Fact Check: Are PPIs safe in pregnancy?

Fact Check: Are PPIs safe in pregnancy?

Published May 7, 2025
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VERDICT
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# Are PPIs Safe in Pregnancy? ## Introduction The safety of proton pump inhibitors (PPIs) during pregnancy has become a topic of increasing concern a...

Are PPIs Safe in Pregnancy?

Introduction

The safety of proton pump inhibitors (PPIs) during pregnancy has become a topic of increasing concern and debate among healthcare professionals and expectant mothers. PPIs are commonly prescribed to alleviate gastrointestinal issues, particularly gastroesophageal reflux disease (GERD), which affects a significant number of pregnant women. However, recent studies have raised questions about the potential risks associated with their use during pregnancy, including teratogenic effects and other adverse outcomes. This article examines the available evidence regarding the safety of PPIs in pregnancy without drawing a final conclusion.

What We Know

  1. Prevalence of PPI Use: PPIs are frequently used by pregnant women to manage GERD symptoms, which can affect between 30% to 85% of this population due to hormonal and physical changes during pregnancy 10.

  2. Concerns About Teratogenicity: A systematic review and meta-analysis from 2020 indicated potential concerns regarding the teratogenic effects of PPIs, suggesting a possible association with congenital malformations 1. However, the evidence remains mixed, with some studies finding no significant increase in risk 5.

  3. Specific Risks Identified: A cohort study published in 2023 examined the association between PPI use during pregnancy and low birth weight, concluding that there may be a correlation, although the authors emphasized the need for further research to establish causation 2.

  4. Pharmacokinetics in Pregnancy: Pregnancy alters the pharmacokinetic properties of medications, including PPIs. Changes in metabolism and clearance rates may affect drug efficacy and safety during pregnancy 6.

  5. Lack of Consensus: Various studies have produced conflicting results. Some research indicates no significant risks associated with PPI use during pregnancy, while others suggest potential links to adverse outcomes, including congenital malformations 37.

Analysis

The evidence surrounding the safety of PPIs in pregnancy is complex and often contradictory.

  • Source Evaluation:

    • The systematic review published in PubMed 1 is a peer-reviewed source, which generally enhances its credibility. However, systematic reviews can be influenced by the selection of studies included and the methodologies employed.
    • The cohort study from PMC 2 also appears credible, as it was approved by an institutional review board, indicating adherence to ethical standards. Nonetheless, cohort studies can be limited by confounding variables that may not be fully accounted for.
    • Articles from JAMA Network 5 and ScienceDirect 10 provide further insights but may also reflect publication bias, as journals often favor studies with significant findings.
  • Conflicts of Interest: It is important to consider potential conflicts of interest, especially in studies funded by pharmaceutical companies that produce PPIs. Such funding could influence the study design, outcomes, and interpretations.

  • Methodological Concerns: Many studies rely on observational data, which can introduce bias and limit the ability to establish causation. Randomized controlled trials (RCTs) are often considered the gold standard for determining safety but are challenging to conduct in pregnant populations due to ethical considerations.

  • Need for Additional Research: Given the mixed findings and the potential implications for maternal and fetal health, further research is necessary. Longitudinal studies that track outcomes over time and consider various confounding factors would be particularly beneficial.

Conclusion

Verdict: Unverified

The safety of proton pump inhibitors (PPIs) during pregnancy remains unverified due to the conflicting evidence surrounding their use. While some studies suggest potential risks, such as teratogenic effects and low birth weight, others indicate no significant associations. The lack of consensus in the research highlights the complexity of this issue, as various factors, including methodological limitations and potential biases, may influence study outcomes.

It is important to acknowledge that the available evidence is not definitive, and further research is needed to clarify the safety profile of PPIs in pregnant populations. Readers should critically evaluate the information presented and consider consulting healthcare professionals when making decisions regarding medication use during pregnancy.

Sources

  1. Use of proton pump inhibitors during pregnancy: A systematic review. PubMed. Link
  2. Maternal Proton Pump Inhibitor Use During Pregnancy and Risk of Low Birth Weight. PMC. Link
  3. Association Between Proton Pump Inhibitor Use During Early Pregnancy and Risk of Congenital Malformations. PubMed. Link
  4. The effects of proton pump inhibitors during pregnancy on treatment of preeclampsia and related maternal, fetal, and neonatal outcomes. Burnet Institute. Link
  5. Association Between Proton Pump Inhibitor Use During Early Pregnancy. JAMA Network. Link
  6. The effects of proton pump inhibitors during pregnancy on treatment of preeclampsia. AJOG MFM. Link
  7. Maternal Proton Pump Inhibitor Use During Pregnancy and Risk of Low Birth Weight. JAMA Network. Link
  8. The effects of proton pump inhibitors during pregnancy on treatment of preeclampsia. ScienceDirect. Link
  9. Prenatal and Early Childhood Exposure to Proton Pump Inhibitors. Springer. Link
  10. Use of proton pump inhibitors during pregnancy: A review. ScienceDirect. Link

