Are PPIs safe to use in pregnancy?

  • Li CM & al.
  • Aliment Pharmacol Ther
  • 07/01/2020

  • Elisabeth Aron, MD, MPH, FACOG
  • Clinical Essentials
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Takeaway

  • Proton pump inhibitors (PPIs) may be associated with a slightly increased risk for congenital anomalies but decreased risk for spontaneous abortion.

Why this matters

  • PPIs are commonly used during pregnancy despite conflicting data on their safety.
  • PPIs have been associated with childhood asthma in offspring and increased risk for cholestasis.
  • PPIs should be used during pregnancy only when the benefits outweigh the risks.

Key results

  • 23 studies reported on congenital malformations.
  • The overall risk for congenital malformations was higher in women using PPIs:
    • OR, 1.28 (95% CI, 1.09-1.52).
  • No significant increased risk seen for hypospadias, cleft palate without cleft lip, cardiovascular malformations, club foot, stillbirth, or preterm birth.
  • 3 studies reported on spontaneous abortion, showing a decreased risk in PPI users:
    • OR, 0.66 (95% CI, 0.43-1.00).

Study design

  • Systematic literature review and meta-analysis (26 studies).
  • Exposure was defined as any type of PPI used during pregnancy.
  • Exposed group was compared with a control group from the same study population.
  • Funding: None disclosed.

Limitations

  • Limitations related to limitations of original studies.
  • Heterogeneity among studies.