Heartburn during pregnancy isn’t just uncomfortable-it’s common. Up to 80% of pregnant people experience it, especially in the second and third trimesters. The growing baby presses on the stomach, and pregnancy hormones relax the valve that keeps acid down. You might feel that burning sensation after eating, when lying down, or even in the middle of the night. It’s normal, but that doesn’t mean you have to suffer. The good news? There are safe options. The tricky part? Knowing which ones are truly safe-and which ones to avoid.
First-Line Defense: Antacids Like Tums
When you’re pregnant and heartburn hits, your first stop should be antacids. Not all of them, though. Calcium carbonate-based antacids like Tums are the gold standard. Why? Because they neutralize stomach acid right away and give you a bonus: extra calcium. Your baby needs calcium to build bones, and so do you. Taking Tums helps both. Other safe antacids include Rolaids (also calcium carbonate with magnesium hydroxide) and Mylanta (aluminum and magnesium hydroxide with simethicone). These work fast-usually within minutes-and last about one to two hours. That’s perfect for quick relief after a meal. But here’s what you need to avoid: antacids with aluminum or magnesium trisilicate. These aren’t proven safe in pregnancy and can cause side effects like constipation or diarrhea. And never use Pepto-Bismol. It contains bismuth subsalicylate, which is related to aspirin. Aspirin during pregnancy can affect your baby’s heart and blood flow, especially later on. Stick to calcium carbonate. It’s the most studied, the safest, and the one your doctor is most likely to recommend. You can take up to 1,500 mg of calcium carbonate every 4 to 6 hours as needed. But don’t go over that without checking in with your provider. Too much calcium can lead to kidney stones or interfere with iron absorption.Second Option: H2 Blockers Like Pepcid
If antacids aren’t doing enough, the next step is an H2 blocker. These don’t neutralize acid-they reduce how much your stomach makes. Famotidine, sold as Pepcid, is the top choice. It’s been studied in thousands of pregnant women and shows no increased risk of birth defects or complications. It starts working in about an hour and lasts up to 12 hours. That’s a big advantage over antacids. You might have heard of Zantac (ranitidine). It used to be popular. But in April 2020, the FDA pulled it off the market because it was contaminated with NDMA, a potential cancer-causing chemical. So even if you have old bottles lying around, don’t use them. Stick with famotidine. It’s the only H2 blocker currently recommended for pregnancy. Cimetidine (Tagamet) is another H2 blocker, but it’s less preferred. Some studies suggest it might interfere with how the liver processes other drugs. So while it’s not outright dangerous, famotidine is the safer bet. Side effects from H2 blockers are rare but possible. A small number of people report headaches or dizziness. If you feel off after taking Pepcid, stop and talk to your provider. Don’t assume it’s just pregnancy.Third-Line Option: PPIs Like Prilosec
If you’re still struggling after antacids and H2 blockers, your provider might suggest a proton pump inhibitor (PPI). These are the strongest acid reducers. Omeprazole (Prilosec), lansoprazole (Prevacid), and pantoprazole (Protonix) all work by shutting down the acid pumps in your stomach lining. They take longer to kick in-1 to 4 hours-but last a full day. Omeprazole is the most studied PPI in pregnancy. Multiple studies, including large ones published in journals like JAMA Pediatrics, haven’t found clear links to birth defects. But here’s the catch: one 2019 study did find a small statistical association between first-trimester PPI use and childhood asthma. That doesn’t mean PPIs cause asthma-it just means researchers are watching closely. Because of this, PPIs are not first or second choices. They’re reserved for cases where other treatments fail. If you’ve tried Tums, Pepcid, and lifestyle changes-and you’re still in pain-then your doctor might say it’s worth trying omeprazole. But only under supervision. Don’t self-prescribe. Long-term PPI use-even outside pregnancy-can affect how your body absorbs calcium, magnesium, and vitamin B12. That’s why most providers recommend using the lowest dose for the shortest time possible.
What About the First Trimester?
