Associations Between Late-Onset Preeclampsia and the Use of Calcium-Based Antacids and Proton Pump Inhibitors During Pregnancy: A Prospective Cohort Study

• Published in: Clinical epidemiology Vol. 14; pp. 1229 - 1240
• Main Authors: Gelder, Marleen MHJ van, Beekers, Pim, Rijt-Weetink, Yrea RJ van, Drongelen, Joris van, Roeleveld, Nel, Smits, Luc JM
• Format: Journal Article
• Language: English
• Published: Macclesfield Dove Medical Press Limited 01.01.2022; Taylor & Francis Ltd; Dove; Dove Medical Press
• Subjects: Antacids; Clinical medicine; Cohort analysis; Data collection; Drug dosages; Epidemiology; extended cox models; Gastroesophageal reflux; gastroesophageal reflux disease; gestational hypertension; Health aspects; Human subjects; Hypertension; longitudinal clustering methods; Maternal & child health; Mortality; Netherlands; Obstetrics; Original Research; Preeclampsia; Pregnancy; Pregnancy complications; Pregnant women; pride study; Proton pump inhibitors; Questionnaires; the dutch pregnancy drug register; Womens health; Netherlands
• ISSN: 1179-1349; 1179-1349
• DOI: 10.2147/CLEP.S382303

Purpose: Preeclampsia is a leading cause of maternal morbidity and mortality. Calcium-based antacids and proton pump inhibitors (PPIs) are commonly used during pregnancy to treat symptoms of gastroesophageal reflux disease. Both have been hypothesized to reduce the risk of preeclampsia. We determined associations of calcium-based antacid and PPI use during pregnancy with late-onset preeclampsia ([greater than or equal to]34 weeks of gestation), taking into account dosage and timing of use. Patients and Methods: We included 9058 pregnant women participating in the PRIDE Study (2012-2019) or The Dutch Pregnancy Drug Register (2014-2019), two prospective cohorts in The Netherlands. Data were collected through web-based questionnaires and obstetric records. We estimated risk ratios (RRs) for late-onset preeclampsia for any use and trajectories of calcium-based antacid and PPI use before gestational day 238, and hazard ratios (HRs) for time-varying exposures after gestational day 237. Results: Late-onset preeclampsia was diagnosed in 2.6% of pregnancies. Any use of calcium-based antacids (RR 1.2 [95% CI 0.9-1.6]) or PPIs (RR 1.4 [95% CI 0.8-2.4]) before gestational day 238 was not associated with late-onset preeclampsia. Use of low-dose calcium-based antacids in gestational weeks 0-16 (<1 g/day; RR 1.8 [95% CI 1.1-2.9]) and any use of PPIs in gestational weeks 17-33 (RR 1.6 [95% CI 1.0-2.8]) seemed to increase risks of late-onset preeclampsia. We did not observe associations between late-onset preeclampsia and use of calcium-based antacids (HR 1.0 [95% CI 0.6-1.5]) and PPIs (HR 1.4 [95% CI 0.7-2.9]) after gestational day 237. Conclusion: In this prospective cohort study, use of calcium-based antacids and PPIs during pregnancy was not found to reduce the risk of late-onset preeclampsia. Keywords: extended Cox models, gestational hypertension, gastroesophageal reflux disease, longitudinal clustering methods, PRIDE study, The Dutch Pregnancy Drug Register