Severe heartburn in the third trimester: what to know

Later in pregnancy, the growing uterus can crowd the stomach. Pregnancy hormones may also relax the muscular valve that normally helps keep stomach contents below the food pipe. Acid moving upward can produce burning behind the breastbone, a sour taste, or fluid coming into the throat, especially after eating or reclining. Acid reflux is a possible cause; gastritis, a hiatus hernia, and peptic ulcer disease can produce overlapping discomfort. The presence of heartburn does not establish any one of these conditions.

Choose smaller portions and stay upright after meals. Leave time between eating and lying down, and raise the upper part of your body for sleep if your maternity team agrees. Identify personal triggers rather than removing foods broadly, and avoid tight clothing around the abdomen. Take only medicines approved for pregnancy by your clinician or pharmacist. Tell them how often symptoms occur, whether they wake you, and whether you have tried any antacid, because product choice and timing matter. Maintain regular fluids and seek advice if vomiting makes this difficult.

Arrange prompt clinical advice when heartburn is difficult to control, interferes with eating or sleep, or appears for the first time with unusual severity. Get urgent help for chest pressure, breathing difficulty, collapse, sweating with chest pain, vomiting blood, black stools, severe abdominal pain, or trouble swallowing. Contact maternity services urgently for severe headache, vision changes, sudden swelling, or pain high in the abdomen, since these symptoms need assessment beyond routine reflux care.

Ask which treatment is suitable at this stage of pregnancy, how long to try it, and what symptoms require urgent review. Ask whether your pattern suggests reflux or needs testing for another upper-digestive problem.