胃酸抑制薬の使用が妊娠中および産後の感染症リスクを高める可能性を示唆(Stomach acid medicine tied to higher infection risk in pregnancy)

2025-10-10

2025-10-09 カロリンスカ研究所(KI)

カロリンスカ研究所とアントワープ大学の研究によると、胃酸抑制薬プロトンポンプ阻害薬(PPI)を妊娠中に使用した女性は、使用しない女性よりも感染症を発症するリスクが26%高いことが分かった。2006～2019年のスウェーデン150万件以上の妊娠データを解析した結果、PPI使用者の約半数が妊娠中または出産後3カ月以内に感染を経験していた。特に消化管の細菌・ウイルス感染が多く、使用頻度は妊婦全体で1.5%から3.4%に増加。研究は観察的であり、生活習慣など未測定要因の影響も考慮が必要とされる。成果は『The Lancet Obstetrics, Gynaecology & Women’s Health』誌に掲載。

<関連情報>

プロトンポンプ阻害薬と妊娠中および産後の感染リスク:スウェーデンにおける人口ベースの登録コホート研究 Proton pump inhibitors and the risk of infection during pregnancy and postpartum: a population-based register cohort study in Sweden

Hana Shabana, MD ∙ Carolyn E Cesta, PhD ∙ Jane Yan, MSc ∙ Prof Nele Brusselaers, MD ∙ Prof Kenny A Rodriguez-Wallberg, MD
The Lancet Obstetrics, Gynaecology & Women’s Health Published: October 2025
DOI:https://doi.org/10.1016/j.lanogw.2025.100009

Summary

Background

Proton pump inhibitors (PPIs) are effective for relieving the symptoms of gastric reflux, which is common in pregnancy. An increased risk of infection after PPI use has been reported in the general population, but studies in pregnant individuals are absent. We aimed to assess the risk of infection in pregnant individuals taking PPIs.

Methods

We conducted a nationwide, population-based register cohort study in Sweden, based on data from the National Medical Birth Register (MBR), the Prescribed Drug Register, the National Patient Register, and the Longitudinal Integrated Database for Health Insurance and Labour Market Studies. We included individuals with singleton pregnancies with dates of delivery between July 1, 2006, and Dec 31, 2019, as registered in the MBR. Pregnant individuals with previous diagnoses of chronic infectious diseases and those with a history of abdominal surgery were excluded. Exposure to PPIs was defined as at least one PPI prescription fill (Anatomical Therapeutic Chemical [ATC] code A02BC) from 90 days before the last menstrual period (LMP) to the end of the first trimester (LMP + 97 days). Infections during pregnancy from the start of the second trimester (LMP + 98 days) to 90 days postpartum were identified through prescription fills for antimicrobials (ATC codes, for mild infections) and diagnoses made in inpatient or outpatient care (ICD-10 codes, for moderate-to-severe infections, subdivided into relevant infection types and locations). Pregnancy complications commonly related to infection (premature rupture of membranes, preterm delivery, meconium presence, and fever during labour) were also identified in the MBR. Risks ratios (RRs) for the association between PPI use and infection outcomes were estimated from log-binomial regression models that were adjusted for characteristics of the pregnant individual as potential confounders (age at delivery, BMI and smoking status in early pregnancy, highest attained education in the year of delivery, birth country of the pregnant individual, and relevant comorbidities).

Findings

The cohort comprised 1 509 102 singleton pregnancies. PPIs were used in 42 293 (2·8%) of the pregnancies, and use of these drugs generally increased over the study period, from 1523 (1·5%) of 100 195 pregnancies delivered in 2006, to 3780 (3·4%) of 110 762 in 2019. Compared with pregnancies with no PPI use (n=1 466 809), those with PPI use had a higher prevalence of any infection (539 831 [36·8%] vs 21 011 [49·7%]), corresponding to a significantly increased risk of any infection with PPI use (adjusted RR 1·26, 95% CI 1·25–1·27). The risk of mild infection (adjusted RR 1·30, 1·28–1·33), moderate-to-severe infection (1·36, 1·33–1·38), and infection-related pregnancy complications (1·09, 1·06–1·12) was also increased with the use of PPIs. Among the studied infection types, PPI use was associated with increased risk of viral infection (adjusted RR 2·07, 1·92–2·23) and bacterial infection (1·43, 1·40–1·47). Among the studied locations of infection, the highest risk was observed for gastrointestinal infections (adjusted RR 2·09, 1·96–2·23).

Interpretation

We found some evidence of an association between PPI use in the preconception and early pregnancy period and the risk of infections during pregnancy and postpartum. However, residual confounding by lifestyle factors cannot be fully accounted for, and these findings should be interpreted cautiously. For individuals with increased susceptibility to infections, the need for PPI therapy during pregnancy should be carefully evaluated.