Digestive Diseases and Sciences

, Volume 55, Issue 6, pp 1610–1614 | Cite as

Heartburn and Regurgitation in Pregnancy: The Effect of Fat Ingestion

  • Valesca Dall’Alba
  • Fernando FornariEmail author
  • Cláudio Krahe
  • Sidia Maria Callegari-Jacques
  • Sérgio Gabriel  Silva de Barros
Original Article



Reflux symptoms are common in pregnancy, but their association with fat ingestion is unclear.


To investigate an association of dietary fats with heartburn and regurgitation in pregnancy.


This is a prospective study in which 89 pregnant women (gestational age 34 ± 4 weeks) attending a low-risk prenatal outpatient clinic were asked to provide information on the frequency they experienced heartburn and regurgitation. Fat ingestion was estimated by means of a 24-h diet record. Symptomatic patients were compared with those with no reflux symptoms (n = 20).


Heartburn once a week or more often occurred in 56 of the 89 patients (63%). The ingested amount of polyunsaturated fatty acids was higher in patients with heartburn (11.2 ± 6.4 vs. 7.7 ± 3.5 mg; P = 0.022) than in controls after adjusting for age, gain weight during pregnancy, ingestion of caffeine and vitamin C, and total energetic intake. The ingestion of monounsaturated fatty acids was higher in patients with heartburn, but with a borderline statistical significance (16.1 ± 11 vs. 11.8 ± 6.5 mg; P = 0.061). No association was observed between the consumption of fats and regurgitation.


This study suggests that heartburn in the third trimester of pregnancy is associated with the ingestion of polyunsaturated fatty acids.


Dietary fats Fatty acids Gastroesophageal reflux disease Heartburn Pregnancy 



This study was supported by grants from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), and Fundo de Incentivo à Pesquisa e Eventos (FIPE)/Hospital de Clínicas de Porto Alegre, Brazil.


