Prenatal Acid-Suppressive Drug Exposure Not Clearly Linked to Childhood IBD: JAMA
South Korea: A large South Korean cohort study has found no clear evidence that prenatal exposure to acid-suppressive medications increases the risk of developing inflammatory bowel disease (IBD) during childhood.
Although a modest association was observed with IBD overall and specifically with Crohn’s disease, no association was found with ulcerative colitis. Importantly, there were no meaningful differences in absolute risk between exposed and unexposed children, suggesting that the clinical impact is likely minimal. These findings provide reassurance regarding the use of acid-suppressive drugs during pregnancy, while highlighting the need for continued research into potential long-term effects on the offspring's health.
The findings, published in JAMA Network Open by Jiyeon Oh and colleagues, investigated whether prenatal exposure to acid-suppressive medications affects the risk of inflammatory bowel disease (IBD) in children. Concerns have been raised that proton pump inhibitors (PPIs) and H2 receptor antagonists (H2RAs) may influence fetal gut and immune development.
Using data from South Korea’s National Health Insurance Service, researchers conducted a nationwide cohort study of mother-child pairs from 2009 to 2017, with follow-up through 2023. After propensity score matching, the analysis included 1,837,916 mother-child pairs. The team evaluated the risk of IBD, Crohn’s disease, and ulcerative colitis, and performed subgroup and sibling analyses to account for potential confounding factors.
Results showed a modest increase in the relative risk of IBD and Crohn’s disease among children exposed to acid-suppressive medications during pregnancy, while no significant association was observed for ulcerative colitis. However, absolute risk differences were minimal, indicating little clinical significance. Moreover, sibling comparison analyses found no significant association between prenatal exposure and the risk of IBD, Crohn’s disease, or ulcerative colitis.
Key findings from the study include:
- Prenatal exposure to acid-suppressive medications was associated with a modest increase in the relative risk of childhood IBD.
- The association was significant for Crohn’s disease but not for ulcerative colitis.
- Absolute risk differences for IBD, Crohn’s disease, and ulcerative colitis were minimal, indicating little clinical impact.
- Sibling comparison analyses showed no significant association between prenatal exposure and the risk of IBD, Crohn’s disease, or ulcerative colitis.
- The findings were consistent with the view that shared familial or genetic factors may partly explain the observed associations.
The researchers noted limitations, including possible underdiagnosis of pediatric IBD, reliance on claims data, and potential unmeasured confounding. Some over-the-counter medication use may also have been missed. However, the large nationwide cohort and sibling analyses strengthen the findings.
The authors concluded that prenatal exposure to acid-suppressive medications was not consistently associated with childhood-onset IBD. The findings suggest that any potential risk is likely small and should be weighed against the clinical need for treatment during pregnancy. Further research is warranted.
Reference:
Oh J, Park J, Kim H, et al. Prenatal Exposure to Acid-Suppressive Medications and Incident Risk of Inflammatory Bowel Disease in Children. JAMA Netw Open. 2026;9(6):e2620030. doi:10.1001/jamanetworkopen.2026.20030
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