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Heartburn in Pregnancy

Ordinarily the oesophagus (food pipe) alerts the stomach (chief cells) to produce acid (HCl) as the swallowed food, called a bolus, mechanically stretch and un-stretch the (smooth) muscles of the food pipe. The production of acid in the stomach is a result of oesophageal mechanical sensations reaching the acid producing cells in the stomach, by spinal reflex.

A women’s higher risk of ligament injury (1) is further increased in pregnancy. Relaxin, the pregnancy hormone, disturbs normal ligament tissue by activating collagenase (2) impacting the hydrostatic tension of collagen (3). This means the ligament’s elastic barrier is altered to facilitate lengthening past where normally possible. The hydrostatic tension of collagen acts like a stopper to tissue lengthening. The diaphragm group of muscles have common tendons (crux) found at the flanks, around the oesophagus, vena cava, aorta and on the lumbar spine.

Pregnancy related Heartburn or dyspepsia occurs in up to 80% of pregnancies (4). The causes of heartburn are a combination of mechanical and hormonal factors (4). The diaphragm is a group of muscles that need to coordinate together with every breath whilst maintaining pressure regulation.

What goes wrong is that the muscular slips of diaphragm can become out of sync and start to stimulate the muscles of the oesophagus, externally. The result is external oesophageal muscular stimulation reaching the acid producing cells of the stomach, just the same as internal stimulation. Making the stomach think there’s food on the way, as you breathe. When the top of the stomach stays open, waiting for food to arrive, stomach acid may reach the unprotected oesophagus.

I have helped many pregnant women with heartburn symptoms by improving the mechanical coordination of their muscles and joints. I begin by looking to balance the core. As mum expands, any previous core imbalances, or the core imbalances that form during expansion, hamper muscular coordination.

In my opinion, there is no need to accept every ache and pain is because you are pregnant (a natural state for adult females). Come and be pleasantly surprised how your uncoordinated diaphragm muscle symptoms can be helped by mechanical interventions. Book a consultation today.

If you are a midwife or a professional doula take a look at the Ontario Midwife’s Association guidance on interprofessional collaboration with Chiropractors to benefit your pregnant patients.

References:

  1. Shultz S.J. (2017) The Effect of Sex Hormones on Ligament Structure, Joint Stability and ACL Injury Risk. In: Hackney A. (eds) Sex Hormones, Exercise and Women. Springer, Cham. https://doi.org/10.1007/978-3-319-44558-8_7
  2. Dehghan F et al (2013) The Effect of Relaxin on the Musculoskeletal System. Scan J Med Sci Sports 24: e220-229
  3. Dragoo JL, Padrez K, Workman R, Lindsey DP (2009). The effect of relaxin on the female anterior cruciate ligament: Analysis of mechanical properties in an animal model. Knee 16 (1): 69-72. https://doi.org/10.1016/j.knee.2008.09.005 PMID: 18964043.
  4. National Institute for Health and Care Excellence; Clinical Knowledge Summary; Dyspepsia – Pregnancy Related (April 2017). Summary. https://cks.nice.org.uk/topics/dyspepsia-pregnancy-associated/
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