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BMJ 2010; 341 doi: (Published 01 December 2010) Cite this as: BMJ 2010;341:c6808

Proton pump inhibitors look to be low risk for pregnant women

Gastro-oesophageal reflux is common in pregnancy. But is it safe for women to take proton pump inhibitors (PPIs)—the most effective treatment? Probably, say researchers from Denmark. They found no evidence of a link between major birth defects and exposure to proton pump inhibitors during the first trimester in a study of 840 968 live births (adjusted prevalence odds ratio 1.10, 95% CI 0.91 to 1.34).

The answer isn’t entirely clear cut, however, thanks to an unexpected increase in major birth defects in women who took proton pump inhibitors in the month before conception (1.39, 1.10 to 1.76). The researchers dug deeper to try to explain the effect and found that the increase was confined to lansoprazole. Omeprazole, the most popular drug, was exonerated. More puzzling still, women who had taken too little of any proton pump inhibitor before conception to have any chance of exposure during the first trimester still had an increased risk of birth defects. The authors blame chance or statistical artefact, probably some sort of confounding. They had no information about the indications for treatment, for example, and no data on folic acid intake.

An editorial (p 2161) agrees that confounding is the most likely explanation. Still, more work needs to be done before women can be completely reassured. These drugs are popular and available over the counter in some countries. Use among pregnant women is likely to increase.

High protein, low GI diets help maintain weight loss

Weight regain is one of the biggest challenges facing successful dieters. Eating less and exercising more is hard to sustain long term, partly because the body responds to weight loss by increased hunger and reduced energy expenditure at rest.

Maintenance diets are more likely to be successful if they have a low glycaemic index, a high protein content, or both, according to a recent trial. …

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