Prenatal exposure to acid-suppressive drugs and the risk of allergic diseases in the offspring: A cohort study

Bianca Mulder, Nynke C.C.M. Schuiling-Veninga, Jens H. Bos, Tjalling W. De Vries, Susan S. Jick, Eelko Hak



Background: Recent studies have reported an increased risk for the development of asthma in children after prenatal exposure to acid suppressive drugs. Allergic diseases often develop simultaneously so associations can also be present for allergic rhinitis and atopic dermatitis. Objectives: To assess the associations between the use of acid suppressive medication during pregnancy and the development of allergic diseases in children. Methods: Using a linked mother-infant subset of the University Groningen prescription database we conducted a pregnancy cohort study among 33,536 children born between 1995 and 2011, with a maximum follow-up of 8 years. Maternal exposure was defined as ≥ 1 dispensed prescriptions for Proton Pump Inhibitors (PPIs) and/or Histamine 2-antagonists (H2As) during pregnancy. Children were considered to have a drug-treated allergic disease if they received either ≥ 2 prescriptions for ointments containing steroids or calcineurin-inhibitors (atopic dermatitis), ≥ 2 prescriptions for inhaled steroids (asthma) or ≥ 2 prescriptions for nasal steroids (allergic rhinitis) in 12 months. Clustered Cox proportional hazard regression was used to estimate crude and adjusted hazard ratios (aHR) with 95% confidence intervals (95% CI). Results: A total of 489 (1.5%) children were exposed to PPIs or H2As during pregnancy. The aHR for the development of any allergic disease was 1.37 (95% CI: 1.14-1.66) for children exposed to PPIs or H2As. Prenatal exposure to PPIs and /or H2As was associated with atopic dermatitis, asthma and allergic rhinitis with aHRs of 1.32 (95% CI 1.06-1.64), 1.57 (95% CI 1.20-2.05) and 2.40 (95% CI 1.42-4.04), respectively. Risks were elevated for the development of two or more (aHR 2.13, 95% CI: 1.43-3.19) and three allergic diseases (aHR 5.18, 95% CI: 2.16-12.42) in exposed children. Conclusions: Prenatal exposure to PPIs and H2As appeared associated with an increased risk of allergic diseases in the offspring, especially with the development of multiple allergic diseases. The benefit-risk balance of these drugs should be reconsidered in pregnancy.
Originele taal-2English
Pagina's (van-tot)380
Aantal pagina's1
TijdschriftPharmacoepidemiology and Drug Safety
Nummer van het tijdschrifts1
StatusPublished - okt-2013

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