The overall risk of asthma in childhood increases with maternal use of proton pump inhibitors and histamine-2 receptor antagonists.
Indigestion is one of the most common conditions a woman can experience while pregnant, so it is no surprise she may often take antacids for some relief. But a new study published in Pediatrics, the Official Journal of the American Academy of Pediatrics, suggests there’s a link between maternal use of antacids and childhood asthma.
“This information will help women use caution when deciding whether to take acid-reducing drugs during pregnancy because of the risk of asthma in offspring,” said co-author Huahao Shen, MD, PhD, a professor at the Zhejiang University School of Medicine in Hangzhou, China.
Researchers collected data from PubMed, Embase, the Cochrane Database of Systematic Reviews, ENSCO Information Services, Web of Science, and Google Scholar. These were observational studies where antacid use during pregnancy and childhood asthma risk were evaluated. Out of the 556 screened articles, 8 population-based studies were chosen for the final analysis.
Results showed that antacid use during pregnancy was associated with an increased risk of asthma in childhood (RR = 1.45; 95% CI; 1.35 to 1.56; I2 = 0%; p < 0.00001). The overall risk of asthma in childhood increased with maternal use of proton pump inhibitors (RR = 1.34; 95% CI; 1.18 to 1.52; I2 = 46%; p < 0.00001) and histamine-2 receptor antagonists (RR = 1.57; 95% CI; 1.46 to 1.69; I2 = 0%; p < 0.00001).
“None of the researchers in the studies in this meta-analysis adjusted for the full panel of known confounders in these associations,” Shen said. “To better address the issues of confounding, more studies are needed including GERD (gastro-esophageal reflux disease) diagnosis, instrumental variables, and restriction.”
Studies have shown that between 30% to 80% of women experience GERD during their pregnancy. Both proton pump inhibitors and histamine-2 receptor antagonists can be safely used by pregnant women; currently, there is no evidence that either medication causes adverse fetal effects. Shen reiterates that this study only shows a correlation between maternal use of antacids and an increase in childhood asthma.
“Observational studies are now warranted to investigate mechanisms and confirm our data,” Shen said. “This would mean following a pregnant group who are taking medication and comparing with a group who did not.”
So, what can a woman do to get herself through those uncomfortable months until she gives birth? Shen said not to rule out these medications yet, much depending on the severity of symptoms.
“We advise clinicians not to jump too quickly to decide that pregnant women should not be taking acid suppressants to prevent asthma in their children, but rather use caution,” Shen said. “However, women may still want to consider other options to relieve heartburn and indigestion. Other medications that can ease these symptoms include Pepto Bismal, domperidone and hydrotalcite.”
The study, "Acid-Suppressive Drug Use During Pregnancy and the Risk of Childhood Asthma: A Meta-analysis," was published online in the journal for American Academy for Pediatrics.
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