Population-based cohort study: proton pump inhibitor use during pregnancy in Sweden and the risk of maternal and neonatal adverse events

Abstract

Background Approximately half of all women suffer from heartburn at some stage during pregnancy. The most effective treatment is proton pump inhibitors, but the safety of use during pregnancy cannot be guaranteed. This study aimed to elucidate the effect of proton pump inhibitors on the risk of pre-eclampsia, gestational diabetes mellitus, preterm birth, an Apgar score at 5 min below 7, and a child being small or large for its gestational age. Methods This Swedish population-based study included 1,089,514 live singleton deliveries between July 2006 and December 2016 in Sweden. Multiple logistic regression was used to model the outcomes as a function of the covariates. Results were presented as odds ratios with 95% confidence intervals. Results In 1.4% of all pregnancies, the mother used proton pump inhibitors in the period from 3 months before the last menstrual period up to delivery. The use of proton pump inhibitors was associated with higher odds of pre-eclampsia (odds ratio = 1.19, 1.10–1.29), gestational diabetes mellitus (odds ratio = 1.29, 1.16–1.43), preterm birth (odds ratio = 1.23, 1.14–1.32), and small for gestational age (odds ratio = 1.27, 1.16–1.40) and lower odds of large for gestational age (odds ratio = 0.84, 0.77–0.91). No significant association was found with a low Apgar score 5 min after birth. Conclusions Proton pump inhibitor use was associated with a higher risk of pre-eclampsia, gestational diabetes, preterm birth, and being born small for gestational age.

Antibiotic or gastric acid inhibitor use during pregnancy and postpartum depression: Population‐based cohort study

“…Only 3.3% of women used gastric acid inhibitors in the present cohort, of which approximately half are proton pump inhibitors 41 . Our findings suggest that gastric acid inhibitors may have a more important impact on postpartum depression than antibiotics.…”

“…40 Only 3.3% of women used gastric acid inhibitors in the present cohort, of which approximately half are proton pump inhibitors. 41 Our findings suggest that gastric acid inhibitors may have a more important impact on postpartum depression than antibiotics. This could be related to a longer exposure period, making it the most important modifiable risk factor assessed in our study.…”

Pharmacological targeting of gastric mucosal barrier with traditional Chinese medications for repairing gastric mucosal injury

“…And ranitidine also has a series of side effects, including contamination with N-nitrosodimethylamine (NDMA) ( Aldawsari, et al, 2021 ), shock ( Russom, et al, 2021 ) and cancer ( Cardwell, et al, 2021 ). In particular, ultra-dose use of PPIs, such as omeprazole and its derivatives, prolonged treatment duration between 1 and 5 years, and overprescription increase the risk of GI bleeding, pre-eclampsia, gestational diabetes, and preterm birth ( Bolek, et al, 2019 ; Breddels, et al, 2022 ). Several studies have highlighted the pathogenic drawbacks of PPIs in the medical treatment of GMI, since PPIs irreversibly inactivate H + /K + -ATPase activity by binding to cysteine 813, thus immobilizing the enzyme in the E2 configuration ( Shin, et al, 2011 ; Bruno, et al, 2019 ).…”

Novel insights from our special issue on maternal factors during pregnancy that influence maternal, fetal and childhood outcomes

“…Interestingly, a reduction in type 1 diabetes incidence was reported among those who smoked, though the authors do not recommend this as a public health intervention. Another population-based cohort study from Sweden reported potential harms associated with pregnant women taking proton pump inhibitors (a treatment for gastric reflux symptoms), including increased risks of preeclampsia, gestational diabetes and the birth of a small for gestational age infant [ 5 ]. Another large-scale study from Taiwan studied the potential risks for mothers of antenatal corticosteroid treatment to improve fetal health.…”