Heartburn Medications in Pregnancy: Safe Options for Antacids, H2 Blockers, and PPIs

Heartburn during pregnancy isn’t just annoying-it’s common. Up to 80% of pregnant people experience it, especially in the second and third trimesters. The growing baby presses up on the stomach, and pregnancy hormones relax the valve that keeps acid down. It’s not a disease, but it can make eating, sleeping, and even breathing uncomfortable. When lifestyle changes don’t cut it, many turn to medication. But which ones are actually safe? And which ones should you avoid?

First-Line Defense: Antacids

When it comes to heartburn relief in pregnancy, antacids are the go-to starting point. They work fast-neutralizing stomach acid right where it’s burning. Calcium carbonate, the main ingredient in Tums a calcium carbonate-based antacid commonly recommended for heartburn relief during pregnancy, is the gold standard. It’s not just safe; it’s helpful. Your body needs extra calcium during pregnancy to build your baby’s bones and teeth. Tums gives you relief and a little bonus nutrition at the same time.

Other antacids like Rolaids a calcium carbonate and magnesium hydroxide antacid used for quick heartburn relief and Mylanta an aluminum hydroxide, magnesium hydroxide, and simethicone antacid used for gas and acid relief are also considered safe. But not all antacids are created equal. Avoid anything with aluminum trisilicate or magnesium trisilicate-these can build up in your system and cause problems. And never use Pepto-Bismol a bismuth subsalicylate product containing aspirin-like compounds contraindicated in pregnancy. It contains salicylates, which act like aspirin and can affect your baby’s development.

How much is too much? Stick to the label. For calcium carbonate, most experts say 500-1500 mg every 4-6 hours as needed. But don’t use them all day, every day. Long-term overuse can lead to constipation, kidney stones, or too much calcium in your blood. If you’re taking antacids more than a few times a week, talk to your provider. You might need something stronger-or a better plan.

Second-Line: H2 Blockers

If antacids aren’t doing the job, the next step is usually an H2 blocker. These don’t neutralize acid-they reduce how much your stomach makes. Famotidine an H2 blocker marketed as Pepcid, considered safe for short-term use in pregnancy, sold as Pepcid, is the most commonly recommended. It kicks in within an hour and lasts up to 12 hours. That means fewer doses throughout the day compared to antacids.

What about ranitidine? You might remember it as Zantac. It used to be a top choice. But in April 2020, the FDA pulled it off the market because it was contaminated with NDMA, a probable cancer-causing chemical. So even if your doctor used to prescribe it, it’s no longer an option. Stick with famotidine. It’s clean, effective, and has years of safety data behind it.

Side effects are rare but possible. A small number of people report headaches or dizziness. If you feel off after taking it, stop and check in with your provider. H2 blockers are fine for short-term use during the second and third trimesters. But in the first 14 weeks, doctors often recommend holding off unless symptoms are severe. That’s when your baby’s organs are forming-and the window for potential harm is highest.

Third-Line: Proton Pump Inhibitors (PPIs)

When H2 blockers don’t cut it, and heartburn is constant-day and night-your provider might suggest a PPI. These are the strongest acid reducers. Omeprazole a proton pump inhibitor, most studied and commonly prescribed for heartburn in pregnancy, sold as Prilosec, is the most researched and safest choice in this group. Others like lansoprazole (Prevacid) and pantoprazole (Protonix) are used too, but there’s less data.

PPIs work by shutting down the acid pumps in your stomach lining. They take longer to start working-1 to 4 hours-but they last a full day. That’s why they’re often taken once daily, before breakfast.

Here’s the catch: while omeprazole is generally considered safe, it’s not risk-free. A 2019 study in JAMA Pediatrics found a possible link between first-trimester PPI use and a slightly higher chance of childhood asthma. But it didn’t prove cause and effect. Other studies haven’t found the same connection. Still, because of this uncertainty, most providers don’t start with PPIs. They’re reserved for cases where antacids and H2 blockers have failed.

Long-term use of PPIs-even outside pregnancy-can affect how well your body absorbs calcium, iron, and vitamin B12. That’s why they’re not meant for indefinite use. If you’re on a PPI for more than a few weeks during pregnancy, your provider should monitor you closely.

What to Avoid

There are a few medications you should never take during pregnancy for heartburn:

• Pepto-Bismol - Contains bismuth subsalicylate, which breaks down into aspirin-like compounds. Risk of bleeding and developmental issues.
• Ranitidine (Zantac) - Withdrawn globally due to cancer-causing contaminants. Not safe, even if you find it on a shelf.
• Antacids with aluminum or magnesium trisilicate - Can accumulate in your body and cause toxicity.
• Herbal remedies and unregulated supplements - No safety data. Don’t risk it.

And while it might sound obvious, don’t assume “natural” means safe. Ginger tea? Fine. Chamomile tea? Maybe. But don’t self-prescribe anything without checking with your provider.

When to Skip Medication Altogether

The best heartburn treatment in pregnancy? Lifestyle changes. Medications help, but they’re not a fix. Try these first:

• Eat smaller meals, five to six times a day instead of three big ones.
• Avoid spicy, fried, or fatty foods-they relax the valve and increase acid.
• Don’t lie down for at least three hours after eating.
• Wear loose clothing. Tight waistbands press on your stomach.
• Sleep with your head elevated. Use pillows or a wedge to raise your upper body.
• Drink fluids between meals, not with them. Too much liquid at once can distend your stomach.

These aren’t just tips-they’re proven strategies. Many women find relief just by adjusting their routine. And if you can avoid medication entirely, especially in the first trimester, that’s the ideal outcome.

Timing Matters: First Trimester Caution

The first 14 weeks of pregnancy are the most sensitive. That’s when your baby’s heart, brain, spine, and limbs are forming. Even safe medications carry a tiny theoretical risk during this time. So unless your heartburn is unbearable and disrupting sleep or eating, hold off on meds. Try the lifestyle changes first. If you’re struggling, talk to your OB/GYN. They can help you decide whether a single dose of Tums or famotidine is worth it.

After the first trimester, the risk drops significantly. That’s when most providers feel comfortable recommending antacids, then H2 blockers, then PPIs if needed. But even then-always check in. Don’t just grab something off the shelf because it worked last time.

What Your Provider Needs to Know

Before you take anything, even an over-the-counter antacid, tell your provider:

• What you’re taking and how often
• When your symptoms started and what makes them worse
• If you’ve tried non-medication options
• Any other medications or supplements you’re on

They might suggest a different brand, adjust the dose, or rule out something more serious-like a hiatal hernia or GERD that needs long-term management. Don’t assume heartburn is just “normal.” If it’s constant, wakes you up at night, or comes with vomiting, difficulty swallowing, or chest pain, get checked. It might be more than heartburn.

Bottom Line: Safety First, Relief Second

Heartburn in pregnancy is common, but it doesn’t mean you have to suffer. You have options. Start with lifestyle changes. If you need help, Tums is your safest bet. Famotidine comes next. Omeprazole is an option-but only if nothing else works. And always, always talk to your provider before taking anything.

There’s no one-size-fits-all solution. What works for one person might not work for another. Your body, your pregnancy, your symptoms-they’re all unique. The goal isn’t to eliminate heartburn at all costs. It’s to find relief without risking your baby’s health. That’s the balance. And with the right approach, you can get through your pregnancy with less burn and more comfort.