Heartburn Medications in Pregnancy: Safe Options Like Tums, Pepcid, and Prilosec
Heartburn during pregnancy isn’t just uncomfortable-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 feels like a burning wave behind your breastbone, often worse after eating or lying down. You want relief. But you also don’t want to risk your baby’s health. So what can you safely take?
First-Line Defense: Calcium Carbonate Antacids
The safest place to start is with antacids made from calcium carbonate. Brands like Tums, Rolaids, and some store generics work by neutralizing stomach acid right away. They don’t stop acid production-they just mop it up. Effects last about 1 to 2 hours, which is fine for occasional flare-ups.
Why calcium carbonate? Because your body needs calcium during pregnancy-to build your baby’s bones and teeth, and to keep your own strong. Tums gives you relief and a little extra calcium at the same time. That’s why doctors recommend it as the first option. The American College of Obstetricians and Gynecologists (ACOG) and major clinics like Cleveland Clinic both list calcium-based antacids as safe throughout pregnancy.
But not all antacids are equal. Avoid products with aluminum hydroxide or magnesium trisilicate. Aluminum can build up in your system and may affect your baby’s development. Magnesium trisilicate has been linked to rare but serious side effects. Also, skip Pepto-Bismol. It contains bismuth subsalicylate, which breaks down into something similar to aspirin-and aspirin is a hard no during pregnancy.
How much is too much? Stick to the label. For Tums, that’s usually 2 to 4 tablets every 4 to 6 hours, not more than 10 tablets in 24 hours. Long-term, daily use-even of Tums-can lead to too much calcium in your blood, which might cause kidney stones or interfere with iron absorption. If you’re taking them every day for more than a week, talk to your provider.
Second-Line: H2 Blockers Like Pepcid
If antacids aren’t doing enough, the next step is an H2 blocker. These work differently. Instead of neutralizing acid, they tell your stomach to make less of it. The most studied and recommended option is famotidine, sold as Pepcid.
Famotidine starts working in about an hour and lasts up to 12 hours. That makes it great for nighttime heartburn or if you know you’re going to eat something spicy. It’s been used safely in pregnancy for decades. Studies tracking thousands of pregnant women show no increase in birth defects or complications when famotidine is taken as directed.
What about Zantac? Don’t use it. Ranitidine, the active ingredient in Zantac, was pulled from the U.S. and Australian markets in 2020 because it was found to contain NDMA, a probable carcinogen. Even if you still have old bottles lying around, throw them out. Stick with famotidine.
Other H2 blockers like cimetidine (Tagamet) are also considered safe in pregnancy, but famotidine is preferred because it has fewer drug interactions and less risk of side effects like headaches or dizziness, which affect about 3-5% of users.
Still, don’t just start taking H2 blockers without checking in. Your provider might suggest using them only after trying antacids for a few days. And avoid long-term daily use unless necessary. The goal is to use the least amount for the shortest time possible.
Third-Line: Proton Pump Inhibitors (PPIs)
If you’re still struggling with heartburn after antacids and H2 blockers, your doctor might consider a proton pump inhibitor (PPI). These are the strongest acid reducers available over the counter. The most commonly prescribed in pregnancy is omeprazole (Prilosec). Lansoprazole (Prevacid) and pantoprazole (Protonix) are also options.
PPIs block acid production at the source-the proton pumps in your stomach lining. They take longer to kick in-1 to 4 hours-but last a full day or more. That’s why they’re used for persistent, daily heartburn, not just occasional flare-ups.
Is it safe? Most studies say yes. Omeprazole is the most researched PPI in pregnancy. Data from large population studies, including one published in JAMA Pediatrics in 2019, show no clear link to major birth defects. But that same study did find a small possible association between first-trimester PPI use and childhood asthma. It didn’t prove cause and effect, but it’s enough for doctors to be cautious.
Because of this, PPIs are reserved for when other treatments fail. They’re not for quick fixes. If you’re in your first trimester and your heartburn is new, your provider will likely tell you to hold off on PPIs unless your symptoms are severe. The first 14 weeks are when your baby’s organs are forming, and even small risks are weighed more heavily.
Long-term PPI use-even outside pregnancy-can affect calcium and magnesium absorption, increase risk of bone fractures, and alter gut bacteria. During pregnancy, these concerns are monitored closely. Your doctor will likely prescribe the lowest effective dose and re-evaluate every few weeks.
What to Avoid Completely
Not all heartburn remedies are created equal-and some are outright dangerous during pregnancy.
- Pepto-Bismol: Contains salicylates (like aspirin). Risk of bleeding complications and fetal harm.
- Ranitidine (Zantac): Withdrawn due to cancer-causing contaminants. Not safe at any stage.
- Aluminum-based antacids: May accumulate in the body and affect fetal development.
- Herbal remedies: Many are unregulated. Chamomile, ginger, and licorice root sound natural, but their safety in pregnancy isn’t proven.
- Over-the-counter combination products: Products that say “heartburn + gas + nausea” often include multiple active ingredients, some unsafe. Always read the label.
If you’re unsure about a product, check the ingredients. If you see “bismuth subsalicylate,” “aspirin,” “naproxen,” or “ibuprofen,” put it back. Even if it’s labeled “for upset stomach,” it’s not safe for pregnancy.
Lifestyle Changes Work-And They’re First
Medications help, but they’re not the only tool. In fact, most experts agree: start with lifestyle changes before reaching for pills.
- Eat smaller meals, 5-6 times a day instead of 3 big ones.
- Avoid trigger foods: spicy dishes, fried foods, chocolate, caffeine, citrus, tomatoes.
- Don’t lie down for at least 3 hours after eating.
- Wear loose clothing. Tight waistbands push on your stomach.
- Elevate your head while sleeping. Use pillows or a wedge under your mattress.
- Don’t smoke. Smoking weakens the lower esophageal sphincter and increases acid reflux.
These aren’t just “tips.” They’re evidence-backed strategies that reduce heartburn in over 70% of pregnant women, according to studies cited by the Cleveland Clinic. Many women find that combining lifestyle changes with occasional Tums gives them full control without needing stronger meds.
When to Call Your Doctor
Heartburn is normal. But if you’re experiencing any of these, call your provider right away:
- Difficulty swallowing or pain when swallowing
- Vomiting blood or black, tarry stools
- Unexplained weight loss
- Chest pain that radiates to your arm, neck, or jaw
- Heartburn that wakes you up at night or doesn’t improve with meds
These could signal something more serious-like GERD complications, esophagitis, or even heart issues. Don’t assume it’s just pregnancy. Get it checked.
What About Breastfeeding?
If you’re breastfeeding, most of these medications are still considered safe. Calcium carbonate passes into breast milk in tiny, harmless amounts. Famotidine is also low-risk-only a small fraction gets into milk. Omeprazole is excreted in breast milk, but at levels far below what would affect a baby.
Still, if you’re nursing, tell your provider. They might adjust your dose or suggest timing your meds right after a feeding to minimize exposure. The bottom line: you don’t have to suffer through heartburn while breastfeeding. Safe options exist.
Final Takeaway
Heartburn in pregnancy doesn’t mean you have to suffer. You have options-and they’re ranked by safety. Start with lifestyle changes. If you need more, reach for calcium carbonate antacids like Tums. If that’s not enough, ask about famotidine (Pepcid). Save PPIs like omeprazole for when nothing else works, and only under your doctor’s guidance.
Always check with your provider before taking anything-even if it’s “just an antacid.” What’s safe for one person might not be right for you. Your pregnancy is unique. So should your treatment plan be.