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 against the stomach, and pregnancy hormones relax the valve that keeps acid down. It’s not your imagination. You’re not alone. And you don’t have to just suffer through it.
What’s Safe to Take for Heartburn While Pregnant?
The good news? Several over-the-counter and prescription options are considered safe when used correctly. But not all heartburn meds are created equal. Some are first-line choices. Others should only be used if nothing else works. And a few? You should avoid them entirely.
Let’s start with the safest option: calcium carbonate antacids. Brands like Tums, Rolaids, and some generic versions work by neutralizing stomach acid right where it’s burning. They start working in minutes and last a couple of hours. What makes them stand out? They’re not just heartburn relief-they’re a source of calcium. Your baby needs calcium to build bones. You need it to keep your own bones strong. So taking Tums isn’t just treating a symptom-it’s helping both of you.
But not all antacids are safe. Avoid any that contain aluminum or magnesium trisilicate. Some older formulas, like Mylanta, also include aluminum hydroxide. While aluminum isn’t outright dangerous, it can build up in the body over time, and there’s not enough data to say it’s completely safe during pregnancy. Magnesium-based antacids can cause diarrhea, which you definitely don’t want when you’re already dealing with bloating and constipation.
When Antacids Aren’t Enough: H2 Blockers
If chewing a few Tums every few hours isn’t cutting it, your provider might suggest an H2 blocker. These work differently. Instead of neutralizing acid, they reduce how much your stomach makes. Famotidine (Pepcid) is the go-to here. It’s been studied in pregnant women for decades. No major red flags. It starts working in about an hour and lasts up to 12 hours-much longer than antacids.
Don’t use ranitidine (Zantac). It was pulled from the market in 2020 because it was found to contain NDMA, a probable carcinogen. Even if you still have an old bottle lying around, don’t take it. It’s not worth the risk.
Other H2 blockers like cimetidine (Tagamet) are also considered safe, but famotidine is preferred because it has fewer side effects. Some people get headaches or dizziness with H2 blockers, but that’s rare-only about 3-5% of users. If you feel off after taking it, stop and talk to your provider.
PPIs: The Strongest Option, But Use with Caution
If you’re still having heartburn after trying antacids and H2 blockers, your provider might consider a proton pump inhibitor (PPI). These are the strongest acid reducers available. Omeprazole (Prilosec) is the most studied PPI in pregnancy. Lansoprazole (Prevacid) and pantoprazole (Protonix) are also used, but there’s less data on them.
PPIs work by shutting down the acid-producing pumps in your stomach lining. They take longer to kick in-1 to 4 hours-but they last all day. That’s why they’re often taken once daily, usually before breakfast.
Here’s the catch: while no major birth defects have been linked to PPIs, some studies have raised questions. A 2019 study in JAMA Pediatrics found a small increase in childhood asthma among kids whose mothers took PPIs during the first trimester. But remember-this was an association, not proof of cause. Other factors could be involved. Still, because of this, doctors usually hold off on PPIs until after the first 12 weeks, and only if symptoms are severe and other treatments have failed.
What You Should NEVER Take
There are a few heartburn meds that are outright off-limits during pregnancy.
- Pepto-Bismol and other bismuth subsalicylate products: These contain salicylates, which are related to aspirin. Aspirin during pregnancy can affect fetal development and increase bleeding risk during delivery.
- Aluminum-containing antacids in large or long-term doses: Too much aluminum might affect the baby’s nervous system, though the risk is low with occasional use.
- Ranitidine (Zantac): Already pulled from shelves. Don’t risk it.
Also avoid herbal remedies unless your provider says it’s okay. Some teas or supplements marketed for digestion aren’t tested in pregnancy and could contain unknown compounds.
Timing Matters: The First Trimester Is Critical
Doctors are extra cautious during the first trimester-weeks 1 to 14. That’s when your baby’s organs are forming. Even safe medications are usually avoided unless absolutely necessary.
If you’re in your first trimester and heartburn is driving you crazy, start with lifestyle changes. Eat smaller meals. Don’t lie down for at least three hours after eating. Avoid spicy, fried, or acidic foods like citrus, tomatoes, and coffee. Sleep with your head slightly elevated. These aren’t just tips-they’re proven ways to reduce reflux without a pill.
After week 14, if symptoms persist, that’s when most providers feel comfortable recommending calcium carbonate antacids. Then H2 blockers. Then, only if needed, PPIs.
