Heartburn Medications in Pregnancy: Safe Options Like 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. Your growing baby is pushing up on your stomach, and hormones like progesterone are relaxing the valve that keeps stomach acid where it belongs. The result? Burning chest, sour taste, and sleepless nights. You want relief. But you also don’t want to risk your baby’s health. So what’s actually safe?

First-Line Defense: Calcium Carbonate Antacids

Other antacids like Mylanta (which contains aluminum hydroxide and magnesium hydroxide) are also considered safe. But avoid anything with aluminum trisilicate or magnesium trisilicate. These can build up in your system and aren’t worth the risk. And don’t use Pepto-Bismol. It contains bismuth subsalicylate, which acts like aspirin-and aspirin during pregnancy can cause complications.

How much is too much? Stick to the label. Most experts suggest no more than 500-1500 mg of calcium carbonate every 4 to 6 hours as needed. Don’t go over that. Long-term, high-dose use can lead to constipation, kidney stones, or imbalances in your electrolytes. And if you’re already taking prenatal vitamins with calcium, you might be getting enough already. Talk to your provider before making this a daily habit.

Second-Line: H2 Blockers Like Famotidine (Pepcid)

If antacids aren’t cutting it, your doctor might suggest an H2 blocker. These work differently. Instead of neutralizing acid, they tell your stomach to produce less of it. Famotidine (Pepcid) is the most commonly recommended in this group. It kicks in within an hour and lasts up to 12 hours. That means you can take it before bed or before a big meal and stay comfortable longer than with antacids alone.

What about ranitidine (Zantac)? It’s off the market. The FDA pulled it in 2020 after finding traces of NDMA, a potential carcinogen. Even if you still have some in your cabinet, don’t use it. Stick with famotidine. It’s been studied in thousands of pregnant women and shows no increased risk of birth defects or complications.

Side effects are rare but possible. A small number of users report headaches, dizziness, or nausea. If you feel off after taking it, stop and call your provider. Don’t assume it’s just pregnancy. Also, avoid cimetidine (Tagamet). It’s less studied in pregnancy and can interfere with how other medications are processed in your body.

Third-Line: Proton Pump Inhibitors (PPIs) Like Omeprazole

PPIs are the strongest option. They shut down the acid pumps in your stomach lining entirely. Omeprazole (Prilosec) and lansoprazole (Prevacid) are the two most studied in pregnancy. They take longer to work-1 to 4 hours-but their effects last over 24 hours. That’s why they’re often used for persistent, severe heartburn that doesn’t respond to antacids or H2 blockers.

Here’s the catch: while most research shows they’re safe, there are still questions. A 2019 study in JAMA Pediatrics found a small link between PPI use in the first trimester and a slightly higher chance of childhood asthma. But it didn’t prove cause and effect. Other studies haven’t found the same link. The bottom line? Doctors won’t prescribe PPIs unless they really need to. If you’ve tried everything else and you’re still in pain, the benefit of relief might outweigh the small, uncertain risk.

Long-term use of PPIs can affect calcium absorption and increase the risk of bone fractures later in life. That’s not a big concern for a few weeks of use during pregnancy, but if you’re on them for months, your provider should monitor you. Don’t self-prescribe. Always get medical approval.

What to Avoid Completely

Some medications are a hard no. Pepto-Bismol is one-because of the aspirin-like ingredient. So is Alka-Seltzer. It contains aspirin and sodium bicarbonate, which can raise blood pressure and affect fetal development. Avoid any product with “salicylate” or “aspirin” in the ingredients.

Also skip herbal remedies unless your provider says it’s okay. Ginger is often recommended for nausea, but its safety for heartburn isn’t well studied in pregnancy. Same with licorice root, aloe vera, and chamomile. They might seem natural, but “natural” doesn’t mean safe during pregnancy.

Timing Matters: First Trimester Caution

The first 14 weeks are the most sensitive. That’s when your baby’s organs are forming. Even safe medications should be avoided if possible during this time. Your body is doing a lot of heavy lifting already. If you can manage heartburn with lifestyle changes, do it.

After week 14, the risk drops significantly. That’s when most providers feel comfortable recommending antacids or H2 blockers. PPIs are still used cautiously, but if you’re struggling with pain that’s affecting your sleep or eating, they’re an option.

Lifestyle Changes: The Real First Step

Medications help-but they’re not the only tool. In fact, they’re meant to support what you’re already doing. Here’s what works:

• Eat smaller meals, 5-6 times a day instead of 3 big ones.
• Avoid spicy, fatty, fried, or acidic foods-citrus, tomatoes, coffee, chocolate, and carbonated drinks are common triggers.
• Don’t lie down for at least 3 hours after eating. Gravity helps keep acid down.
• Wear loose clothing. Tight waistbands press on your stomach.
• Elevate your head while sleeping. Use pillows or a wedge to raise your upper body by 6-8 inches.
• Drink fluids between meals, not during. Too much liquid during eating can overfill your stomach.

These aren’t just tips-they’re evidence-based strategies. Studies show that combining lifestyle changes with medication gives the best results. Many women find they need less medicine-or none at all-once they adjust their habits.

When to Call Your Doctor

Heartburn is normal. But some symptoms aren’t. Call your provider if:

• Your heartburn wakes you up at night regularly.
• You’re vomiting blood or your vomit looks like coffee grounds.
• You’re losing weight or having trouble swallowing.
• You have chest pain that radiates to your arm, jaw, or back.

These could signal something more serious-like GERD complications, a hiatal hernia, or even heart issues. Don’t assume it’s just pregnancy. Get it checked.

What About Breastfeeding?

Good news: most of these medications are safe while breastfeeding. Calcium carbonate doesn’t enter breast milk in meaningful amounts. Famotidine passes into breast milk in tiny amounts, and studies show no effect on babies. Omeprazole is also considered low risk. The amount your baby gets through milk is far below what they’d get from direct treatment.

Still, if you’re taking any medication long-term while nursing, talk to your provider. Watch your baby for unusual fussiness, diarrhea, or poor feeding. Most won’t have any issues, but it’s good to stay alert.

Bottom Line: Safer Choices, Smarter Use

Heartburn in pregnancy is common, treatable, and rarely dangerous. You don’t have to suffer. But you also don’t need to guess what’s safe. Start with lifestyle changes. If you need more, reach for calcium carbonate antacids like Tums. If that’s not enough, ask about famotidine. Save PPIs for when nothing else works-and only with your doctor’s okay.

Every pregnancy is different. What works for one person might not work for another. That’s why talking to your provider isn’t just a good idea-it’s essential. They know your history, your health, and your baby’s needs. Let them help you choose the right path.