USE OF PROTON PUMP INHIBITORS (PPIs) IN PREGNANCY

Proton Pump Inhibitors (PPIs), omeprazole, lansoprazole, esomeprazole, pantoprazole and rabeprazole are used in the management of dyspepsia, gastro-oesophageal reflux and peptic ulceration. The manufacturer of omeprazole state that it may be used in pregnancy if required.

Although a large meta-analysis indicated an increased risk of any malformation for PPIs as a class, there are methodological flaws associated with this analysis, and combination of the highest quality evidence did not indicate an increased risk of malformation following first trimester PPI exposure. Data from other studies for individual PPIs do not demonstrate that PPI exposure during early pregnancy increases the overall risk of congenital malformation. However, the available data for esomeprazole, pantoprazole, lansoprazole and rabeprazole is currently limited.

There is currently no evidence that gestational use of PPIs as a class is associated with an increased risk of miscarriage, preterm delivery, low birth weight or stillbirth. Data regarding these outcomes for lansoprazole, esomeprazole, pantoprazole and rabeprazole are currently too limited to allow an evidence-based assessment of their pregnancy safety profile. The data for omeprazole are currently reassuring, but also limited. There are no data on neurodevelopmental outcomes in children exposed to PPIs in utero.

Studies have shown that gastric acid suppression during pregnancy may increase the likelihood of atopy in the infant. There is some evidence that this effect may not be drug-specific. The currently available data on PPIs are, however, limited and conflicting; more research is therefore required before a link can be confirmed or refuted.

Exposure to a PPI at any stage in pregnancy would not usually be regarded as medical grounds for termination of pregnancy or any additional fetal monitoring. However, other risk factors may be present in individual cases which may independently increase the risk of adverse pregnancy outcome. Clinicians are reminded of the importance of consideration of such factors when performing case-specific risk assessments.