Is Indigestion a Sign of Pregnancy?

By OBGYN Dr. Kenosha Gleaton

Early symptoms of pregnancy can range from a missed period to frequent nausea and vomiting. [1] Indigestion may also be a symptom of pregnancy, and some research suggests that heartburn, acid reflux, and morning sickness may all be correlated. [2]

What is indigestion and what does it feel like?

Indigestion is sometimes used as a blanket term to refer to various symptoms. The technical description for indigestion is discomfort in the upper abdomen. This can feel like an upset stomach, feeling full or bloated, gassiness, burning or pain in the abdomen, and nausea. [3] Some people refer to heart burn as indigestion and vice versa, however these are technically two different conditions. [3]

What causes indigestion?

Researchers have been unable to pinpoint what exactly causes abdominal pain and indigestion as the cause can vary from person to person. [3] Some potential links include genetics, psychological problems, an infection such as salmonella or giardia, problems in the small intestine, and basic eating, drinking, and lifestyle habits. Indigestion may also be caused by a variety of underlying conditions and medications. [3] Those with digestive tract conditions such as acid reflux, gastritis, irritable bowel syndrome, etc. may be more likely to experience indigestion. Other potential causes include drinking too much coffee, alcohol, or carbonation. Eating too fast or too much, consuming spicy, fatty, acidic, or greasy foods, smoking, and high levels of stress may also play a role in indigestion. [3]

When someone experiences indigestion, the pain or discomfort associated with indigestion is often tied to the lower esophageal sphincter (LES). [4] The LES has an important job of closing off the esophagus from the stomach, which is full of acidic gastric contents. If there is a malfunction with the LES, someone is likely to experience acid reflux, GERD, indigestion, or heartburn. 

Can pregnancy cause indigestion?

Pregnancy is a major cause of indigestion for many people. It’s been reported that around 67% to 80% of pregnant people will experience some sort of gastroesophageal reflux disease (GERD), and common symptoms of GERD include heartburn and indigestion. [5-6] It’s suspected that the hormonal changes during pregnancy paired with increased nausea and vomiting cause indigestion to occur. [6] The LES pressure decreases in response to increased hormones, and a noticeable dip in LES pressure has been observed at around 36 weeks gestation. Increased pressure from the fetus and growing uterus may also play a role in the occurrence of GERD and indigestion. [6]

Indigestion may appear as early as the first trimester and often progresses throughout the entire pregnancy. Not everyone will experience indigestion or heartburn during pregnancy, and other early symptoms of pregnancy are likely to arise before or alongside indigestion. This includes a missed period, fatigue, nausea or vomiting, sore breasts, and more. [1]

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The relationship between gas, morning sickness, and indigestion

Nausea and vomiting during pregnancy, also commonly referred to as morning sickness, is a common symptom of pregnancy. It is also common to experience increased gas and bloating during pregnancy. These are all relatively connected and are likely all caused in part by changing hormones. [2,5,6] There isn’t one specific cause of morning sickness, but we do know that increased levels of progesterone lead to our muscles relaxing (including smooth muscle) which can lead to the slowing of digestion, gas building up, indigestion, and more. [2,7] Severe morning sickness has also been associated with indigestion, heartburn, and acid reflux. [5] The good news is the treatment for indigestion, morning sickness, and methods for managing gas during pregnancy are all relatively similar. 

To help manage these pregnancy symptoms, consider incorporating remedies like vitamin B6 and ginger gummies for nausea into your routine, as they have been shown to provide effective relief from morning sickness and related discomfort.

Pregnancy safe treatments for indigestion

Having indigestion on top of everything else you’re experiencing during pregnancy can make for a very uncomfortable few months. Fortunately there are some ways to lessen or treat indigestion that are pregnancy safe, and many may also help combat morning sickness and manage gas. 

