A: Pregnancy does a number on your intestinal tract. For starters, the hormones of pregnancy tend to relax the muscle controlling the flow of food from the esophagus to the stomach. Instead of just letting the food in, the muscle (we call it a sphincter) loosens, allowing acid from the stomach to leak backward into the esophagus. This creates inflammation and burning pain in the esophagus, which you feel in the mid-chest. Remember, Paula, anytime you eat, your stomach will respond by producing acid to break down the food. Unfortunately, some of the acid will irritate the esophagus and trigger more heartburn, especially awhile after eating.

Treatment can help reduce or prevent heartburn. The first line of treatment is an antacid. These medications are safe during pregnancy and reduce heartburn's symptoms. Tums, Rolaids and Mylanta are a few examples of antacids. I suggest that my patients take the antacids when they get symptoms. If the heartburn happens after meals or at bedtime, I ask my patients to take an antacid 30 minutes after each meal and before bedtime. This seems to do the job.

Troubling cases of heartburn can be managed by using over-the-counter Zantac or Tagamet. Both of these medications have been studied during pregnancy and appear to be safe for mother and baby, but you should never take any medication during pregnancy without first clearing it with your practitioner. I suggest speaking with your practitioner if the simple treatments fail to alleviate your symptoms. Occasionally, a patient will need to see a gastroenterologist during pregnancy to help manage her condition.