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Which heartburn medicines are safe during pregnancy?

Many pregnant women get heartburn, sometimes referred to as acid indigestion or acid reflux. This condition is generally harmless, but it can be very uncomfortable. Fortunately, most cases can be safely treated with over-the-counter remedies, along with simple diet and lifestyle changes. For those who need them, some prescription heartburn medications are also considered safe to take during pregnancy.

Here are some guidelines to help you understand which heartburn medicines are appropriate to use during pregnancy. (As with any medication, get the okay from your healthcare provider first.)

Your first line of defense should probably be chewable antacids made from calcium carbonate (sometimes just called "calcium" on the label). Fast, portable, and effective, they may be all you need. Some of them even taste pretty good.

Antacids containing magnesium hydroxide or magnesium oxide are also a good choice during pregnancy. These come in tablet or liquid form.

Bear in mind that swallowing any liquid, even the liquid you need to wash down a tablet, will cause your stomach to do what it does naturally: produce digestive juices – including acid, the very thing you're trying to reduce. So it's best to swallow tablets with as little liquid as possible when you're having trouble with heartburn.

All of these antacid medicines work by neutralizing the acid that's already in your stomach and causing you pain. Chewable and liquid antacids act much more quickly than tablets because they're already dissolved. You can experiment to see which type works most effectively for you.

Avoid antacids that list aluminum (such as aluminum hydroxide or aluminum carbonate) as an ingredient. Aluminum can be constipating and, in large doses, toxic. So even though these products are probably safe when used occasionally at the recommended dosage, they're not your best choice when pregnant.

Remedies containing aspirin (such as Alka-Seltzer) should also be avoided during pregnancy. Aspirin may be listed on a label as salicylate or acetylsalicylic acid.

Also steer clear of sodium bicarbonate (baking soda), which is sold as an antacid in tablet form, and sodium citrate. Both are high in sodium, which causes water retention. And if you're far enough along in your pregnancy to have gone into a panic trying to remove rings from your swollen fingers or looked down in horror at a pair of puffy ankles, you'll understand why that's the last thing you want right now.

Remember that even the chewable antacids that come in yummy fruit flavors are medicine. If you find yourself popping more of them than recommended, you may want to ask your provider about using something more effective and longer lasting, usually called an "acid reducer." Instead of neutralizing your stomach acid like antacids do, acid reducers actually stop your stomach from producing most of the acid it normally would.

Acid reducers won't help with the acid already in your stomach, so they work best when taken before a meal. Some acid-reducing medications are a combination of an acid reducer (such as famotidine) and an antacid (such as calcium carbonate or magnesium hydroxide), so they can provide immediate relief from the acid that's already distressing you and reduce further acid production for up to 12 hours.

Some acid reducers are available over-the-counter and others require a prescription. All are currently considered safe to take during pregnancy, even during the first trimester. But new research is happening all the time, so be sure to ask your healthcare provider to go over the potential risks and benefits of taking any of these drugs.