(241) Proton Pump Inhibitors Use and Risk of Preeclampsia: A Meta-Analysis of Pharmacoepidemiological Studies

Publication Number: 572

Background: Evidence from preclinical studies suggests a preventive effect of proton pump inhibitors (PPIs) in preeclampsia. Recently, several epidemiological studies described conflicting associations between the use of PPIs during pregnancy and preeclampsia risk.

Objectives: To evaluate the association between PPIs use and risk of preeclampsia.

Methods: Studies reporting the preeclampsia risk with the use of PPIs were eligible for inclusion. Literature screening, data extraction, and risk of bias assessment were performed independently by two investigators. Risk of preeclampsia and preterm preeclampsia among women receiving PPIs during pregnancy. Random-effect meta-analysis was performed to generate relative risks (RR) and 95% confidence intervals (CI). The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology.

Results: This meta-analysis comprised of three studies involving 4,877,565 pregnant women, of whom 119,017 were PPIs users. The included studies were judged to have a low risk of bias. The risk of preeclampsia among pregnant women who received PPIs anytime during pregnancy was statistically significantly increased [ RR 1.27 (95%CI: 1.23 to 1.31)] although the increase was trivial in absolute terms (2 per 1,000). Subgroup analysis revealed that the risk was increased in each of the three trimesters. The risk of preterm preeclampsia among pregnant women receiving PPIs anytime during pregnancy was not statistically significantly increased [RR 1.04 (95% CI: 0.70 – 1.55)]. The certainty evaluated by GRADE in these estimates was low.

Conclusions: PPIs use may be associated with a trivial increase in the risk of preeclampsia in pregnant women. There is no evidence supporting that PPI use decreases the risk of preeclampsia or preterm preeclampsia.