating to protect your stomach lining from acid. Your esophagus does not. When stomach acid gets into your esophagus, you get heartburn.

An ulcer is more serious than heartburn, although the symptoms can be similar. An ulcer is an open sore caused by stomach acids that get through the mucosal barrier. An ulcer can form in your stomach, called a gastric ulcer, or more commonly in the first part of your upper intestine, called a duodenal ulcer. Together, gastric and duodenal ulcers are called peptic ulcers. More rarely ulcer sores can form in the esophagus, called erosive esophagitis.

Why Heartburn Is Frequent During Pregnancy

Stomach acid seeping up into your esophagus is called gastroesophageal reflux. During pregnancy, reflux is more common because pregnancy hormones slow down your digestive system and relax the valve that normally keeps acid in your stomach. Add to this the growing baby in your belly pushing up against your stomach and you can understand why heartburn is a common problem for pregnant women. In fact, up to 80 percent of women complain of heartburn.

Why Ulcers Are Less Common During Pregnancy

 It was once believed that ulcers were caused by stress and diet. Today we know that most ulcers are caused by over-the-counter medicines called NSAIDs or a bacterial infection of the stomach caused by the bacteria Helicobacter pylori (H. pylori). Both of these interfere with the mucosal barrier and allow stomach acid to create an ulcer in the lining of the esophagus, stomach, or duodenum.

Pregnancy does not change H. pylori or NSAIDs from weakening the mucosal barrier, but it does another very important thing. It decreases stomach acid. In fact, you have enough acid reduction to make ulcer disease almost non-existent during pregnancy. Studies show that ulcers occur in less than one-tenth of one percent of pregnant women. Even if you had an ulcer before pregnancy, your ulcer will probably get better.

NSAIDs and H. pylori During Pregnancy

NSAIDs are nonsteroidal anti-inflammatory drugs. They are commonly used OTC for pain and swelling. You know these drugs by common brand names Advil, Motrin, or Aleve. Aspirin is also an NSAID. In any case, NSAIDs are generally considered unsafe during pregnancy, so they should not be a cause of ulcer disease for you.

There is a good chance you already have H. pylori in your stomach. About half of all pregnant women may have these bacteria, probably since childhood. In most people they never get active and cause an ulcer. There is little evidence that you need to worry about H pylori causing an ulcer during pregnancy. Even if you are diagnosed with H. pylori, most doctors will wait to treat this infection until after pregnancy and after breastfeeding.

What if You Have Bad Heartburn During Pregnancy

The main symptoms of ulcer disease or reflux is heartburn. If you have an ulcer you may have a gnawing pain under your breast bone. You may also have an acid taste in the back of your throat, acid burps, or nausea.

Always let your obstetric care provider know about these symptoms. Although foods do not cause or cure ulcers or reflux, if you have an irritated or ulcerated surface, some foods or drinks will burn, which is not surprising. Here are the treatments for heartburn or ulcer symptoms:

  • Eat smaller meals more frequently.
  • Don’t eat anything during the three hours before bedtime. Don’t lie down after eating.
  • Avoid foods and drinks that make your symptoms worse. Common culprits include acidic, spicy, and fatty foods. Drinks include acidic juices, coffee and alcohol (which you should avoid at all costs during pregnancy).
  • Elevate the head of your bed 6 to 8 inches by putting blocks under the top of your bed or by using a wedge under your mattress.
  • If you need medications, OTC antacids are the safest, since they are not absorbed.
  • If antacids don’t help, ask your doctor about an H2 receptor blocker. These are effective and generally considered safe in pregnancy. OTC brand names include Zantac, Pepcid, and Axid.
  • If nothing else is helping, the most effective acid blocking medications are proton pump inhibitors (PPIs). These medications are probably safe during pregnancy, but they are newer than other drugs, so there is less safety information. OTC brand names are Prevacid, Prilosec, Protonix, and Nexium. The best safety information is for Prevacid. Ask your doctor if one of these would be safe for you.

Bottom Line on Ulcers and Pregnancy

Although heartburn is common during pregnancy, ulcer disease is extremely uncommon. In the rare event that you do have an ulcer during pregnancy, treatment would be avoiding NSAIDs and going through the same treatments as you would for heartburn. If you have an ulcer caused by H. pylori, your doctor will probably delay treatment until after pregnancy and breast feeding.

Christopher Iliades
Dr. Chris Iliades is a medical doctor with 20 years of experience in clinical medicine and clinical research. Chris has been a full time medical writer and journalist since 2004. His byline appears in over 1,000 articles online including EverydayHealth, The Clinical Advisor, and Healthgrades. He has also written for print media including Cruising World Magazine, MD News, and The Johns Hopkins Children's Center Magazine. Chris lives with his wife and close to his three children and four grandchildren in the Boston area.

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