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. When over-the-counter remedies like baking soda or home remedies don’t cut it, many wonder: What heartburn meds are actually safe during pregnancy?
First-Line Defense: Calcium Carbonate Antacids
When it comes to heartburn relief in pregnancy, Tums (calcium carbonate) is the go-to. It’s not just safe-it’s smart. Calcium carbonate neutralizes stomach acid right away, giving relief within minutes. But here’s the bonus: it also gives your body extra calcium, which your baby needs to build bones and teeth. Your body uses more calcium during pregnancy, so getting it from a heartburn pill isn’t a bad trade-off.Other calcium-based antacids like Rolaids also work well. Mylanta, which includes aluminum and magnesium hydroxide, is considered safe too-but only if you don’t take it too often. Aluminum can cause constipation, and magnesium can cause loose stools. Both are fine in small doses, but if you’re already dealing with pregnancy constipation, stick to calcium carbonate.
What to avoid? Antacids with aluminum hydroxide alone, or those containing magnesium trisilicate. These aren’t well studied in pregnancy and could carry unknown risks. And never use Pepto-Bismol. It contains bismuth subsalicylate, which breaks down into something similar to aspirin. Aspirin during pregnancy can affect fetal development and increase bleeding risk.
Second-Line: H2 Blockers Like Famotidine
If antacids don’t give you enough relief after a few days, the next step is an H2 blocker. These reduce how much acid your stomach makes, rather than just neutralizing it. The most trusted option is famotidine (Pepcid). It’s been studied in thousands of pregnant women over decades. No clear link to birth defects or complications has been found.It starts working in about an hour and lasts up to 12 hours. That’s much longer than antacids, which wear off in 1-2 hours. Famotidine is often prescribed for nighttime heartburn because it keeps acid down while you sleep.
What about ranitidine (Zantac)? It used to be a top choice. But in April 2020, the FDA pulled it from the market because it was contaminated with NDMA, a probable carcinogen. Even if you still have old bottles at home, don’t use them. Stick with famotidine-it’s the only H2 blocker with strong safety data in pregnancy.
Side effects are rare but can include mild headaches or dizziness in about 3-5% of users. If you feel off after taking it, talk to your provider. Don’t assume it’s just pregnancy.
Third-Line: Proton Pump Inhibitors (PPIs)
If you’re still having daily heartburn despite antacids and H2 blockers, your provider might suggest a PPI. These are the strongest acid reducers available over the counter. The most studied one in pregnancy is omeprazole (Prilosec). Lansoprazole (Prevacid) and pantoprazole (Protonix) are also used, but omeprazole has the most data.PPIs block acid production at the source-the stomach’s acid pumps. They take 1-4 hours to start working, but once they do, they last all day. That’s why they’re often taken once daily, before breakfast.
Are they safe? Most studies say yes. But they’re not risk-free. A 2019 study in JAMA Pediatrics found a small association between first-trimester PPI use and childhood asthma. That doesn’t mean PPIs caused asthma-it just means there’s a correlation that needs more research. Still, many doctors won’t prescribe them in the first trimester unless absolutely necessary.
Long-term use of PPIs may affect how well your body absorbs calcium, iron, or vitamin B12. That’s why they’re reserved for persistent cases. If you’re on a PPI for more than a few weeks, your provider should monitor you for nutrient levels.
Timing Matters: Avoid Medications in the First Trimester When Possible
The first 14 weeks of pregnancy are when your baby’s organs are forming. That’s the most sensitive time. Even if a medication is generally safe, doctors recommend avoiding all non-essential drugs during this window.If your heartburn starts early, try lifestyle changes first: eat smaller meals, don’t lie down after eating, avoid spicy or fried foods, and sleep with your head slightly elevated. If you must use something, calcium carbonate antacids are the safest bet-even in the first trimester.
After the first trimester, your options open up. H2 blockers and PPIs become more acceptable if symptoms persist. But even then, use the lowest effective dose for the shortest time possible.
What Not to Take
Some heartburn remedies are off-limits during pregnancy:- Pepto-Bismol - Contains aspirin-like compounds. Avoid completely.
