Acid-Reducing Drugs May Not Be Risky in Pregnancy
Study Shows Proton-Pump Inhibitors Do Not Cause Birth Defects When Used in First Trimester
An Obstetrician’s Perspective continued...
“Furthermore, the specific reasons for the patients to be taking the medication are not available, and certain medical conditions can independently increase the risk of birth defects,” she says. “Although this study is not definitive, it should provide reassurance to women with pregnancy exposure to this class of medications [and] given the large number of patients in the study, it is unlikely that the investigators would have missed a large increase in a major anomaly.”
Her bottom line? “Pregnant women should always discuss with their doctor any medications they are taking, including herbs and over-the-counter medications,” Gelber says. “Women should not start or stop any medications during pregnancy without a discussion with their physician [and] with any pregnancy exposure, patients and their physicians should weigh the potential benefits of a medication with the theoretical risk to the fetus.”
“My general recommendations for heartburn are lifestyle modifications first,” Gelber says. “Before I recommend PPIs for patients, I do an individualized assessment about how much discomfort they have from their heartburn, I review their history and physical to make sure there are no underlying medical illnesses other than pregnancy causing their symptoms, and discuss the fact that there is no known risk to PPIs, but that the data is limited,” she says. “This study supports that view, but again the study is not definitive.”
Robert Kimura, MD, director of neonatology at Rush University Medical Center in Chicago, is cautiously optimistic about the use of PPIs during pregnancy. He sees newborns and is not in the habit of asking new moms if they took these drugs during pregnancy, but may start doing so.
“There are certain drugs we know are associated with anomalies, but PPIs have not been that high on the radar screen,” he says.
“Some obstetricians may cite this study and tell their pregnant patients that these drugs are safe,” he says. “If a woman is really symptomatic, you can use these drugs to treat heartburn, but we shouldn’t use them like water,” he says.
Often, risks do not become apparent until millions of people take the drugs, he says.