Can esomeprazole (proton pump inhibitor) cause abortion?

Esomeprazole and Risk of Abortion During Pregnancy

Esomeprazole does not cause abortion and is generally considered safe to use during pregnancy when medically indicated. Based on the available evidence, there is no association between esomeprazole use during pregnancy and increased risk of spontaneous abortions.

Safety Profile of Esomeprazole in Pregnancy

Evidence on Safety

• Studies on omeprazole (the racemic mixture containing esomeprazole) have shown no increased risk of spontaneous abortions or major malformations when used during pregnancy 1
• A multicenter prospective controlled study found that rates of spontaneous abortions in women exposed to omeprazole during pregnancy were comparable to control groups 1
• Research on esomeprazole specifically shows limited placental transfer, with cord blood concentrations reaching only about 40% of maternal serum levels 2

Clinical Use in Pregnancy

• Proton pump inhibitors (PPIs) like esomeprazole are used for acid-related disorders during pregnancy when clinically indicated
• When used for preeclampsia in a clinical trial, esomeprazole did not show any adverse effects on pregnancy continuation compared to placebo 3

Medication Abortion vs. PPI Use

It's important to clarify that medication abortion involves specific medications:

• Medication abortion regimens use mifepristone and misoprostol, not PPIs 4, 5
• Esomeprazole has no role in medication abortion protocols
• There is no evidence that esomeprazole has any abortifacient properties

Considerations for PPI Use in Pregnancy

When considering esomeprazole use during pregnancy:

1. Benefit vs. Risk Assessment:

   • Use the lowest effective dose for the shortest duration needed
   • Consider the severity of the acid-related condition being treated
   • Benefits of treating severe GERD or other acid-related conditions may outweigh potential risks

2. Monitoring:

   • Regular follow-up during pregnancy is recommended
   • No special monitoring is required specifically due to esomeprazole use

3. Potential Interactions:

   • If the patient is also on other medications like clopidogrel, consider potential interactions 6, 7
   • In such cases, pantoprazole might be preferred over esomeprazole due to fewer drug interactions

Conclusion for Clinical Practice

When counseling patients about esomeprazole use during pregnancy:

• Reassure that it does not cause abortion
• Explain that limited data show no increased risk of adverse pregnancy outcomes
• Emphasize that medication abortion requires specific medications (mifepristone and misoprostol), not PPIs
• Consider alternative acid-suppressing medications if appropriate for the clinical situation

For patients requiring continued PPI therapy during pregnancy, esomeprazole can be used when clinically indicated without concern for abortifacient effects.