The Business of Being Born Message Board

Q: Is it ok to take papaya enzyme for heartburn during pregnancy (2nd trimester)? Any other suggestion?
Thanks,
Lisa

A: The higher estrogen levels of pregnancy naturally relax the lower esophageal sphincter (between the lower esophagus and stomach), allowing stomach acids to rise up to cause the sensation of “heartburn”. As the pregnancy grows, it presses up into your stomach and intestines and leaving less room to accommodate large meals. It is helpful to eat smaller meals more frequently instead of larger meals, and be sure not to lie down for at least 2-3 hours after eating. Foods that may cause increased heartburn include acidic and spicy foods. Sweet foods and fruits on top of proteins/fats/heavy meals can also cause heartburn. Avoid mint, which relaxes the lower esophageal sphincter. Sucking candies and chewing gum increase stomach acid production thus should be avoided. Stress is another factor that can contribute to heartburn, and responds well to deep breathing, prenatal yoga, acupuncture, pregnancy massage, etc. An excellent remedy for heartburn is umeboshi plum, which you can obtain whole, in paste or balls that dissolve. This is a traditional Japanese food, and can be found in Japanese and macrobiotic markets and many health food stores. A small amount of the paste on the tip of a spoon may be enough. It is highly alkaline and a great antacid. While many pregnant women do use papaya enzymes for heartburn with success and apparent safety, papaya enzyme does present significant potential risks and adverse effects in pregnancy that are important for you to be aware of. Women in India, the Philippines, and other parts of Asia typically avoid papaya in pregnancy, particularly unripe papaya which naturally contains latex and enzymes. Studies have found that unripe, enzymatically active papaya can cause miscarriage and uterine contractions. Also, the latex component, which is naturally present, is for some women highly allergenic. Ripe papaya fruit should be fine, but avoid eating the seeds. Also keep in mind that digestive enzymes taken between meals are more absorbed beyond the intestine with more potential for side effects. Therefore, although papaya enzymes are widely used by pregnant women in the USA with extensive anecdotal reports of apparent safety, there are potential risks and side effects that need to be taken into consideration when making an informed choice, and exploring options with less potential for risk and speaking with a knowledgeable prenatal provider is essential.

Eden G. Fromberg, DO, FACOOG, DABHM
SOHO OB/GYN
430 West Broadway #2A
New York, NY 10012
(212)941-0011
fax (212)941-5977
www.dredenfromberg.com
www.sohoobgyn.com