Can Tums (calcium carbonate) be given to a 13-week gestation pregnant female with severe heartburn?

Calcium Carbonate (Tums) for Heartburn in Pregnancy

Yes, calcium carbonate (Tums) can safely be given to a 13-week gestation pregnant female with severe heartburn. 1

First-Line Management for Heartburn in Pregnancy

Heartburn is a common condition during pregnancy, affecting approximately two-thirds of pregnant women 2. The primary cause is decreased lower esophageal sphincter pressure due to hormonal changes, particularly increased progesterone levels 2.

Treatment should follow a step-up approach:

Step 1: Non-Pharmacological Approaches

• Lifestyle and dietary modifications should be the initial management 3:
  • Small, frequent meals 4
  • Avoiding spicy, fatty, acidic, and fried foods 4
  • Avoiding lying down immediately after eating 2
  • Elevating the head of the bed 2

Step 2: First-Line Pharmacological Treatment

• Calcium-containing antacids (like Tums) are the preferred first-line medication treatment 3
• Calcium carbonate is considered safe during pregnancy according to FDA labeling (which recommends consulting a healthcare professional before use) 1
• Antacids provide quick relief by neutralizing stomach acid and are not systemically absorbed, making them safe for the fetus 5

Step 3: If Symptoms Persist

• Sucralfate 1g three times daily can be added if antacids alone are insufficient 3
• Histamine-2 receptor antagonists (H2RAs) like ranitidine may be used as third-line therapy 2, 6
• Proton pump inhibitors should be reserved for intractable symptoms or complicated reflux disease 6

Efficacy and Safety

• Pharmaceutical treatments (including antacids) are more effective than placebo for complete heartburn relief in pregnancy (RR 1.85,95% CI 1.36 to 2.50) 7
• Calcium carbonate antacids have the additional benefit of providing supplemental calcium, which may be beneficial during pregnancy 3
• The safety profile of calcium carbonate in pregnancy is well-established, with minimal systemic absorption and no evidence of teratogenicity 5

Important Considerations

• Severe, persistent heartburn may require evaluation to rule out complications, though these are rare during pregnancy 2
• Calcium carbonate may cause constipation in some pregnant women, which is already a common issue during pregnancy 8
• If constipation occurs, increasing dietary fiber intake to approximately 30g/day and adequate fluid intake can help 8

Monitoring and Follow-up

• If symptoms persist despite calcium carbonate, reevaluation is necessary to consider stepping up therapy 3
• Severe symptoms with warning signs (dysphagia, odynophagia, weight loss, or gastrointestinal bleeding) would warrant further investigation 2

Calcium carbonate antacids like Tums represent an effective and safe first-line pharmacological treatment for heartburn during pregnancy, including at 13 weeks gestation 1, 3.