Prenatal PPI use is not linked to fracture risk in offspring

  • Wolfe HL & al.
  • Birth
  • 5 Mar 2019

  • International Clinical Digest
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Takeaway

  • 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.

Key results

  • 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.

Study design

  • 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.

Limitations

  • The usual limitations of retrospective studies.
  • Lower fracture rate than in previously published studies, possibly because of incomplete data capture.

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