Prenatal and Infant Exposure to Acid-Suppressive Medications and Risk of Allergic Diseases in Children

The purpose of this study was to determine if an association exists between prenatal and/or infant exposure to acid-suppressive medications (ASMs) and the development of allergic diseases in children.

A cohort of mother-child linked pairs was derived from the National Health Insurance Service database of South Korea from January 2007 to December 2020. The prenatal exposure group included women ages 19 to 44 who received at least 1 ASM prescription during pregnancy. The infant exposure group included children who received at least 1 ASM prescription during the first 6 months of life.

Study outcomes were defined by International Classification of Diseases, 10th Edition codes for asthma, allergic rhinitis, food allergies, and atopic dermatitis when listed as the primary diagnosis in a clinical encounter. The primary outcome was a composite end point of all 4 diagnoses, whereas the secondary outcomes were development of the individual diseases. Authors measured outcomes in exposed individuals as compared with unexposed, using propensity score (PS)-matched as well as sibling-matched cohorts to control for confounders. Cox proportional hazard regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals were used to determine statistical significance.

For the prenatal exposure group, analysis of both PS-matched and sibling-matched cohorts found no meaningful association with allergic diseases (HRs of only 1.01–1.03 for all outcomes). Alternatively, infant exposure was associated with a 16% increased risk of asthma in the PS-matched cohort (HR 1.16, P < .05), and a 13% increased risk of asthma in the sibling-matched cohort (HR 1.13, P < .05). The PS-matched cohort also demonstrated an increased risk of food allergies; however, this finding was not replicated in the sibling matched cohort. There was a minimally increased risk for other outcomes in the prenatal exposure group.

Infant exposure to ASMs was associated with an increased risk of asthma across both PS-matched and sibling-matched cohorts. Prenatal exposure to ASMs was not associated with an increased risk of any allergic disease.

This study should encourage pediatricians to be thoughtful in the prescribing of ASMs to infants, as it is associated with a mild to moderately increased risk of asthma. If prescribed, parents should be counseled on this risk and children should be monitored for disease development. Future studies can explore potential ways to mitigate this risk.