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Are Proton Pump Inhibitors Safe during Pregnancy and Lactation?

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Abstract

Symptoms of gastro-oesophageal reflux disease (GORD or GERD) are estimated to occur in 30–50% of pregnancies, with the incidence approaching 80% in some populations. As with many other conditions in pregnancy, medical therapy with pharmaceutical agents is a concern, as the potential teratogenicity of medications is not well known. Although prevalence numbers are high, many patients have mild and infrequent symptoms, which often respond to lifestyle and dietary modifications. The exact mechanism and pathogenesis of GERD associated with pregnancy is likely multifactorial. Treatment strategies for patients not responding to conservative therapies include a step-up approach initially starting with antacids and alginates, and progressing to histamine H2 receptor antagonists followed by proton pump inhibitor (PPI) therapy if indicated by symptoms. Although PPI therapy is the most effective treatment available for GERD, the data related to the safety for use during pregnancy and postpartum breastfeeding are mostly obtained from cohort analysis. Given the significant adverse impact of GERD on quality of life and functionality, the use of this class of medications should not be overly restricted based solely on the pregnancy. Based on the studies presented, exposure to PPI therapy during pregnancy seems to predispose the fetus to minimal risk and, overall, these medications should be discussed with the primary physician if symptomatically necessary in the pregnant patient. This evidence-based review will address the management and safety of PPI therapy during pregnancy and lactation, and briefly review the pathogenesis, clinical presentation and diagnosis of GERD in this population.

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Acknowledgements

Dr Johnson reports clinical grants from AstraZeneca and Takeda Pharmaceuticals. He is a clinical investigator for AstraZeneca and Takeda Pharmaceuticals and a consultant for AstraZeneca, Takeda, Esai and Xenoport. He is also on the speakers bureau for Takeda Pharmaceuticals. Dr Majithia discloses no conflicts of interest relating to this article. No sources of funding were used to conduct this study or prepare this manuscript.

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Authors and Affiliations

  1. Division of Gastroenterology, Washington Hospital Center, Washington DC, USA

    Raj Majithia

  2. Division of Gastroenterology, Eastern Virginia Medical School, 885 Kempsville Rd, Suite 114, Amelia Building, Norfolk, VA, 23502, USA

    David A. Johnson MD FACG FASGE (Chief)

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  1. Raj Majithia
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  2. David A. Johnson MD FACG FASGE
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Correspondence to David A. Johnson MD FACG FASGE.

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Majithia, R., Johnson, D.A. Are Proton Pump Inhibitors Safe during Pregnancy and Lactation?. Drugs 72, 171–179 (2012). https://doi.org/10.2165/11597290-000000000-00000

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