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.
Can I take Tums every day during pregnancy?
Tums is safe for occasional use during pregnancy and even provides extra calcium. But taking it every day, especially in large amounts, can lead to side effects like constipation or too much calcium in your blood. Stick to the recommended dose-500-1500 mg every 4-6 hours as needed-and don’t use it long-term without talking to your provider.
Is famotidine (Pepcid) safe in the first trimester?
Famotidine is considered safe in pregnancy, but most providers recommend avoiding all medications in the first 14 weeks unless symptoms are severe. If your heartburn is keeping you from eating or sleeping, talk to your doctor. They might approve a low dose of famotidine, but lifestyle changes are still the first step.
Can omeprazole cause birth defects?
There’s no strong evidence that omeprazole causes birth defects. Large studies have not found a clear link between omeprazole use in pregnancy and major congenital abnormalities. However, one study suggested a possible association with childhood asthma when used in the first trimester. Because of this, it’s reserved for cases where other treatments fail. Always use it under medical supervision.
Why was Zantac taken off the market?
Ranitidine (Zantac) was pulled from the market in April 2020 because testing found it contained NDMA, a chemical that can cause cancer with long-term exposure. Even though it was once considered safe in pregnancy, it’s no longer available anywhere due to this contamination risk. Don’t use old bottles or try to buy it online.
Are natural remedies like ginger safe for pregnancy heartburn?
Ginger tea and ginger candies are generally considered safe and may help ease nausea and mild heartburn. But don’t rely on them alone if your symptoms are severe. There’s no standard dose, and some ginger supplements may interact with other medications. Always check with your provider before using any herbal remedy, even if it’s labeled “natural.”
Ian Glover
My name is Maxwell Harrington and I am an expert in pharmaceuticals. I have dedicated my life to researching and understanding medications and their impact on various diseases. I am passionate about sharing my knowledge with others, which is why I enjoy writing about medications, diseases, and supplements to help educate and inform the public. My work has been published in various medical journals and blogs, and I'm always looking for new opportunities to share my expertise. In addition to writing, I also enjoy speaking at conferences and events to help further the understanding of pharmaceuticals in the medical field.
13 Comments
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Frank Dahlmeyer
November 20, 2025 AT 01:45Look, I get it - heartburn is the worst part of pregnancy, and honestly, I’m surprised more people don’t talk about how it feels like your stomach is trying to escape through your throat while you’re trying to nap at 3 a.m. I’ve been through two pregnancies, and I can tell you this: Tums are the MVP, no contest. But here’s the thing - if you’re on them every day, you’re basically turning your body into a calcium factory, and your kidneys? They’re not thrilled. I had a friend who developed kidney stones because she thought ‘it’s just Tums’ - turns out, it’s not just a candy. And famotidine? Absolute lifesaver after week 20. I started it when Tums stopped working, and I swear I could breathe again. PPIs? Only if you’re literally crying over your dinner. And please, for the love of all that is holy, don’t touch Zantac. Even if you find a bottle in your mom’s cabinet from 2018, throw it out. It’s not medicine anymore - it’s a science experiment gone wrong.
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Reema Al-Zaheri
November 20, 2025 AT 11:19It is important to note that while calcium carbonate is generally safe, excessive intake may lead to hypercalcemia, particularly in those with renal impairment or those taking vitamin D supplements concurrently. Furthermore, magnesium hydroxide, while effective, may cause diarrhea in susceptible individuals, and aluminum-containing antacids may interfere with phosphate absorption. The use of famotidine is supported by multiple cohort studies, including a 2018 Danish registry analysis, which found no significant increase in major congenital malformations. Omeprazole, while classified as Category C, has been used in over 10,000 pregnancies without consistent evidence of teratogenicity; however, the JAMA Pediatrics association with childhood asthma warrants caution, particularly in the first trimester. Always consult with a maternal-fetal medicine specialist before initiating long-term therapy.
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Derron Vanderpoel
November 22, 2025 AT 11:06I took Tums like candy for three months straight. I thought I was being smart. I was NOT. I ended up constipated to the point I had to go to urgent care. My OB looked at me like I’d just confessed to eating a whole cake at 2 a.m. and said, ‘Honey, you’re not a rock.’ I cried. Then I switched to famotidine. And now? I can eat pizza. I can sleep. I can live. Don’t be me. Please. 😭
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Timothy Reed
November 22, 2025 AT 11:28This is a well-structured and evidence-based summary. The distinction between first-line, second-line, and third-line therapies is clinically accurate and aligns with ACOG and SMFM guidelines. The emphasis on lifestyle modifications as the cornerstone of management is appropriate and should be reinforced. The caution regarding first-trimester exposure is prudent. The inclusion of specific agent names, mechanisms, and contraindications enhances utility for both patients and providers. Well done.