- Ranitidine (Zantac) - Pulled from the market in 2020 due to contamination.
- Aluminum-only antacids - Poorly studied; risk of constipation without benefit.
- Herbal remedies - Many are unregulated. Ginger is generally okay, but chamomile, licorice, or peppermint tea can trigger reflux or affect hormones.
Even if something is sold as “natural,” that doesn’t mean it’s safe in pregnancy. Always check with your provider before trying anything new.
How Much Is Too Much?
Dosing matters. You can’t just take antacids whenever you feel like it.For calcium carbonate (Tums), the typical max is 1,500 mg per dose, up to 4 times a day. That’s about 6-8 regular Tums tablets. Don’t exceed that unless your provider says so. Too much calcium can lead to kidney stones or interfere with iron absorption.
For famotidine, the usual dose is 10-20 mg once or twice daily. For omeprazole, 20 mg once daily is standard. Never double up if you miss a dose. Just wait until the next scheduled time.
Long-term use of any of these medications-especially PPIs-should be reviewed by your provider. You don’t want to become dependent on them when lifestyle changes could help.
When to Call Your Provider
Heartburn is common. But some symptoms aren’t normal:- Heartburn that wakes you up at night
- Vomiting blood or black, tarry stools
- Difficulty swallowing or pain when swallowing
- Unexplained weight loss
- Heartburn that doesn’t improve with medication
These could signal something more serious-like GERD complications, ulcers, or even a rare condition called HELLP syndrome. Don’t wait. Call your OB/GYN or midwife if you’re unsure.
Non-Medication Tips That Actually Work
Medications help, but they’re not the whole story. Many women find relief just by changing habits:- Eat 5-6 small meals instead of 3 big ones
- Avoid trigger foods: citrus, chocolate, caffeine, onions, garlic, fried foods
- Wait 3 hours after eating before lying down
- Sleep on your left side-it reduces pressure on your stomach
- Wear loose clothing around your belly
- Chew gum after meals-it increases saliva, which neutralizes acid
These aren’t just “old wives’ tales.” They’re backed by clinical observation and widely recommended by OB/GYNs and gastroenterologists alike.
Is Tums safe to take every day during pregnancy?
Yes, Tums (calcium carbonate) is safe for daily use during pregnancy, as long as you don’t exceed the recommended dose-usually no more than 1,500 mg per dose, up to four times a day. It even helps meet your increased calcium needs. But if you’re taking it daily for more than a few weeks, talk to your provider to make sure you’re not overdoing it or masking a bigger issue.
Can I take famotidine (Pepcid) in the first trimester?
Famotidine is considered safe in the first trimester, but most providers recommend trying lifestyle changes and antacids first. If your heartburn is severe and not improving, famotidine is a reasonable option. It’s been studied in thousands of pregnancies with no increased risk of birth defects. Still, always check with your provider before starting any medication.
Are PPIs like omeprazole linked to birth defects?
No large study has shown that omeprazole causes birth defects. It’s one of the most studied PPIs in pregnancy. However, a 2019 study in JAMA Pediatrics found a possible link between first-trimester PPI use and childhood asthma-but that doesn’t mean PPIs caused it. Other factors like genetics or maternal health could play a role. Doctors usually avoid prescribing PPIs in the first trimester unless absolutely necessary.
Why can’t I use Pepto-Bismol when pregnant?
Pepto-Bismol contains bismuth subsalicylate, which breaks down into salicylates-similar to aspirin. Aspirin during pregnancy can increase the risk of bleeding, affect fetal growth, and lead to complications during delivery. Even small amounts aren’t worth the risk. Stick to antacids like Tums or ask your provider for a safe alternative.
What if heartburn doesn’t improve with medication?
If your heartburn persists despite antacids, H2 blockers, and lifestyle changes, it could be a sign of something else-like GERD, a hiatal hernia, or even a rare pregnancy complication. Don’t just keep increasing your dose. Schedule a visit with your OB/GYN or a gastroenterologist. They can evaluate whether you need further testing or a different treatment plan.
