Heartburn during pregnancy is a burning sensation of different intensity and duration, which is more often felt behind the sternum, less often in the throat, occurs mainly in the second and third trimesters of the gestational age. In most pregnant women, heartburn is due to physiological causes and the field of childbirth disappears on its own. The symptom can also be provoked by an exacerbation of chronic diseases of the gastrointestinal tract. To clarify the causes of retrosternal burning, ultrasound and endoscopic examination, manometry, and functional tests are performed. To alleviate the condition, antacids, antisecretory drugs, prokinetics are indicated.
Causes of heartburn during pregnancy
Physiological background
Burning sensations behind the sternum occur in the second half of pregnancy, when intra-abdominal pressure rises and hormonal changes occur. From the 20th week of gestation, about 1/3 of the patients complain of heartburn; a few weeks before the birth, the symptom develops in 3/4 of the pregnant women. The burning sensation lasts from several minutes to several hours and can be repeated several times during the day. In the vast majority of cases, the disorder is associated with natural changes in the body aimed at maintaining pregnancy and preparing for childbirth. Causes of heartburn include:
- Influence of progesterone . A side effect of the hormone is the interaction with the receptors of the smooth muscles of the gastrointestinal tract, leading to inhibition of motility, the reflux of acidic contents into the esophagus. Women may feel periodic retrosternal burning sensation from the first trimester of pregnancy, but the symptom reaches its greatest intensity at 33-36 weeks of gestation. Heartburn is aggravated by bending over.
- uterus growth . Burning sensations in the throat, behind the sternum often appear in a horizontal position, which contributes to the passive flow of acid due to relaxation of the lower esophageal sphincter against the background of increased intra-abdominal pressure. The intensity and frequency of heartburn attacks increases in proportion to the duration of pregnancy, 1-2 weeks before delivery, relief often occurs due to a slight prolapse of the uterus.
- Diet errors . Most women notice that heartburn occurs after eating certain foods: strong tea, spicy or fatty foods, meat dishes. Unpleasant sensations begin on average half an hour after eating, can be long-lasting and combined with sour belching (eructation). Retrosternal burning is observed after overeating due to distension of the stomach and lack of digestive enzymes.
- Aerophagy . Eating "on the go", the habit of talking while eating cause increased swallowing of air, which stretches the stomach and causes a reflex contraction of smooth muscles with a reverse reflux of contents. Women complain of mild heartburn that lasts up to 1 minute. Burning sensations are often accompanied by loud belching of air. During pregnancy, psychogenic aerophagia is also possible.
- Uncomfortable sleeping position . In the third trimester, it becomes difficult for a woman to find a comfortable sleeping position due to the ever-increasing belly. Pregnant women notice an increase in the intensity of retrosternal burning in the position on the left side, associated with squeezing the stomach, which sometimes causes sleep disturbances and frequent nocturnal awakenings. Heartburn often worries patients in the morning, combined with nausea on an empty stomach, sour erection.
- Wrong posture . Stoop, scoliosis, constantly lowered shoulders - all this causes an increase in the pressure of the internal organs on the stomach during pregnancy, which worsens the woman's condition. With violations of posture, constant discomfort with burning sensation both behind the sternum and in the throat area, accompanied by nausea, worries. The intensity of heartburn increases after prolonged sitting in an uncomfortable position, riding in transport.
- Constipation . Retrosternal burning in stool disorders is associated with an increase in pressure inside the intestines and a reflex contraction of the muscles of the stomach. The intensity of heartburn varies from mild discomfort in the chest to severe burning, which significantly impairs a woman's quality of life. Characterized by an increase in symptoms with a prolonged absence of defecation, against this background, belching with air or rotten is possible.
GERD during pregnancy
In 55-70% of pregnant women, the disease occurs without morphological signs of damage to the esophageal mucosa, the intensity of symptoms does not depend on the form of GERD. Periodic retrosternal discomfort is observed already in the first trimester, but heartburn delivers the greatest concern in the 2nd half of gestation. In the initial stages, the symptom occurs several times during the day, the duration of retrosternal burning does not exceed 5-1 minutes. Unpleasant sensations are provoked by the use of spicy or smoked foods, physical activity, torso tilts.
With the progression of GERD, the intensity and duration of heartburn attacks increase, chest discomfort is especially pronounced in the morning. Strong burning sensations may be accompanied by sour belching, pain in the retrosternal region with irradiation to the shoulder blade and neck. Against the background of severe heartburn, appetite decreases, women refuse to eat, so as not to provoke new attacks. Characterized by constant discomfort and burning of the throat, increased salivation.
cholestasis of pregnancy
Heartburn against the background of stagnation of bile is observed in women after the 30th week of pregnancy. Retrosternal burning differs in intensity, duration. It is not always possible to trace the pattern of occurrence of uncomfortable sensations - in most patients, their appearance is not associated with food intake or other provoking factors. Heartburn is accompanied by bitter erection, constant nausea. The severity of retrosternal burning increases as the term of childbirth approaches. As a rule, such heartburn disappears on its own in the first 2 weeks of the postpartum period.
