Possible Increased Risk of Heart Defects in Children Exposed to PPIs In-Utero
More bad press for Proton Pump Inhibitors (PPIs) is looming on the horizon. At the annual conference known as Digestive Disease Week, researchers presented a retrospective study which showed that babies who are exposed to PPIs during the first trimester of pregnancy have double the risk of heart defects. They did not find any increased risk of any other malformations due to the PPIs. The researchers are unsure of why there is an increased risk and also noted that there was also an increased risk of heart defects in babies exposed to H2 blockers although the authors2 reporting on this research did not specify how m-uch increased risk with H2 blockers.
This is scary information for any woman who is pregnant or is thinking about becoming pregnant and is on medications for GERD. But, don’t panic - yet. The reason I brought this research to light is that it is very likely to really hit the presses soon and I want anyone hearing the news to take a step back and look at some of the details before panicking.
Medications causing birth defects are always big (and scary) news. However, there are some really important things to note. First of all, this is preliminary unpublished research. It hasn’t gone through the rigorous process of being peer-reviewed and being published in a respected journal. Do we know if the research is really sound? Further, the authors themselves don’t know causality. In other words, is there something about Moms with GERD that make their babies more likely to have heart defects or is the medicine they take. Also, as for the H2 blockers – there is conflicting evidence (published in a peer reviewed journal) by Magee, et.al. which shows no increased risk of birth defects when H2 blockers are taken during pregnancy. Finally, like all medications the benefits vs. risks needs to be evaluated for each patient. Yes, doubled risk sounds like a lot but the risk is still very low for each child even when you double it. This would need to be weighed against the risk of the mother’s health.
I’m sure more research will be coming out about PPIs in the future and some of it will be sensational. It’s important to remember though to always go back to the source of the research when possible and read what they found. It’s also important to talk to your doctor about your risk/benefits. You shouldn’t stop any medication before going to your doctor and having a discussion about why you did. Don’t have an appointment for another month? Call up and make an appointment sooner to have this discussion.
If you are thinking of becoming pregnant or find out that you are pregnant and you are taking ANY medication (over the counter or prescription) – get to your doctor and discuss your list of meds. Is there something you can substitute during pregnancy and nursing? If not, is there anything you can do to lower the risk? Being an informed parent before the baby is born is one of the best ways to help keep your baby healthy from the very start.
1 Laino, C. (2010). PPI Exposure in Utero Linked to Cardiac Birth Defects: Presented at DDW. On the World Wide Web: http://www.docguide.com/news/content.nsf/news/852576140048867C8525771D007962E6
2 Magee, et.al. (1996). Safety of first trimester exposure to Histamine H2 blockers: A prospective cohort study. Digestive Diseases and Sciences, 41(6), 1145-49.
3 Rhim, A. et.al. (2010). Presentation title: Maternal Use of Proton Pump Inhibitors (PPI) During Pregnancy Is Associated With an Increased Risk for Cardiac Birth Defects: Analysis of 208,951 Pregnancies From the GPRD/THIN Database. Abstract 475b