I'm seven months pregnant and have severe heartburn every day. My doctor told me to take Tums, but that's not working. I'm in pain all the time, and I vomit sometimes too. What can I do to feel better without hurting the baby?

K.

Heartburn is extremely common in pregnancy. Up to one in three women will experience heartburn during some part of the pregnancy. While we are not certain of the cause, it is probably related to a change in your hormonal balance. Another factor that may be involved is the pressure on your diaphragm (breathing muscle) generated by the growing baby.

Your doctor has correctly recommended that you use an antacid, such as Tums, because antacids are not absorbed into the body and are the safest for your baby. You might try a stronger antacid such as Maalox, Mylanta or Gaviscon. The latter is a combination of a weak antacid and a compound called alginate that may create a foamy layer on top of the acid and prevent it from burning your throat tissues.

If you have heartburn at night, you should attempt to sleep with the head of the bed elevated six inches, by placing blocks under the head of the bed or by sleeping on a wedge designed to elevate your shoulders. If at all possible, you should eat multiple small meals, as a full stomach increases the risk of heartburn from gastroesophageal reflux.

There are no prescription drugs that have been approved by the Food and Drug Administration for use in pregnancy, but in the appropriate clinical circumstances and in the third trimester your doctor may wish to try a drug called sucralfate (Carafate) or an H2-receptor blocker (Zantac, Tagamet, Pepcid). Clinical experience suggests that these may be safe and effective in pregnancy, but I caution you that these should be used only after consultation with physician.

There is no definite association of heartburn during pregnancy and the future development of chronic heartburn, so there is every possibility that your heartburn will disappear after the baby is born.