The Safety of Histamine 2 (H2) Blockers in Pregnancy: A Meta-analysis
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Heartburn and acid reflux increase the severity of nausea and vomiting of pregnancy, and may lead to more serious medical conditions. The fetal safety of histamine 2 (H2) blockers, the most common antireflux medication, during pregnancy needs to be determined. The aim herein is to determine the fetal safety of H2 blockers during pregnancy through systematic review. All original research assessing the safety of H2 blockers in pregnancy was sought. Data included congenital malformations, spontaneous abortions, preterm delivery, and small for gestational age. A random-effects model combined results. With data from 2,398 exposed and 119,892 nonexposed to H2 blockers, overall odds ratio was 1.14 [0.89, 1.45]. Further analysis revealed no increased risks for spontaneous abortions, preterm delivery, and small for gestational age with odds ratios and 95% confidence intervals (CIs) of 0.62 [0.36–1.05], 1.17 [0.94, 1.147], and 0.28 [0.06, 1.22], respectively. H2 blockers can be used safely in pregnancy.
- Baron T, Ramirez B, Richter J. Gastrointestinal motility disorders in pregnancy. Ann Intern Med. 1993;118(5):366–375.
- Ali R, Egan L. Gastroesophageal reflux disease in pregnancy. Best Pract Res Clin Gastroenterol. 2007;21(5):793–806. doi:10.1016/j.bpg.2007.05.006. CrossRef
- Broussard C, Richter J. Treating gastro-oesophageal reflux during pregnancy and lactation: what are the safest therapy options? Drug Saf. 1998;19(4):325–337. doi:10.2165/00002018-199819040-00007. CrossRef
- Mahadevan U. Gastrointestinal medications in pregnancy. Best Pract Res Clin Gastroenterol. 2007;21(5):849–877. doi:10.1016/j.bpg.2007.06.002. CrossRef
- Richter J. Review article: The management of heartburn in pregnancy. Aliment Pharmacol Ther. 2005;22:749–757. doi:10.1111/j.1365-2036.2005.02654.x. CrossRef
- Castro L. Reflux esophagitis as the cause of heartburn in pregnancy. Am J Obstet Gynecol. 1967;98:1–10.
- Marrero J, Goggin P, de Caestecker J, Pearce J, Maxwell J. Determinants of pregnancy heartburn. Br J Obstet Gynaecol. 1992;99:731–734.
- Everson G. Gastrointestinal motility in pregnancy. Gastroenterol Clin North Am. 1992;21(4):751–756.
- Rey E, Rodriguez-Artalejo F, Herraiz M, et al. Gastroesophageal reflux symptoms during and after pregnancy: a longitudinal study. Am J Gastroenterol. 2007;102:2395–2400. doi:10.1111/j.1572-0241.2007.01452.x. CrossRef
- Bor S, Kitapcioglu G, Dettmar P, Baxter T. Association of heartburn during pregnancy with the risk of gastroesophageal reflux disease. Clin Gastroenterol Hepatol. 2007;5(9):1035–1039. doi:10.1016/j.cgh.2007.05.003. CrossRef
- Gill SK, Maltepe C, Koren G. The effect of heartburn and acid refux on the severity of nausea and vomiting of pregnancy. Can J Gastroenterol (accepted).
- Downs S, Black N. The feasibility of creating a checklist for the assessment of methodological quality of both randomized and non-randomised studies of health care interventions. J Epidemiol Community Health. 1998;52:377–384. CrossRef
- Garbis H, Elefabt E, Diav-Citran O, et al. Mathieu-Nolf M: Pregnancy outcome after exposure to ranitidine and other H-2 blockers: a collaborative study of the European Network of Teratology Information Services. Reprod Toxicol. 2005;19:453–458. doi:10.1016/j.reprotox.2004.09.002. CrossRef
- Magee L, Inocencion G, Kamboj L, Rossetti F, Koren G. Safety of first trimester exposure to H2 blockers: a prospective cohort study. Dig Dis Sci. 1996;41(6):1145–1149. doi:10.1007/BF02088230. CrossRef
- Ruigomez A, Rogriguez L, Cattaruzzi C, et al. Use of cimetidine, omeprazole and ranitidine in pregnant women and pregnancy outcomes. Am J Epidemiol. 1999;150(5):476–481.
- Matok I, Gorodischer R, Koren G, Levy A. The safety of intrauterine exposure to H2-blockers: a study by linking computerized databases. Proceedings of the 11th Congress of the European Society for Developmental Pharmacology. Rotterdam, The Netherlands, June 2008, Abstract 45.
- Colin Jones DG, Langman MJ, Lawson DH, Vessey MP. Post-marketing surveillance of the safety of cimetidine: twelve-month morbidly report. Q J Med. 1985;54:253–268.
- Kallen B. Delivery outcome after the use of acid-suppressing drugs in early pregnancy with special reference to omeprazole. Br J Obstet Gynaecol. 1998;105(8):877–881.
- Lalkin A, Loebstein R, Addis A, et al. The safety of omeprazole during pregnancy: a multicenter prospective controlled study. Am J Obstet Gynecol. 1998;179(3):727–730. doi:10.1016/S0002-9378(98)70072-9. CrossRef
- Koren G, Zemlickis D. Outcome of pregnancy after 1st trimester exposure to H2 receptor antagonists. Am J Perinatol. 1991;8:37–38. CrossRef
- Larson J, Patatanian E, Miner P, Rayburn W, Robinson M. Double-blind, placebo controlled study of ranitidine for gastroesophageal reflux symptoms during pregnancy. Obstet Gynecol. 1997;90(1):83–87. doi:10.1016/S0029-7844(97)00126-9. CrossRef
- The Safety of Histamine 2 (H2) Blockers in Pregnancy: A Meta-analysis
Digestive Diseases and Sciences
Volume 54, Issue 9 , pp 1835-1838
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- H2 blockers
- Acid reflux
- Industry Sectors
- Author Affiliations
- 1. The Motherisk Program, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
- 2. Department of Pharmacology, University of Toronto, Toronto, Ontario, Canada
- 3. Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada