Prenatal Exposure to Acid-Suppressive Medications and Incident Risk of Inflammatory Bowel Disease in Children
Abstract
Importance: Acid-suppressive medications, including proton pump inhibitors (PPIs) and H2 receptor antagonists (H2RAs), are commonly used during pregnancy; however, concerns have emerged about their potential impact on gut and immune development in children.
Objective: To examine the association between prenatal exposure to acid-suppressive medications and the risk of inflammatory bowel disease (IBD), including Crohn disease (CD) and ulcerative colitis (UC).
Design, setting, and participants: This nationwide cohort study assessed mother-child pairs from the National Health Insurance Service of South Korea identified between January 1, 2009, and December 31, 2017, with follow-up through December 31, 2023. Offspring exposed to acid-suppressive medications were matched 1:3 to those who were unexposed.
Exposure: Prenatal exposure to 1 or more prescriptions for PPIs or H2RAs.
Main outcomes and measures: Incident risk of IBD, UC, and CD in children. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) with corresponding 95% CIs. Subgroup analysis was conducted by medication type, timing of exposure, prescription count, maternal gastrointestinal history, and sibling comparisons (to control for shared familial factors).
Results: After 1:3 PS matching, 1 837 916 mother-child pairs were included (mean [SD] maternal age, 32.1 [4.7] years; 913 260 [49.7%] female infants). Prenatal exposure to acid-suppressive medications was associated with an elevated…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 41 participants or records.
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