January 24, 2018
Pediatrics
TAKE-HOME MESSAGE
- The authors of this systematic review of eight population-based studies evaluated the association between use of acid-suppressive drugs in pregnancy and the risk of childhood asthma in the offspring. The relative risk of asthma in childhood was 1.45 for those using acid-suppressive drugs in pregnancy compared with no use (P < .00001). The risk increased with use of proton pump inhibitors (RR, 1.34; P < .00001) and H2-receptor antagonists (RR, 1.57; P < .00001).
- Maternal use of acid-suppressive drugs during pregnancy is associated with an increased risk of childhood asthma. Physicians and patients should consider this risk when evaluating treatment options for reflux during pregnancy.
Abstract
CONTEXT
The association between acid-suppressive drug exposure during pregnancy and childhood asthma has not been well established.
OBJECTIVE
To conduct a systematic review and meta-analysis on this association to provide further justification for the current studies.
DATA SOURCES
We searched PubMed, Medline, Embase, the Cochrane Database of Systematic Reviews, EBSCO Information Services, Web of Science, and Google Scholar from inception until June 2017.
STUDY SELECTION
Observational studies in which researchers assessed acid-suppressive drug use during pregnancy and the risk of childhood asthma were included.
DATA EXTRACTION
Of 556 screened articles, 8 population-based studies were included in the final analyses.
RESULTS
When all the studies were pooled, acid-suppressive drug use in pregnancy was associated with an increased risk of asthma in childhood (relative risk [RR] = 1.45; 95% confidence interval [CI] 1.35-1.56; I2 = 0%; P < .00001). The overall risk of asthma in childhood increased among proton pump inhibitor users (RR = 1.34; 95% CI 1.18-1.52; I2 = 46%; P < .00001) and histamine-2 receptor antagonist users (RR = 1.57; 95% CI 1.46-1.69; I2 = 0%; P < .00001).
LIMITATIONS
None of the researchers in the studies in this meta-analysis adjusted for the full panel of known confounders in these associations.
CONCLUSIONS
The evidence suggests that prenatal, maternal, acid-suppressive drug use is associated with an increased risk of childhood asthma. This information may help clinicians and parents to use caution when deciding whether to take acid-suppressing drugs during pregnancy because of the risk of asthma in offspring.
Antacids in pregnancy and asthma risk in offspring
Pregnancy is associated with a lot of heartburn for which many moms take antacids. This meta-analysis of eight studies showed that both proton pump inhibitors and H2-blockers are associated with a relative risk of 1.45 for asthma in the offspring of mothers who used these drugs.
How might acid suppression lead to asthma?
Acid suppression may increase the immune sensitization to food proteins. Acid is needed to activate proteases, which are needed to digest proteins into subunits that are less immunogenic and easily absorbed as nutrition. Without acid, protease is not activated, and digestion is less efficient, resulting in more intact immunogenic proteins that may trigger an IgE response.
More questions?
This meta-analysis included observational studies that do not control for confounding variables, so there are many other factors that could be playing a role. For example, it could be GERD and not the treatment of GERD that is associated with asthma risk in the offspring. The only way to find this out is to study mothers with GERD that did not take antacids, which this review did not include.
Until we learn more about this association, it may be wise to encourage coating therapy with antacids for pregnancy-associated GERD and heartburn instead of acid-suppressive therapy, particularly in those with a personal or family history of asthma.