Other diseases of the gastrointestinal tract
During the bearing of a child, changes occur in all organs associated with violations of the regulatory influences of brain structures, an increase in the effects of sex hormones. The appearance of heartburn during pregnancy contributes to the exacerbation of organic and functional pathologies of the gastrointestinal tract. In this situation, burning is accompanied by other symptoms of dyspepsia, the intensity of which depends on the variant of the disease. The most common causes of heartburn are:
- Chronic gastritis . With inflammation of the stomach in pregnant women, there are periodic discomfort along the esophagus, due to errors in the diet, a violation of the diet. Burning sensations are localized behind the sternum, in the region of the xiphoid process. Occasionally there are attacks of severe heartburn with nausea and vomiting. Women also complain of nausea and burning in the throat after waking up.
- Duodenitis . Complaints of heartburn behind the sternum during pregnancy are characteristic of an exacerbation of the inflammatory lesion of the duodenum 12. Unpleasant sensations occur at any time of the day, but more often retrosternal burning develops on an empty stomach. Heartburn is provoked by the irritating effect of bile on the esophagus, therefore it is combined with bitter belching and nausea. The intake of fatty or fried foods predisposes to increased symptoms.
- pancreatitis . Retrosternal heartburn is associated with impaired digestion of food due to pancreatic enzyme deficiency during pregnancy. With an exacerbation of pancreatitis, burning is preceded or manifested simultaneously with it by other dyspeptic phenomena (belching, nausea). Heartburn can last for several hours, and its intensity is not related to body position or physical activity. Diarrhea and polyfaeces are possible.
- Hepatitis . At the beginning of the disease, retrosternal heartburn bothers 2-3 times a day due to the use of "heavy" food, overeating. As the pathology of the liver progresses, the burning sensation becomes constant, complaints of bitter erection and dull pain in the right hypochondrium appear. Sometimes, against the background of severe heartburn, vomiting of food eaten with bile impurities opens, which does not bring relief.
- Functional dyspepsia . Retrosternal burning is one of the symptoms of disorders of the nervous regulation of digestion caused by pregnancy. Women note that the frequency and duration of heartburn is not the same on different days - the symptom intensifies after emotional stress, against the background of stress. Discomfort in the throat or behind the sternum usually completely disappears after the normalization of the psycho-emotional state.
Survey
Most cases of heartburn during pregnancy are associated with physiological causes, however, for all women with complaints of retrosternal burning, the gastroenterologist prescribes instrumental and laboratory tests to exclude the organic basis of complaints. The diagnostic plan includes only methods that are safe for the health of the child and the expectant mother. The most informative for detecting the causes of heartburn in pregnant women are:
- Ultrasound . Ultrasound of the abdominal cavity is the main method for diagnosing gastrointestinal diseases during pregnancy, since the method is safe for the child and allows you to assess the morphological features of the digestive organs, to detect signs of organic pathology. According to the indications, a targeted study of individual organs is carried out.
- Endoscopy . EGDS can be administered to women at any gestational age in the absence of contraindications from other systems. The study is informative for the diagnosis of lesions of the esophageal mucosa in GERD, the method also helps to identify signs of chronic diseases of the upper digestive tract.
- pH meter . Heartburn of any etiology is accompanied by a change in the acid-producing function of the secretory cells of the stomach, to assess the degree of these disorders, a daily measurement of acidity is carried out. Intraesophageal pH-metry, which is performed to control treatment and determine prognosis, has a high diagnostic value.
- Manometry . Measurement of pressure indicators in the body and the lower third of the esophagus in combination with manometry of the lower esophageal sphincter makes it possible to assess the motor function of the gastrointestinal tract and the coordination of the work of muscle groups, to identify signs of functional dyskinesia. In patients with heartburn, cardia insufficiency is more often detected.
- Functional Tests . A rapid alkaline test is performed to confirm the presence of gastroesophageal reflux - the result is positive if, after taking antacids, a woman notes a decrease in retrosternal burning. The omeprazole test helps to confirm the diagnosis - the appointment of omeprazole in a standard dose relieves extraesophageal symptoms.
Pregnant women undergo a standard study of feces, determine the level of elastase and fecal antigen of Helicobacter pylori infection. Perform a standard biochemical blood test, measure the level of gastrin and pepsinogen. All women are prescribed a comprehensive gynecological examination, in some cases, the concentration of sex hormones is measured.
Normalization of the diet is the basis for the fight against heartburn during pregnancy
Symptomatic therapy
Heartburn of moderate intensity, which occurs from the second half of the gestational period, is usually caused by natural causes and lends itself well to non-drug correction. A woman is recommended to normalize her diet: avoid eating spicy or salty foods, eat 5-6 times a day in small portions. After eating, you can not take a horizontal position, bend over, so as not to provoke reflux. It is better to sleep on a high pillow in a comfortable position, you can use a special pillow for pregnant women.
Before a clinical diagnosis is made, non-absorbable antacids help to reduce discomfort in the chest, which do not penetrate the systemic circulation and do not affect the child's body. For the relief of symptoms, prokinetics are recommended, with strong and prolonged burning, antisecretory drugs are prescribed. Intense heartburn during pregnancy, accompanied by other dyspeptic disorders, abdominal pain, is an indication for contacting a specialist.