Systematic review with meta‐analysis: the risks of proton pump inhibitors during pregnancy

Li, Cheng Mei; Zhernakova, Alexandra; Engstrand, Lars; Wijmenga, Cisca; Brusselaers, Nele

doi:10.1111/apt.15610

Cited by 43 publications

(43 citation statements)

References 59 publications

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“…NSAIDs, [38][39][40][41][42][43][44][45] two antiepileptics, [46][47][48] two β-blockers, [49][50][51] two calcium channel blockers, 50,52 two antiemetics (5-HT3 receptor antagonists), 53,54 two antipsychotics, 55,56 two antihistamines, 57,58 and one each assessed serotonin and norepinephrine reuptake inhibitors (SNRIs), 59,60 tricyclic antidepressants, 59,60 benzodiazepines, 61,62 corticosteroids, 63 oral magnesium, 64 triptans (5-HT1B/1D receptor agonists), 65 analgesics/antipyretics, 66 and intravenous magnesium. 67 Twelve SRs reported maternal adverse effects and 23 reported fetal/child adverse effects.…”

Section: All 26 Srs Assessed Pharmacologic Interventions: Eight Assessedmentioning

confidence: 99%

Management of primary headaches during pregnancy, postpartum, and breastfeeding: A systematic review

et al. 2021

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Background: Primary headaches (migraine, tension headache, cluster headache, and other trigeminal autonomic cephalgias) are common in pregnancy and postpartum. It is unclear how to best and most safely manage them. Objective: We conducted a systematic review (SR) of interventions to prevent or treat primary headaches in women who are pregnant, attempting to become pregnant, postpartum, or breastfeeding. Methods: We searched Medline, Embase, Cochrane CENTRAL, CINAHL, ClinicalTrials. gov, Cochrane Database of SRs, and Epistemonikos for primary studies of pregnant women with primary headache and existing SRs of harms in pregnant women regardless of indication. No date or language restrictions were applied. We assessed strength of evidence (SoE) using standard methods. Results: We screened 8549 citations for studies and 2788 citations for SRs. Sixteen studies (mostly high risk of bias) comprising 14,185 patients (total) and 26 SRs met the criteria. For prevention, we found no evidence addressing effectiveness. Antiepileptics, venlafaxine, tricyclic antidepressants, benzodiazepines, β-blockers, prednisolone, and oral magnesium may be associated with fetal/child adverse effects, but calcium channel blockers and antihistamines may not be (1 single-group study and 11 SRs; lowto-moderate SoE). For treatment, combination metoclopramide and diphenhydramine may be more effective than codeine for migraine or tension headache (1 randomized controlled trial; low SoE). Triptans may not be associated with fetal/child adverse effects (8 nonrandomized comparative studies; low SoE). Acetaminophen, prednisolone, indomethacin, ondansetron, antipsychotics, and intravenous magnesium may be associated with fetal/child adverse effects, but low-dose aspirin may not be (indirect evidence; low-to-moderate SoE). We found insufficient evidence regarding non-pharmacologic treatments.

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Section: All 26 Srs Assessed Pharmacologic Interventions: Eight Assessedmentioning

confidence: 99%

Management of primary headaches during pregnancy, postpartum, and breastfeeding: A systematic review

et al. 2021

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“…A recent meta-analysis showed that PPI may carry an increased risk of causing congenital malformations of the fetus. However, such malformations were not specified, and it was shown that their use does not correlate with miscarriage, neonatal death, and preterm delivery [24]. When taken in the early stages of pregnancy, PPI are considered to possibly cause either early or late preeclampsia.…”

Section: Level Of Evidencementioning

confidence: 99%

Complexities of oral antiplatelet drugs use in pregnancy

Antonijević¹,

Gosnjic²,

Rankovic³

et al. 2020

Hosp Pharm Int Multi J

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Introduction: Given the increasing occurrence of pregnancy at a relatively older age in the current clinical practice, many therapeutic approaches characteristically used in the elderly population are becoming an important consideration point for the clinicians. Antiplatelet drugs: The safety of antiplatelet drug administration in pregnancy should be brought into a sharper focus regarding both mother and child. It is a complex clinical task since the pregnancy is followed by many changes potentially affecting the drug choice-increased blood coagulability, changes in platelet aggregation, and pharmacokinetic alternations of the drug itself. Acetylsalicylic acid, as the most commonly used antiplatelet drug, appears to be mostly safe and effective for mother and fetus in many conditions occurring during pregnancy when used in low doses. However, although considered generally safe, its use requires careful approach due to many drug and pregnancy specificities. On the other hand, evidence showing adequate clinical use of P2Y12 receptor antagonists (clopidogrel, ticagrelor, prasugrel, and ticlopidine) are scarce. Cases showing their use in clinical practice are emerging and the future practice and treatment approach might be changed with the new cases becoming available. Conclusion: Regardless of the drug, pregnancy itself and any indication for the treatment used in this patient population are typically complex and require well-coordinated management by the interdisciplinary clinical team.

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“…To view these articles, visit https://doi.org/10.1111/apt.15610 and https://doi.org/10.1111/apt.15947 Selin Acar 1,2 Elif Keskin-Arslan 1,2 Nusret Uysal 1,2 Barış Karadaş 1,2 Yusuf C.…”

Section: N K Ed Co Ntentmentioning

confidence: 99%

“…The meta‐analysis by Li et al 1 investigating the association between proton pump inhibitor (PPI), or H 2 ‐receptor antagonist use in pregnancy and risk of congenital malformations was interesting. We appreciate the authors' efforts in undertaking such a comprehensive meta‐analysis.…”

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confidence: 99%