The first 14 weeks of pregnancy are the most sensitive. That’s when your baby’s organs are forming. Even safe medications carry a tiny theoretical risk during this time. So unless your heartburn is unbearable, avoid all medications in the first trimester. Instead, focus on lifestyle changes:- Eat smaller meals-five or six a day instead of three big ones.
- Avoid spicy, fatty, fried, or acidic foods like citrus, tomatoes, coffee, and chocolate.
- Don’t lie down for at least three hours after eating.
- Wear loose clothing. Tight waistbands put pressure on your stomach.
- Sleep with your head slightly elevated. Use a wedge pillow or stack a couple of regular pillows.
What to Avoid Completely
Some medications are off-limits. Here’s your short list:- Pepto-Bismol and any product with bismuth subsalicylate (it’s related to aspirin).
- Ranitidine (Zantac)-off the market since 2020 due to contamination.
- Aluminum or magnesium trisilicate antacids-lack safety data.
- NSAIDs like ibuprofen (Advil, Motrin) or naproxen (Aleve)-especially after 20 weeks. They can affect fetal kidney function and amniotic fluid levels.
When to Call Your Doctor
Heartburn is common. But some symptoms aren’t normal. Call your provider if you have:- Difficulty swallowing or pain when swallowing.
- Vomiting blood or black, tarry stools.
- Unexplained weight loss.
- Heartburn that wakes you up at night or doesn’t improve with medication.
What’s Safe While Breastfeeding?
Good news: most of the medications that are safe in pregnancy are also safe while breastfeeding. Calcium carbonate, famotidine, and omeprazole all pass into breast milk in tiny, harmless amounts. The American Academy of Pediatrics considers them compatible with nursing. You don’t need to pump and dump. Just stick to the lowest effective dose. And if your baby seems unusually fussy, gassy, or has diarrhea, talk to your pediatrician. It’s rare, but possible.Final Takeaway
You don’t have to live with heartburn during pregnancy. There are safe, effective options. Start with lifestyle changes. If you need more, reach for calcium carbonate antacids like Tums. If that’s not enough, ask your provider about famotidine. Save PPIs like omeprazole for when nothing else works-and only with their approval. The goal isn’t to eliminate all discomfort. It’s to find relief without risking your baby’s health. Every choice you make matters. But you’re not alone. Millions of pregnant people have walked this path-and found relief, safely.Can I take Tums every day while pregnant?
Yes, you can take Tums daily during pregnancy, as long as you stay within the recommended dose-up to 1,500 mg of calcium carbonate every 4 to 6 hours as needed. Tums provide calcium, which supports your baby’s bone development. But don’t exceed the daily limit without talking to your provider. Too much calcium can interfere with iron absorption or increase your risk of kidney stones.
Is Pepcid safe during pregnancy?
Yes, famotidine (Pepcid) is considered safe during pregnancy. It’s been studied in large groups of pregnant women and shows no increased risk of birth defects or complications. It’s often used when antacids like Tums don’t provide enough relief. It’s preferred over older H2 blockers like ranitidine, which was removed from the market in 2020 due to contamination.
Can I take omeprazole while pregnant?
Omeprazole (Prilosec) is generally considered safe during pregnancy, especially when other treatments fail. It’s the most studied PPI in pregnant women, and most research hasn’t found a link to birth defects. However, one study suggested a possible association with childhood asthma when taken in the first trimester. Because of this, doctors only recommend it if the benefits clearly outweigh the risks-and always under supervision.
Why is Pepto-Bismol not safe in pregnancy?
Pepto-Bismol contains bismuth subsalicylate, which is chemically related to aspirin. Aspirin and similar compounds can affect fetal circulation, especially in the third trimester, and may increase the risk of bleeding or delay labor. Even small amounts aren’t recommended during pregnancy. Always check labels and avoid any product with salicylates.
What’s the best way to prevent heartburn during pregnancy?
The best prevention is lifestyle: eat smaller, more frequent meals; avoid trigger foods like spicy, fatty, or acidic items; don’t lie down for at least three hours after eating; wear loose clothing; and sleep with your head slightly elevated. These simple changes help most women reduce or eliminate heartburn without needing medication.