  1. 1.
    Dowswell T, Neilson JP. Interventions for heartburn in pregnancy. Cochrane Database Syst Rev. 2008;(4):CD007065.Google Scholar
  2. 2.
    Knudsen A, Lebech M, Hansen M. Upper gastrointestinal symptoms in the third trimester of the normal pregnancy. Eur J Obstet Gynecol Reprod Biol. 1995;60:29–33.CrossRefPubMedGoogle Scholar
  3. 3.
    Marrero JM, Goggin PM, de Caestecker JS, Pearce JM, Maxwell JD. Determinants of pregnancy heartburn. Br J Obstet Gynaecol. 1992;99:731–734.PubMedGoogle Scholar
  4. 4.
    Al-Amri SM. Twenty-four hour pH monitoring during pregnancy and at postpartum: a preliminary study. Eur J Obstet Gynecol Reprod Biol. 2002;102:127–130.PubMedGoogle Scholar
  5. 5.
    Ali RA, Egan LJ. Gastroesophageal reflux disease in pregnancy. Best Pract Res Clin Gastroenterol. 2007;21:793–806.CrossRefPubMedGoogle Scholar
  6. 6.
    Bainbridge ET, Nicholas SD, Newton JR, Temple JG. Gastro-oesophageal reflux in pregnancy. Altered function of the barrier to reflux in asymptomatic women during early pregnancy. Scand J Gastroenterol. 1984;19:85–89.PubMedGoogle Scholar
  7. 7.
    Baron TH, Richter JE. Gastroesophageal reflux disease in pregnancy. Gastroenterol Clin North Am. 1992;21:777–791.PubMedGoogle Scholar
  8. 8.
    Fisher RS, Roberts GS, Grabowski CJ, Cohen S. Inhibition of lower esophageal sphincter circular muscle by female sex hormones. Am J Physiol. 1978;234:E243–E247.PubMedGoogle Scholar
  9. 9.
    Hey VM, Cowley DJ, Ganguli PC, Skinner LD, Ostick DG, Sharp DS. Gastro-oesophageal reflux in late pregnancy. Anaesthesia. 1977;32:372–377.CrossRefPubMedGoogle Scholar
  10. 10.
    Van Thiel DH, Gavaler JS, Joshi SN, Sara RK, Stremple J. Heartburn of pregnancy. Gastroenterology. 1977;72:666–668.PubMedGoogle Scholar
  11. 11.
    Lind JF, Smith AM, McIver DK, Coopland AT, Crispin JS. Heartburn in pregnancy—a manometric study. Can Med Assoc J. 1968;98:571–574.PubMedGoogle Scholar
  12. 12.
    Richter JE. Review article: the management of heartburn in pregnancy. Aliment Pharmacol Ther. 2005;22:749–757.CrossRefPubMedGoogle Scholar
  13. 13.
    Lewis JH, Weingold AB. The use of gastrointestinal drugs during pregnancy and lactation. Am J Gastroenterol. 1985;80:912–923.PubMedGoogle Scholar
  14. 14.
    Suzuki S, Dennerstein L, Greenwood KM, Armstrong SM, Satohisa E. Sleeping patterns during pregnancy in Japanese women. J Psychosom Obstet Gynaecol. 1994;15:19–26.CrossRefPubMedGoogle Scholar
  15. 15.
    Bor S, Kitapcioglu G, Dettmar P, Baxter T. Association of heartburn during pregnancy with the risk of gastroesophageal reflux disease. Clin Gastroenterol Hepatol. 2007;5:1035–1039.CrossRefPubMedGoogle Scholar
  16. 16.
    Meyer LC, Peacock JL, Bland JM, Anderson HR. Symptoms and health problems in pregnancy: their association with social factors, smoking, alcohol, caffeine and attitude to pregnancy. Paediatr Perinat Epidemiol. 1994;8:145–155.CrossRefPubMedGoogle Scholar
  17. 17.
    Holloway RH, Lyrenas E, Ireland A, Dent J. Effect of intraduodenal fat on lower oesophageal sphincter function and gastro-oesophageal reflux. Gut. 1997;40:449–453.PubMedGoogle Scholar
  18. 18.
    Fox M, Barr C, Nolan S, Lomer M, Anggiansah A, Wong T. The effects of dietary fat and calorie density on esophageal acid exposure and reflux symptoms. Clin Gastroenterol Hepatol. 2007;5:439–444.CrossRefPubMedGoogle Scholar
  19. 19.
    Meyer JH, Lembo A, Elashoff JD, Fass R, Mayer EA. Duodenal fat intensifies the perception of heartburn. Gut. 2001;49:624–628.CrossRefPubMedGoogle Scholar
  20. 20.
    Shapiro M, Green C, Bautista JM, et al. Assessment of dietary nutrients that influence perception of intra-oesophageal acid reflux events in patients with gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2007;25:93–101.PubMedGoogle Scholar
  21. 21.
    El-Serag HB, Satia JA, Rabeneck L. Dietary intake and the risk of gastro-oesophageal reflux disease: a cross sectional study in volunteers. Gut. 2005;54:11–17.CrossRefPubMedGoogle Scholar
  22. 22.
    Centro de Informática em Saúde da Escola Paulista de Medicina. Nutrition Support Program [Computer Program]. Version 2.5 DOS. São Paulo: Escola Paulista de Medicina; 2001.Google Scholar
  23. 23.
    Revicki DA, Wood M, Maton PN, Sorensen S. The impact of gastroesophageal reflux disease on health-related quality of life. Am J Med. 1998;104:252–258.CrossRefPubMedGoogle Scholar
  24. 24.
    Block G, Woods M, Potosky A, Clifford C. Validation of a self-administered diet history questionnaire using multiple diet records. J Clin Epidemiol. 1990;43:1327–1335.CrossRefPubMedGoogle Scholar
  25. 25.
    Faggiano F, Vineis P, Cravanzola D, et al Validation of a method for the estimation of food portion size. Epidemiology. 1992;3:379–382.CrossRefPubMedGoogle Scholar
  26. 26.
    Nebel OT, Castell DO. Lower esophageal sphincter pressure changes after food ingestion. Gastroenterology. 1972;63:778–783.PubMedGoogle Scholar
  27. 27.
    Nebel OT, Castell DO. Inhibition of the lower oesophageal sphincter by fat—a mechanism for fatty food intolerance. Gut. 1973;14:270–274.CrossRefPubMedGoogle Scholar
  28. 28.
    Melone J. Vagal receptors sensitive to lipids in the small intestine of the cat. J Auton Nerv Syst. 1986;17:231–241.CrossRefPubMedGoogle Scholar
  29. 29.
    Sifrim D, Mittal R, Fass R, et al Review article: acidity and volume of the refluxate in the genesis of gastro-oesophageal reflux disease symptoms. Aliment Pharmacol Ther. 2007;25:1003–1017.PubMedCrossRefGoogle Scholar
  30. 30.
    Spence AA, Moir DD, Finlay WE. Observations on intragastric pressure. Anaesthesia. 1967;22:249–256.CrossRefPubMedGoogle Scholar
  31. 31.
    Van Thiel DH, Wald A. Evidence refuting a role for increased abdominal pressure in the pathogenesis of the heartburn associated with pregnancy. Am J Obstet Gynecol. 1981;140:420–422.PubMedGoogle Scholar
  32. 32.
    Broussard CN, Richter JE. Treating gastro-oesophageal reflux disease during pregnancy and lactation: what are the safest therapy options? Drug Saf. 1998;19:325–337.CrossRefPubMedGoogle Scholar
  33. 33.
    Schulze K, Christensen J. Lower sphincter of the opossum esophagus in pseudopregnancy. Gastroenterology. 1977;73:1082–1085.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Valesca Dall’Alba
    • 1
  • Fernando Fornari
    • 1
    • 2
    Email author
  • Cláudio Krahe
    • 3
  • Sidia Maria Callegari-Jacques
    • 4
  • Sérgio Gabriel  Silva de Barros
    • 1
  1. 1.Post-Graduate Program, Sciences in Gastroenterology, School of Medicine and Hospital de Clinicas de Porto AlegreUniversidade Federal do Rio Grande do Sul (UFRGS)Porto AlegreBrazil
  2. 2.School of MedicineUniversidade de Passo FundoPasso FundoBrazil
  3. 3.Department of Gynecology, School of MedicinePontifícia Universidade Católica do Rio Grande do Sul (PUC-RS)Porto AlegreBrazil
  4. 4.Department of Statistics and Post-Graduate Program in Genetics and Molecular BiologyUFRGSPorto AlegreBrazil

Personalised recommendations