- Researchers expected to find that maternal use of proton pump inhibitors (PPIs) during pregnancy would increase a child’s risk of fractures in early childhood.
- Instead, they found an apparent protective effect.
Why this matters
- Gastroesophageal reflux disease is common in pregnancy, and medications for it are often prescribed.
- Some studies have linked PPIs to fracture risk in older people, but results are mixed, and information about risk from fetal exposure is limited.
- The authors’ explanation for the protective effect is that the women may have already tried calcium carbonate-containing antacids, essentially supplementing with calcium.
- Fracture risk with meds vs without:
- Relative risk, 0.70 (95% CI, 0.58-0.85).
- Risk did not vary with PPI use vs histamine type 2 receptor antagonists.
- Children born from multigestation pregnancies had increased fracture risk:
- Relative risk, 1.38 (95% CI, 1.04-1.85).
- Factors such as preeclampsia, gestational diabetes, breech presentation did not affect risk.
- Cohort of TRICARE beneficiaries.
- Retrospective data analyzed after linkage of mother-infant data (378,150 deliveries).
- Most women took PPIs (84.5%).
- Funding: Defense Health Agency.
- The usual limitations of retrospective studies.
- Lower fracture rate than in previously published studies, possibly because of incomplete data capture.