Hussain Salman, Singh Ambrish, Antony Benny, Klugarová Jitka, Murad M Hassan, Jayraj Aarthi S, Langaufová Alena, Klugar Miloslav
Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic, Kamenice 5, 62500 Brno, Czech Republic.
Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS 7000, Australia.
J Clin Med. 2022 Aug 10;11(16):4675. doi: 10.3390/jcm11164675.
Evidence from preclinical studies suggests a preventive effect of proton pump inhibitors (PPIs) in preeclampsia. Recently, several epidemiological studies have described a conflicting association between the use of PPIs during pregnancy and preeclampsia risk. This study aimed to evaluate the association between PPI use and the risk of preeclampsia. We searched databases, including MEDLINE, Embase, Scopus, Web of Science Core Collection, Emcare, CINAHL, and the relevant grey literature from inception until 13 September 2021. Studies reporting the preeclampsia risk with the use of PPIs were eligible for inclusion. Literature screening, data extraction, and the risk of bias assessment were performed independently by two investigators. Random-effect meta-analysis was performed to generate relative risks (RR) and 95% confidence intervals (CI). The risk of preeclampsia and preterm preeclampsia among women receiving PPIs during pregnancy were the primary outcomes of interest. This meta-analysis comprised three studies involving 4,877,565 pregnant women, of whom 119,017 were PPI users. The included studies were judged to have a low risk of bias. The risk of preeclampsia among pregnant women who received PPIs anytime during pregnancy was significantly increased (RR 1.27 (95% CI: 1.23-1.31)), although the increase was trivial in absolute terms (2 per 1000). The subgroup analysis revealed that the risk was increased in each of the three trimesters. The risk of preterm preeclampsia among pregnant women receiving PPIs anytime during pregnancy was not significantly increased (RR 1.04 (95% CI: 0.70-1.55)). The certainty evaluated by GRADE in these estimates was low. PPI use may be associated with a trivial increase in the risk of preeclampsia in pregnant women. There is no evidence supporting that PPI use decreases the risk of preeclampsia or preterm preeclampsia.
临床前研究的证据表明质子泵抑制剂（PPI）对先兆子痫有预防作用。最近，几项流行病学研究描述了孕期使用PPI与先兆子痫风险之间相互矛盾的关联。本研究旨在评估PPI使用与先兆子痫风险之间的关联。我们检索了包括MEDLINE、Embase、Scopus、Web of Science核心合集、Emcare、CINAHL以及相关灰色文献在内的数据库，检索时间从数据库创建至2021年9月13日。报告使用PPI时先兆子痫风险的研究符合纳入标准。文献筛选、数据提取和偏倚风险评估由两名研究人员独立进行。采用随机效应荟萃分析生成相对风险（RR）和95%置信区间（CI）。孕期接受PPI治疗的女性中先兆子痫和早产先兆子痫的风险是主要关注的结果。这项荟萃分析包括三项研究，涉及4,877,565名孕妇，其中119,017名是PPI使用者。纳入的研究被判定为偏倚风险较低。孕期任何时候接受PPI治疗的孕妇发生先兆子痫的风险显著增加（RR 1.27（95%CI：1.23 - 1.31）），尽管从绝对数值来看增加幅度很小（每1000人中有2人）。亚组分析显示，在三个孕期中每个孕期的风险都有所增加。孕期任何时候接受PPI治疗的孕妇发生早产先兆子痫的风险没有显著增加（RR 1.04（95%CI：0.70 - 1.55））。这些估计值经GRADE评估的确定性较低。使用PPI可能与孕妇先兆子痫风险的轻微增加有关。没有证据支持使用PPI可降低先兆子痫或早产先兆子痫的风险。
