On the basis of these results, PPIs are not associated with an increased risk for major congenital birth defects, spontaneous abortions, or preterm delivery. The narrow range of 95% CIs is further reassuring, suggesting that PPIs can be safely used in pregnancy.

BACKGROUND-Birth defects affect 3% of babies born, and are one of the leading causes of infant mortality. Both younger and older maternal age may pose increased risks for certain birth defects. This study assessed the relationship between maternal age at the estimated delivery date and the risk for birth defects.

Background Previous studies noted associations between birth defects and some antibiotics (e.g., nitrofurantoin, sulfonamides) but not others (e.g., penicillins). It is unclear if previous findings were due to antibiotic use, infections, or chance. To control for potential confounding by indication, we examined associations between antibiotic use and birth defects, among women reporting urinary tract infections (UTIs). Methods The National Birth Defects Prevention Study is a multi-site, population-based case-control study. Case infants/fetuses have any of over 30 major birth defects and controls are live-born infants without major birth defects. We analyzed pregnancies from 1997 to 2011 to estimate the association between maternally reported periconceptional (month before conception through the third month of pregnancy) use of nitrofurantoin, trimethoprim-sulfamethoxazole, or cephalosporins and specific birth defects, among women with periconceptional UTIs. Women with periconceptional UTIs who reported penicillin use served as the comparator. Results Periconceptional UTIs were reported by 7.8% (2029/26,068) of case and 6.7% (686/10,198) of control mothers. Most (68.2% of case, 66.6% of control mothers) also reported antibiotic use. Among 608 case and 231 control mothers reporting at least one periconceptional UTI and certain antibiotic use, compared with penicillin, nitrofurantoin use was associated with oral clefts in the offspring (adjusted odds ratio, 1.97 [95% confidence interval, 1.10–3.53]), trimethoprim-sulfamethoxazole use with esophageal atresia (5.31 [1.39–20.24]) and diaphragmatic hernia (5.09 [1.20–21.69]), and cephalosporin use with anorectal atresia/stenosis (5.01 [1.34–18.76]). Conclusion Periconceptional exposure to some antibiotics might increase the risk for certain birth defects. However, because individual birth defects are rare, absolute risks should drive treatment decisions.

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Nausea and vomiting of pregnancy (NVP) is the most common medical condition of pregnancy, affecting up to 80% of all pregnancies to some degree. In most cases it subsides by the week 16 of pregnancy, although up to 20% of women continue to have symptoms throughout pregnancy. Severe NVP (Hyperemesis gravidarum) affects < 1% of women and in some severe cases can require hospitalization and rehydration of fluids. Women suffer not only physically but also psychologically, which has been documented in a number of studies. In addition, some women have decided to terminate their pregnancy rather than tolerate severe symptoms. Even less severe cases of NVP can have significant adverse effects on the quality of a woman's life, affecting her occupational, social, domestic functioning and general well being. Therefore, it is of great importance to treat this condition effectively to improve the quality of life for these women. In this paper, the authors review different classes of antiemetics used to treat this condition and discuss that some have better safety profiles than others, but most appear to be safe to use in pregnancy. Also included is a treatment algorithm that can assist the healthcare provider in treating this condition in pregnant safely and effectively.

The present cohort study is the first to demonstrate that HB/RF are associated with increased severity of NVP. Managing HB/RF may improve the severity of NVP.

Prenatal multivitamin supplements (PMS) are recommended during pregnancy. Suboptimal adherence in women experiencing gastrointestinal (GI) conditions is thought to be attributed to the high elemental iron content in PMS. This study sought to quantify adherence and tolerability of iron-containing PMS in women with pre-existing GI conditions by recruiting women who called the Motherisk Helpline. Women with (n = 36) and without (n = 166) pre-existing GI conditions were randomised to either PregVit (n = 106) or Orifer F (n = 96). Monthly follow-up interviews were conducted to assess pill intake and GI adverse effects associated with PMS. The results of our study suggest that with the use of small size and low dose iron PMS, women with pre-existing GI conditions do not experience (1) more GI adverse effects, (2) lower adherence than women with no such conditions, and (3) may experience less severe nausea and vomiting of pregnancy. Supplementing with small tablets of low dose iron PMS should be considered.

Heartburn and acid reflux increase the severity of nausea and vomiting of pregnancy, and may lead to more serious medical conditions. The fetal safety of histamine 2 (H2) blockers, the most common antireflux medication, during pregnancy needs to be determined. The aim herein is to determine the fetal safety of H2 blockers during pregnancy through systematic review. All original research assessing the safety of H2 blockers in pregnancy was sought. Data included congenital malformations, spontaneous abortions, preterm delivery, and small for gestational age. A random-effects model combined results. With data from 2,398 exposed and 119,892 nonexposed to H2 blockers, overall odds ratio was 1.14 [0.89, 1.45]. Further analysis revealed no increased risks for spontaneous abortions, preterm delivery, and small for gestational age with odds ratios and 95% confidence intervals (CIs) of 0.62 [0.36-1.05], 1.17 [0.94, 1.147], and 0.28 [0.06, 1.22], respectively. H2 blockers can be used safely in pregnancy.