(B-235) Acid-Suppressive Medications and Risk of Childhood Asthma: A Meta-Analysis of Observational Epidemiological Studies

Background: Acid-suppressive medications (ASMs), including H2-receptor antagonists (H2RA) and proton pump inhibitors (PPI), are primary treatments for dyspepsia and gastroesophageal reflux disease during pregnancy and in children. The association between prenatal and infant exposure to ASMs and the risk of childhood asthma remains controversial.

Objectives: This study aimed to systematically investigate whether prenatal or infant exposure to ASMs is linked to an increased risk of childhood asthma through a meta-analysis of observational epidemiological studies.

Methods: A comprehensive literature search was conducted in PubMed, Medline, Embase, and Scopus until December 2024. Two reviewers independently screened search results for eligibility and extracted data from included studies. The Newcastle-Ottawa Scale assessed the quality of included cohort and case-control studies. The primary analysis determined the asthma risk in subjects exposed vs. not exposed to ASMs, presented as pooled odds ratios (OR) and 95% confidence intervals (CI) using a random-effects model. Subgroup meta-analyses were performed based on ASM type and exposure time. Heterogeneity was assessed using the I² statistic, and publication bias was evaluated using Egger’s regression test and funnel plots. Sensitivity analyses were conducted through leave-one-out meta-analysis to assess individual study impact on the result robustness.

Results: This meta-analysis included 12 studies. Prenatal exposure to ASMs significantly increased the risk of childhood asthma (OR = 1.32, 95% CI 1.28-1.51). First and third-trimester ASM use associated with an increased risk of asthma (OR = 1.37, 95% CI 1.23-1.51; OR = 1.20, 95% CI 1.01-1.43, respectively), while second-trimester exposure did not (OR = 1.50, 95% CI 0.99-2.29). H2RA use during pregnancy was associated with an increased risk of childhood asthma (OR = 1.37, 95% CI 1.10-1.71), contrasting with PPIs (OR = 1.26, 95% CI 0.99-1.61). Infant exposure to ASMs was linked to an increased asthma risk (OR = 1.48, 95% CI 1.31-1.66). Both PPIs and H2RAs use in infants were associated with increased asthma risk (OR = 1.42, 95% CI 1.14-1.76; OR = 1.30, 95% CI 1.17-1.44).

Conclusions: Prenatal and infant exposure to ASMs is associated with an increased risk of childhood asthma. Clinicians should carefully consider the benefits of prescribing ASMs to pregnant women and children, emphasizing subsequent close monitoring for any clinically relevant safety signals.