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Christopher K
November 23, 2025 AT 10:56Oh wow. So now we’re giving pregnant women a whole damn pharmacy manual just to eat a sandwich? What’s next? A permit to burp? I’m from the U.S., and I’ve seen my mom take Tums like they were Skittles in the ‘80s - no doctor, no problem. Now we’re treating pregnancy like it’s a nuclear reactor? Grow up. If you’re scared of Tums, maybe you shouldn’t be pregnant. Just saying.
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harenee hanapi
November 23, 2025 AT 13:41Okay but have you considered that maybe your heartburn isn’t just heartburn? Maybe it’s your soul crying out because you’re not living your truth? I had this one friend who took Zantac and then her baby cried for three days straight. The universe was sending her a message. I tried lavender oil and chanting. It worked. Tums? That’s just suppressing the energy. You need to align your chakras. Also, I read a blog that said PPIs cause autism. I’m not saying it’s true, but… have you thought about it?
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Christopher Robinson
November 24, 2025 AT 18:54Big thanks for this! 🙌 I was terrified to take anything, but now I feel way more confident. I’ve been using Tums 3x a day and sleeping with 3 pillows - total game changer. Also, ginger tea + lemon water in the morning? Magic. Just don’t forget to tell your doc if you’re using anything, even if it’s ‘just tea.’ You’re not being paranoid - you’re being smart. 💪
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James Ó Nuanáin
November 26, 2025 AT 04:40It is, of course, entirely unsurprising that American medical guidance continues to prioritize pharmacological intervention over traditional British approaches, which have long emphasized dietary moderation, posture, and the avoidance of citrus - a practice dating back to the 19th century. One wonders whether the proliferation of antacids reflects a cultural aversion to discomfort rather than genuine medical necessity. The notion that a calcium supplement can be simultaneously a remedy and a nutritional aid is, frankly, a marketing triumph - not a clinical revelation. And yet, here we are.
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Kara Binning
November 26, 2025 AT 18:08Ugh. I just spent 2 hours reading this like it’s a thesis. Can we just agree that Tums = good? And Zantac = bad? And that if you’re not taking anything, you’re just suffering for no reason? I took PPIs. My kid is fine. My heartburn is gone. You’re all overthinking it. I’m not a lab rat. I’m a pregnant lady who wants to sleep. That’s it.
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river weiss
November 28, 2025 AT 08:43Thank you for this comprehensive overview. I’m a midwife, and I’ve shared this with every patient I’ve seen this month. The breakdown of antacids, H2 blockers, and PPIs is spot-on. I especially appreciate the emphasis on avoiding aluminum/magnesium trisilicate - many patients don’t realize those are even in some OTC products. Also, the note about first-trimester caution is critical. I always say: ‘If you can manage it with posture and meals, do it. If you can’t, you’re not weak - you’re human.’ And yes - tell your provider everything. Even the ginger chews.
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Brian Rono
November 28, 2025 AT 22:29Let’s be real - this whole ‘safe during pregnancy’ thing is a corporate smokescreen. Tums? Made by a pharma giant that also makes opioids. Famotidine? Developed by a company that got fined $1.2 billion for hiding side effects. Omeprazole? The same drug that got pulled in Europe for causing vitamin B12 deficiency in seniors. You think they care if your baby’s fine? They care if you keep buying. This isn’t medicine - it’s a subscription service for anxiety. Go eat a banana. Sit up. Breathe. You don’t need a pill to be a parent. You need courage.
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Steve and Charlie Maidment
November 30, 2025 AT 22:15So… I read all of this. And I still don’t know if I can eat tacos. Like, I’m 28 weeks. I had Tums yesterday. I took famotidine last week. I’m not sure if I’m allowed to have both. Or if I’m supposed to wait 4 hours between them. Or if I should just give up on tacos forever. Also, why is everyone so obsessed with the first trimester? I didn’t even know I was pregnant until I was 10 weeks. Did I ruin my baby? I’m not even mad. Just confused. And hungry.
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Dana Dolan
November 19, 2025 AT 15:33Just took Tums for the third time today and felt like a genius. My doctor said it’s fine, and honestly? I’m not touching anything else. Calcium bonus? Yes please. Also, I’m sleeping upright now like a king. Worth it.
Also, ginger tea is my new best friend. Not magic, but it helps.