The Safety of Histamine 2 (H2) Blockers in Pregnancy: A Meta-analysis

Abstract

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.

Safety of Drugs during Pregnancy and Breastfeeding in Cystic Fibrosis Patients

“…Fixed combinations of aluminum and magnesium salts should be preferred and used at recommended doses. No associations with an increased rate of birth defects have been detected after more than 1,500 exposures during the first trimester with ranitidine [71,72] . No associations have been found between proton pump inhibitor use during pregnancy and increased rate of birth defects in studies including several thousands of patients [73,74] .…”

Management of hyperemesis gravidarum

“…Symptoms of gastroesophageal reflux disease are common in women with hyperemesis gravidarum and drugs that reduce gastric acid secretion such as H 2 antagonists and proton pump inhibitors are thought to be safe and may reduce the severity of nausea and vomiting 35–37. A safe outcome was defined as no increased risk of spontaneous abortions, pre-term delivery, small for gestational age babies or congenital malformations in the newborn 35…”

Prenatal care

“…However, if heartburn is severe enough to warrant this action, medication should begin after consultation with a health care professional. Antacids, H 2 blockers, and proton pump inhibitors all have acceptable safety profiles for the pregnant woman (102)(103)(104).…”