How Much Is Too Much?
Even safe meds can become risky if overused.
For calcium carbonate antacids, the typical maximum is 1,500 mg per dose, up to four times a day. That’s about four to six Tums 500 mg tablets in 24 hours. Long-term daily use-especially beyond a few weeks-can lead to high calcium levels, kidney stones, or even interfere with iron absorption. If you’re taking them every day for more than a month, talk to your provider.
For famotidine, the usual dose is 10-20 mg once or twice daily. Don’t go over the label unless your provider says so. For omeprazole, 20 mg once daily is standard. Higher doses aren’t usually needed in pregnancy.
Always check the label. Some store brands have different strengths. What’s safe on one product might be too much on another.
What If It Still Hurts?
Heartburn that doesn’t improve with meds, or that comes with vomiting, weight loss, trouble swallowing, or chest pain that radiates to your arm or jaw? That’s not normal. It could be something else-like a stomach ulcer, gallbladder issues, or even a heart problem. Don’t assume it’s just pregnancy. Call your provider. Get checked.
Also, if you’re taking heartburn meds and still waking up at night coughing or feeling like you’re choking, that’s a sign your reflux is severe. Your provider might refer you to a gastroenterologist who specializes in pregnancy-related digestive issues.
What About Breastfeeding?
Good news: most of these medications are safe while breastfeeding. Calcium carbonate doesn’t enter breast milk in any meaningful amount. Famotidine passes into breast milk in tiny amounts, but studies show no effect on infants. Omeprazole is also considered safe-only about 1% of the maternal dose ends up in breast milk.
Still, always tell your provider you’re breastfeeding. They’ll pick the option with the lowest possible exposure to your baby.
Bottom Line: Start Simple, Stay Smart
Heartburn in pregnancy is common. It doesn’t mean you’re doing anything wrong. But you don’t have to just endure it.
Start with lifestyle changes. Eat smaller meals. Don’t eat late. Prop yourself up at night. If that’s not enough, reach for Tums or another calcium carbonate antacid. If you still need more, ask your provider about famotidine. Save PPIs for when nothing else works.
And always, always check with your provider before taking anything-even if it’s on the shelf and labeled ‘safe.’ Your body, your baby, and your peace of mind are worth the extra step.
Can I take Tums every day while pregnant?
Yes, but not indefinitely. Tums (calcium carbonate) are safe for occasional daily use during pregnancy and even provide extra calcium. But taking more than 1,500 mg per dose or more than four doses a day for longer than a few weeks can lead to high calcium levels or interfere with iron absorption. If you need heartburn relief daily for more than a month, talk to your provider about other options.
Is omeprazole safe during pregnancy?
Omeprazole is considered one of the safest proton pump inhibitors (PPIs) in pregnancy, especially after the first trimester. It’s been studied the most and has no clear link to birth defects. However, some research suggests a possible small increase in childhood asthma risk when used in the first 12 weeks. Doctors usually recommend it only if antacids and H2 blockers haven’t worked and symptoms are severe.
Why was Zantac taken off the market?
Ranitidine (Zantac) was removed from the U.S. market in April 2020 because testing found it contained NDMA, a chemical linked to cancer in animals and suspected in humans. Even though it was once considered safe in pregnancy, the contamination risk made it too dangerous to keep selling. Don’t use any leftover bottles-switch to famotidine (Pepcid) instead.
Can I take Pepto-Bismol for heartburn while pregnant?
No. Pepto-Bismol contains bismuth subsalicylate, which is related to aspirin. Aspirin during pregnancy can increase bleeding risk and affect fetal development. Even occasional use is not recommended. Stick to calcium carbonate antacids or approved H2 blockers instead.
When should I see a doctor about heartburn in pregnancy?
See your provider if heartburn doesn’t improve with lifestyle changes and over-the-counter meds, if you’re vomiting frequently, losing weight, having trouble swallowing, or feeling chest pain that spreads to your arm or jaw. These could be signs of something more serious, like an ulcer, gallbladder disease, or even a heart issue. Don’t wait.
Are heartburn meds safe while breastfeeding?
Yes. Calcium carbonate antacids, famotidine (Pepcid), and omeprazole (Prilosec) are all considered safe during breastfeeding. Only tiny amounts pass into breast milk, and studies show no harm to babies. Still, always tell your provider you’re nursing so they can pick the lowest effective dose.