Reflux in Pregnancy

One of the most common complaints I hear from women in my prenatal yoga classes is acid reflux or heartburn.

It is estimated that 30-50% of women will experience reflux or GERD (gastroesophageal reflux disease) during pregnancy.¹ And many of them will have never experienced it before. Some will present with the trademark burning sensation while others may not have any burning but rather a feeling of food being stuck in their throat. The latter is what I experienced in both of my pregnancies and is called silent reflux or laryngopharyngeal reflux (LPR). Luckily, pregnancy induced reflux goes away once baby is born!

Symptoms of heartburn (GERD)

~Burning in throat or chest

~Persistent coughing

~Nausea and/or vomiting

~Throat issues (difficulty swallowing, hoarseness, laryngitis)

Symptoms of silent reflux (LPR)

~Feeling of something stuck in the throat

~Feeling the need to keep clearing your throat

~Persistent coughing

~Throat issues (difficulty swallowing, hoarseness, laryngitis)

~Breathing difficulties

What Causes GERD and LPR?

Progesterone, produced in abundance by the placenta during pregnancy, relaxes the sphincter separating your stomach and your esophagus. This allows the backwards flow of stomach acid or even stomach contents up into the throat. Also your growing uterus causes the rest of the organs in your torso to move to accommodate. This creates abdominal pressure and may also be a factor in reflux.

Symptoms can be triggered by certain lifestyle behaviors such as:

~Eating certain foods, you’ll need to see what impacts you as this can be very individual. Common culprits include spicy food, caffeine, alcohol, peppermint, onions, and garlic.¹

~Eating larger meals – try to eat smaller meals instead and stop eating two to three hours before you plan to go to sleep.

~Lying down after eating – if you want to rest, stayed propped to allow gravity to help keep symptoms at bay. This can be helpful at bedtime as well.

~Abdominal pressure – don’t wear tight clothes around your bump and get into those maternity clothes as soon as possible!

~Excess weight gain – ok, what? Yeah, this is a hard one when pregnant. Expect to gain weight, OF COURSE. But if you find you are having severe symptoms, check with your doctor if your weight gain is excessive and see about modifying your diet to manage your weight and reflux. Know that if you have healthy weight gain that you will not be able to control the reflux by trying to slow your weight gain because progesterone is the main reason it is occuring. DO NOT TRY TO AVOID GAINING THE HEALTHY WEIGHT! It is necessary for you and baby.

Reflux Remedies

Beyond lifestyle adjustments, the following may help alleviate symptoms:

~Ginger tea – drinking before eating may reduce symptoms. Use pre-packaged tea bags or make your own by simmering slices of ginger root in water for 30 minutes.

~Chamomile tea – balances the acidity levels in your stomach and reduces stress in the body.

~Eat foods that reduce stomach acid such as green leafy veggies, non-acid fruits such as bananas and apples, oatmeal, lean meats, avocado, & walnuts.

~Chew gum that is NOT mint flavored for 30 minutes after eating a meal. This creates saliva and can help reduce acid.

~When all else fails, speak to your doctor about safe medication options. I took Zantac 75 (which is now recalled) or once a day Pepcid – but I suggest always checking with your doctor first before taking any medication at all. I tried Tums, but they were absolutely useless and most of my prenatal yoga student mamas tell me the same.

How to Manage Reflux in Yoga

When practicing yoga, anytime a pose involves going upside down, instead keep your torso and head parallel to the floor. Here are some common poses practiced in a prenatal yoga class and how to modify them to keep gravity as your friend:

~In a wide legged forward fold, use blocks under your hands and keep your torso parallel to the ground. Focus on lengthening from the outer sides of your feet up to each hip and lengthening your spine.

~In a wide-kneed child’s pose, don’t rest your head on the floor. Instead place a block, bolster, or rolled blanket under your forehead so that your torso and head stay even with your hips.

~Don’t do downward facing dog on the floor, instead do it with hands against the wall. Walk your feet away from the wall as you walk your hands down to hip height and you are standing in an upside down L shape. Press your heels into the floor as you lift your hips and press the wall away with your hands.

~Set up a recliner with blocks and a bolster for your savasana. So relaxing!

Resources/Links

¹ Treatment of Gastroesophageal Reflux Disease During Pregnancy: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3966174/²

Management of Heartburn in Pregnancy: https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1365-2036.2005.02654.x

Progesterone and acid reflux: https://www.livestrong.com/article/413318-progesterone-and-acid-reflux/

Silent reflux: https://www.medicalnewstoday.com/articles/314531.php

Heartburn: https://www.medicalnewstoday.com/articles/146619.php

Guidelines for diagnosis and treatment of GERD: https://www.nature.com/articles/ajg200530

Food to avoid and foods to eat with GERD: https://www.fishertitus.org/health/foods-to-avoid-with-gerd

Natural remedies for GERD: https://www.fishertitus.org/health/natural-gerd-remedies