No clear link between prenatal acid suppressant use and IBD in offspring

In vitro exposure to acid-suppressive medications does not appear to be associated with an increased risk of inflammatory bowel disease (IBD) development in offspring, as shown in a nationwide cohort study.

The study included 1,837,916 mother–child pairs (mean maternal age 32.1 years, 49.7 percent female infants) from the National Health Insurance Service of South Korea. Of these, 463,853 pairs were in the exposed group (with prenatal exposure to at least one prescription for proton pump inhibitors or H2 receptor antagonists) and 1,374,063 in the unexposed group, matched based on propensity scores.

The main outcome was the risk of incident IBD and its subtypes in offspring.

In Cox proportional hazards regression models, prenatal exposure to acid-suppressive medications was associated with an increased risk of IBD in offspring (hazard ratio [HR], 1.08, 95 percent confidence interval [CI], 1.01–1.15). This association was pronounced for Crohn’s disease (CD) (HR, 1.10, 95 percent CI, 1.02–1.19) but not for ulcerative colitis (UC) (HR, 1.04, 95 percent CI, 0.93–1.17).

However, the exposed and unexposed groups showed no clear difference in absolute risk differences (RD) for IBD (RD, 0.41 per 1,000 children), CD (RD, 0.51 per 1,000 children), and UC (RD, 0.21 per 1,000 children).

In sibling comparison analyses, prenatal exposure to acid-suppressive medications had a null association with the risks of IBD (HR, 1.06, 95 percent CI, 0.88–1.27), CD (HR, 1.03, 95 percent CI, 0.84–1.27), and UC (HR, 1.10, 95 percent CI, 0.78–1.55) in offspring.