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Heartburn Medications in Pregnancy: Antacids, H2 Blockers, and PPIs Explained

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. The growing baby presses up against your stomach, and hormones like progesterone relax the valve that keeps acid down. It’s not a sign of something wrong; it’s just part of how your body changes. But when it’s burning your throat at 2 a.m., you want relief-and fast. The question isn’t just what works, but what’s safe for your baby.

First-Line Defense: Antacids

Start with antacids. They’re the go-to because they work fast and have the best safety record. Calcium carbonate, found in Tums and Rolaids, neutralizes stomach acid right away. It’s not just safe-it’s helpful. Your baby needs calcium to build bones, and so do you. Taking Tums gives you relief and a little extra calcium. That’s a win-win.

Avoid antacids with aluminum or magnesium trisilicate. Aluminum can cause constipation, and trisilicate has unclear long-term effects in pregnancy. Mylanta is okay if it’s the version with aluminum hydroxide and magnesium hydroxide, but skip the ones with added simethicone unless you’re also bloated. Stick to calcium-based options.

Dosing matters. You can take up to 1,500 mg of calcium carbonate every 4 to 6 hours as needed. But don’t go over 7,500 mg a day. Too much calcium can lead to kidney stones or interfere with iron absorption. And never use Pepto-Bismol. It contains bismuth subsalicylate, which breaks down into something like aspirin-and aspirin during pregnancy is a no-go.

Second Option: H2 Blockers

If antacids aren’t enough after a few days, talk to your provider about H2 blockers. These reduce acid production instead of just neutralizing it. Famotidine (Pepcid) is the top pick. It’s been studied in thousands of pregnant women and shows no increased risk of birth defects. It starts working in about an hour and lasts up to 12 hours.

Ranitidine (Zantac) used to be common, but it was pulled off shelves in 2020 after the FDA found cancer-causing contaminants. Don’t use it. Ever. Even if you have an old bottle at home. Stick with famotidine.

Cimetidine (Tagamet) is another H2 blocker, but it’s less preferred because it can interact with other medications. Famotidine is cleaner and more reliable. Side effects are rare but can include mild headaches or dizziness in about 3-5% of users. Still, for most, the benefit outweighs the risk.

Third-Line: Proton Pump Inhibitors (PPIs)

PPIs like omeprazole (Prilosec), lansoprazole (Prevacid), and pantoprazole (Protonix) shut down acid production at the source. They’re stronger than H2 blockers and last a full day. But they’re not first or even second choice. Use them only if your heartburn is severe and doesn’t respond to antacids or H2 blockers.

Omeprazole is the most studied PPI in pregnancy. Data from large studies, including one published in JAMA Pediatrics in 2019, show no major increase in birth defects. But that same study found a small possible link between first-trimester PPI use and childhood asthma. It’s not proven to cause it-just an association. That’s why doctors don’t prescribe PPIs lightly.

PPIs are best used for short periods. Long-term use might affect calcium absorption, which matters when your body is already working hard to supply your baby. If you’re on a PPI for more than a few weeks, your provider should monitor you.

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 carry a tiny risk. So, unless your heartburn is unbearable, hold off on meds in the first trimester. Try lifestyle changes first.

Eat smaller meals. Five or six small meals a day keep your stomach from getting too full. Avoid spicy, fried, or acidic foods-tomatoes, citrus, coffee, chocolate. Don’t lie down for at least three hours after eating. Prop yourself up with pillows when you sleep. Wear loose clothes. These aren’t just tips-they’re proven ways to cut heartburn by half.

What About Breastfeeding?

If you’re nursing, you’re probably wondering: are these meds safe for my baby? The good news is yes. Calcium carbonate passes into breast milk in tiny amounts, and it’s not harmful. Famotidine and omeprazole also enter breast milk in very low levels. Studies show no adverse effects in nursing infants. You can use them as directed, but keep the dose as low as possible. If your baby seems fussy or has diarrhea, talk to your pediatrician.

Red Flags: When to Call Your Doctor

Not all heartburn is normal. If you have trouble swallowing, vomit blood, lose weight without trying, or feel chest pain that spreads to your arm or jaw-don’t assume it’s just heartburn. These could be signs of something more serious, like GERD complications or even a heart issue. Call your provider right away.

Also, if you’ve tried antacids and H2 blockers for two weeks and still feel burning daily, it’s time to reassess. You might need a different approach, or you might have another condition like a hiatal hernia.

What Doesn’t Work (and What’s Risky)

Some remedies you’ve heard of are dangerous. Pepto-Bismol? Avoid it. Alka-Seltzer? Contains aspirin-skip it. Herbal teas like ginger are fine in moderation, but don’t rely on them alone. And never take anything without checking with your provider-even if it’s labeled “natural.”

Also, don’t double up on meds. Taking Tums and Pepcid together is okay, but don’t mix PPIs with H2 blockers unless your doctor says so. More isn’t better. It can increase side effects without adding benefit.

Real-Life Scenarios

Sarah, 32, was 28 weeks pregnant and couldn’t sleep because of heartburn. She started with Tums-two tablets after dinner and again at bedtime. That helped, but not enough. Her OB suggested famotidine 20 mg at night. Within three days, she slept through the night. No side effects. She kept using it until delivery.

Maria, 29, had severe heartburn in her first trimester. She refused meds and stuck to eating every two hours, avoiding coffee, and sleeping on three pillows. Her symptoms dropped by 70%. She didn’t need any medication.

Both women had different needs. There’s no one-size-fits-all. Your body, your symptoms, your stage of pregnancy-they all matter.

Final Takeaway

You don’t have to suffer. Heartburn in pregnancy is treatable. Start with calcium-based antacids. If that’s not enough, move to famotidine. Save PPIs for when everything else fails. Always check with your provider before starting anything-even something as simple as Tums. And never ignore warning signs.

The goal isn’t to eliminate heartburn completely. It’s to manage it safely so you can rest, eat, and enjoy your pregnancy without burning out.