From the Guidelines
Omeprazole is the preferred proton pump inhibitor (PPI) for use during pregnancy when acid suppression therapy is necessary. According to the guidelines, proton pump inhibitors are allowed throughout pregnancy and breastfeeding 1. The safety of omeprazole in pregnancy is well-documented, and it is considered safe in all trimesters.
Key Points
- Omeprazole has the most extensive safety data among PPIs in pregnant women.
- The typical dosage is 20-40 mg once daily, with treatment duration based on symptom severity and clinical response.
- All PPIs, including omeprazole, should be used at the lowest effective dose for the shortest duration necessary to control symptoms.
- PPIs are indicated for persistent GERD symptoms during pregnancy that don't respond to lifestyle modifications and first-line treatments like antacids or H2 blockers.
- As with any medication during pregnancy, it's essential to weigh the benefits and risks, and omeprazole remains the first choice based on accumulated safety evidence 1.
From the FDA Drug Label
Available data from published observational studies overall do not indicate an association of adverse pregnancy outcomes with lansoprazole treatment In a prospective study by the European Network of Teratology Information Services, outcomes from a group of 62 pregnant women administered median daily doses of 30 mg of lansoprazole were compared to a control group of 868 pregnant women who did not take any PPIs There was no difference in the rate of major malformations between women exposed to PPIs and the control group, corresponding to a Relative Risk (RR)=1.04, [95% Confidence Interval (CI) 0.25-4. 21]
Lansoprazole might be used in pregnant women, as available data from published observational studies do not indicate an association of adverse pregnancy outcomes with lansoprazole treatment 2.
- The data suggests that lansoprazole may be a potential option for pregnant women who require a proton pump inhibitor (PPI).
- However, it is essential to weigh the potential benefits and risks and consider the individual patient's situation before making a decision.
- It is also important to note that the estimated background risk of major birth defects and miscarriage for the indicated population is unknown, and all pregnancies have a background risk of birth defect, loss, or other adverse outcomes.
From the Research
Proton Pump Inhibitors (PPIs) in Pregnant Women
- The use of PPIs in pregnant women is a common practice to relieve gastrointestinal symptoms 3.
- A systematic review and meta-analysis of congenital malformations found no significant association between first-trimester PPI exposure and the risk of major congenital malformations 3.
Available PPI Options
- Several PPIs are available, including lansoprazole, omeprazole, pantoprazole, and rabeprazole 4, 5, 6, 7.
- These PPIs have similar potency and efficacy in inhibiting gastric acid secretion, but may differ in their pharmacokinetics, pharmacodynamics, and potential for drug interactions 4, 5, 6, 7.
- Esomeprazole, the S-isomer of omeprazole, exhibits a somewhat higher potency than the other PPIs, but its clinical advantage is not well established 4, 7.
Considerations for PPI Use in Pregnant Women
- The choice of PPI in pregnant women should be based on the individual patient's needs and medical history, as well as the potential risks and benefits of each medication 3, 7.
- While the available evidence suggests that PPIs are generally safe for use in pregnant women, further studies are needed to fully evaluate their safety and efficacy in this population 3.