Dietary and lifestyle changes

The first recommended treatment for many experiencing indigestion is to alter any dietary and lifestyle habits contributing to the abdominal pain. [6] Try to avoid foods that are extremely fatty, spicy, or acidic, as these can worsen your indigestion. It’s also recommended that you avoid drinking a lot of caffeine or carbonated beverages. Alcohol and smoking should also be avoided. When eating, attempt to eat multiple small meals rather than eating larger meals. Research also suggests that elevating the head while laying down, lying on your left side, and avoiding lying down for a few hours after eating may help you avoid indigestion. [6]

Over the counter medications

Over the counter (OTC) antacids have been shown to decrease heartburn and indigestion in pregnant women. A study found that antacids provided some relief to 93% of pregnant women suffering from heartburn. [6] The recommended medications for pregnancy are calcium or magnesium containing antacids, as these minerals have also been associated with a decreased risk of preeclampsia and hypertension. [6] These minerals are also found in stand-alone supplements, prenatal vitamins, and even drink mixes. Magnesium is known for its pregnancy-safe, helpful effects in treating constipation, heartburn, and indigestion. [8] Natalist Magnesium Plus contains magnesium, calcium, and vitamin D3!

It is recommended that pregnant women avoid using antacids containing bicarbonate or magnesium trisilicate, as these may result in negative maternal and fetal health effects. [6] 

Prescription medications 

If lifestyle modifications and OTC medications are unable to control or provide relief from indigestion, some healthcare providers may move on to prescription medications such as sucralfate and acid-suppression therapy. [6] Sucralfate is an oral medication that is commonly used to treat ulcers. It has anti-peptic effects and increases mucus, which may help protect against stomach acid. [9] Other prescription medication options include histamine-2 receptor antagonists and proton pump inhibitors. These are considered third-line treatment options during pregnancy and are likely to be used if no other treatment options are providing relief. [6] 

Key takeaways

• Indigestion is a somewhat vague term for any abdominal pain or discomfort. Indigestion is commonly thought of as heartburn, acid reflux, etc. even though these are separate conditions.
• Indigestion commonly feels like bloating, fullness, gassiness, burning or pain, nausea, etc.
• There are many potential causes of indigestion, including medications, underlying gastric conditions, genetics, food and drink, lifestyle habits, and so on.
• Indigestion is commonly experienced during pregnancy, likely due to morning sickness, increased hormones, and increased internal pressure. 
• Preventing and treating indigestion can be done through avoiding spicy, greasy, acidic foods, and carbonated, caffeinated, and alcoholic beverages. 
• Antacids and prescription medications can also be helpful for treating indigestion.

References:

1. What are some common signs of pregnancy? National Institutes of Health. Reviewed January 31 2017. URL.
2. Lee NM, Saha S. Nausea and vomiting of pregnancy. Gastroenterol Clin North Am. 2011;40(2):309-vii. doi:10.1016/j.gtc.2011.03.009
3. Indigestion (Dyspepsia). National Institutes of Health.  Reviewed November 2016. URL. 
4. Rosen RD, Winters R. Physiology, Lower Esophageal Sphincter. [Updated 2023 Mar 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557452/
5. Law R, Maltepe C, Bozzo P, Einarson A. Treatment of heartburn and acid reflux associated with nausea and vomiting during pregnancy. Can Fam Physician. 2010;56(2):143-144.
6. Altuwaijri M. Evidence-based treatment recommendations for gastroesophageal reflux disease during pregnancy: A review. Medicine (Baltimore). 2022;101(35):e30487. doi:10.1097/MD.0000000000030487
7. Al-Shboul OA, Mustafa AG, Omar AA, et al. Effect of progesterone on nitric oxide/cyclic guanosine monophosphate signaling and contraction in gastric smooth muscle cells [published correction appears in Biomed Rep. 2020 Jan;12(1):36]. Biomed Rep. 2018;9(6):511-516. doi:10.3892/br.2018.1161
8. Magnesium Fact Sheet for Consumers. National Institutes of Health. Updated March 22 2021. URL.
9. Kudaravalli P, John S. Sucralfate. [Updated 2022 Feb 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551527/