Heartburn during pregnancy isn’t just annoying-it’s common. Up to 80% of pregnant people experience it, especially in the second and third trimesters. Your stomach is getting squeezed, hormones are relaxing the valve between your esophagus and stomach, and acid is backing up where it shouldn’t be. It’s not a sign you’re doing anything wrong. But when it hits hard, you start looking for relief-and that’s where things get tricky. Not all heartburn meds are safe during pregnancy. Some can wait. Others? You need to know exactly when and how to use them.
First-Line Defense: Antacids Like Tums
If you’re only just starting to feel the burn, start with antacids. They’re the first thing most doctors recommend. Calcium carbonate, the main ingredient in Tums, works fast. It neutralizes stomach acid right where it is, giving you relief in minutes. And here’s the bonus: you’re not just treating heartburn-you’re also giving your body extra calcium. Your baby needs calcium to build bones, and your body pulls it from your own stores if you don’t get enough. Tums helps both.
Other safe antacids include Rolaids and Mylanta. These usually combine calcium carbonate with magnesium hydroxide. Magnesium helps balance out the constipation that calcium can cause. But watch out for antacids that contain aluminum or magnesium trisilicate. They’re not recommended during pregnancy. Aluminum can build up in your system, and trisilicate has unclear safety data.
How much is too much? Stick to the label: 500-1500 mg of calcium carbonate every 4 to 6 hours as needed. Don’t go over 7,500 mg in a day. Long-term, high-dose use can lead to kidney stones or electrolyte imbalances. And if you’re already taking iron supplements, take antacids at least two hours apart-they can block iron absorption.
When Antacids Aren’t Enough: H2 Blockers
If you’re still burning after a few days of antacids, it’s time to think about H2 blockers. These don’t neutralize acid-they reduce how much your stomach makes. The most commonly used and safest option is famotidine, sold as Pepcid. It starts working in about an hour and lasts up to 12 hours. That means you can take it once at night and sleep through the burn.
Don’t use ranitidine (Zantac). It was pulled from the U.S. market in 2020 because of a cancer-causing contaminant called NDMA. Even if you find it on a shelf somewhere, don’t take it. Famotidine is the new standard.
Other H2 blockers like cimetidine (Tagamet) are also considered safe in pregnancy, but famotidine is preferred because it has more data backing it up. Side effects are rare but can include headaches or dizziness in about 3-5% of users. If you feel off after taking it, talk to your provider. It’s not dangerous, but you should still be monitored.
For Persistent Heartburn: PPIs Like Omeprazole
If you’ve tried antacids and H2 blockers and you’re still struggling-especially if you’re waking up at night with burning or have trouble swallowing-your doctor might suggest a proton pump inhibitor (PPI). Omeprazole (Prilosec) is the most studied PPI in pregnancy. It’s powerful. It shuts down acid production at the source, and its effects last over 24 hours.
Other PPIs like lansoprazole (Prevacid) and pantoprazole (Protonix) are also used, but omeprazole has the most safety data. That doesn’t mean it’s risk-free. A 2019 study in JAMA Pediatrics found a possible link between first-trimester PPI use and childhood asthma, but it didn’t prove cause and effect. Still, doctors are cautious. PPIs are not first or second-line. They’re third-line. Only if you’ve tried everything else and you’re suffering.
Long-term PPI use during pregnancy might affect how well your body absorbs calcium and magnesium. That’s why your provider will monitor you and likely recommend a prenatal vitamin with extra calcium. They’ll also want to make sure you’re not taking it longer than needed.
What to Avoid Completely
Some heartburn remedies are off-limits during pregnancy. Pepto-Bismol? Don’t touch it. It contains bismuth subsalicylate, which turns into aspirin in your body. Aspirin during pregnancy can cause bleeding problems, low birth weight, or even premature labor. Same goes for any product with salicylates.
Also skip any medication that says “for indigestion” but doesn’t list its ingredients. If you’re unsure, don’t guess. Call your provider or pharmacist. And remember: just because something is sold over the counter doesn’t mean it’s safe for you right now.
Timing Matters: First Trimester Caution
The first 14 weeks of pregnancy are the most sensitive. That’s when your baby’s organs are forming. Even safe medications should be avoided if possible during this time. If your heartburn is mild, stick to lifestyle changes. Eat smaller meals. Don’t lie down for three hours after eating. Avoid spicy, fatty, or acidic foods like citrus, coffee, or chocolate. Sleep with your head slightly elevated. These aren’t just tips-they’re proven ways to reduce symptoms without any medication.
If you’re in your second or third trimester and you need help, the options open up. That’s when antacids, H2 blockers, and even PPIs become reasonable choices under medical supervision. But even then, the goal is to use the least amount for the shortest time.
When to Call Your Provider
Heartburn is normal. Pain that won’t quit? Not always. If you’re having trouble swallowing, vomiting blood, losing weight without trying, or feeling chest pain that radiates to your arm or jaw-get checked. These aren’t typical heartburn signs. They could point to something more serious like a hiatal hernia, GERD complications, or even heart issues.
Also, if you’ve been using antacids daily for more than two weeks and you’re not getting relief, talk to your doctor. You might need a different approach. Or you might need testing. Don’t keep pushing through discomfort thinking it’s just “pregnancy stuff.”
Non-Medication Strategies That Actually Work
Medications help, but they’re not the whole story. Many women find that changing how they eat and live makes the biggest difference.
- Eat five or six small meals instead of three big ones.
- Wait at least three hours after eating before lying down or going to bed.
- Wear loose clothes. Tight waistbands put pressure on your stomach.
- Stay upright after meals. Don’t slouch.
- Drink fluids between meals, not during. Too much liquid during meals can overfill your stomach.
- Try chewing gum after meals. It increases saliva, which helps neutralize acid.
- Keep a food diary. What triggers your heartburn? It’s often different for everyone.
These steps don’t require a prescription. But they can cut your need for meds by half-or more.
Final Thought: It’s Personal
There’s no one-size-fits-all answer. What works for your friend might not work for you. Your body, your pregnancy, your history-all of it matters. That’s why talking to your provider before taking anything is non-negotiable. Even something as simple as Tums should be discussed if you have kidney issues, high blood pressure, or are on other medications.
The goal isn’t to eliminate heartburn completely. It’s to manage it safely so you can rest, eat, and feel like yourself again. You’re not alone in this. Millions of people have been here. And with the right info, you can get through it without putting your baby at risk.