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Fact Check: Autistic Non-Verbal Episodes in Marriage: Why Words Vanish Sometimes and What to Do About It Neurodiverse Couples Tuesday, august 12, 2025. Here’s the scene: You’re in the middle of a conversation with your spouse. Maybe the topic is small (“Did you pay the water bill?”) or monumental (“Are we happy?”). And then—without warning—your autistic partner’s voice disappears. No yelling, no slammed doors. Just… gone. You’re left holding the conversational steering wheel while they’ve quietly climbed into the trunk. If you’ve never lived with high-functioning autism, this can be tragically misconstrued as stonewalling or contempt. It isn’t. It’s just neurology pulling the emergency brake. Why This Happens: The Science Without the Lab Coat Smell For autistic adults, losing speech under stress is often a shutdown—a form of nervous system overload that knocks language production offline. Think of it like your phone freezing: all the apps are still there, but none of them open when you tap. Research calls this autistic burnout when it happens in a longer, chronic cycle—linked to masking (Hull et al., 2017; Raymaker et al., 2020). Masking is the art of “performing normal” so well that non-autistic people think you’re fine. The issue is that it eats through your energy reserves like a car idling in traffic with the A/C on full blast (Mantzalas et al., 2022). Eventually, one hard conversation can tip you from functional to frozen. And here’s where couples therapy meets neuroscience: physiological flooding—the body’s fight/flight/freeze switch—is a known relationship killer (Malik et al., 2019; Gottman Institute, 2024). In other words, for some autistic partners, flooding may tend to show up sooner, last longer, and is more likely to pull the plug on speech entirely. The Danger Loop in Marriage Autistic partner goes non-verbal — brain says “nope.” Non-autistic partner reads it as avoidance — brain says “attack.” Pressure increases — “Just say something.” Shutdown deepens — and now you’ve both lost. Do that a few hundred times and you’ll start conflating a physiological response into a moral failing. That’s the real marriage-killer. The Protocol: Three Phases, Zero Guesswork This is where we get practical. You can’t “love away” a temporary shutdown, but you can stop it from turning into World War III. Before: Build the Net Name the state. Agree on a phrase or signal ( I call this a couple code)—such as “words offline,” “shutdown,” a hand over the heart. The point is to make the invisible visible. The Shutdown Card. A literal card that says: I can’t speak right now. Please lower lights, reduce sound, give me X minutes. I promise I will circle back. The Pause Rule. Require a minimum of 20 minutes before resuming any tough talk. Autistic partner may need 90+. Agree ahead of time. Downgrade Kit. the usual gear; earplugs, soft light, weighted blanket, fidget, a quiet room. You know, human decency in object form. Reduce Daily Load. Avoid heavy talks right after work or big social events. Chronic overload makes a nervous shutdown more probable. During: Do Less, Better Autistic Partner: Give the signal. Exit stimulation. Switch channels if possible (text, notes app, yes/no cards). Send a short pre-written message: “Safe, can’t talk, back at 8:15.” Non-Autistic Partner: Acknowledge once—“Got it, I’m with you.” Hold the pause boundary. Lower stimuli. Go regulate your own nervous system—walk, journal, pet the dog. Don’t rehearse comebacks. Both: Avoid sarcasm, interrogation, ultimatums. Nothing lengthens a shutdown like moral outrage. After: Close the Loop Check in: “Are you ready to talk, or should we start in text?” Debrief: Identify triggers and what helped. Solve the actual problem. 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F., et al. (2023). The lived experience of meltdowns for autistic adults. Autism, 27(7), 1787–1799. https://doi.org/10.1177/13623613221145783 Malik, J., et al. (2019). Emotional flooding in response to negative affect in romantic relationships. Journal of Couple & Relationship Therapy, 18(4), 327–349. https://doi.org/10.1080/15332691.2019.1641188 Gottman Institute. (2024, March 4). Making sure emotional flooding doesn’t capsize your relationship. Retrieved from https://www.gottman.com/blog/making-sure-emotional-flooding-doesnt-capsize-your-relationship/

Detailed fact-check analysis of: Autistic Non-Verbal Episodes in Marriage: Why Words Vanish Sometimes and What to Do About It Neurodiverse Couples Tuesday, august 12, 2025. Here’s the scene: You’re in the middle of a conversation with your spouse. Maybe the topic is small (“Did you pay the water bill?”) or monumental (“Are we happy?”). And then—without warning—your autistic partner’s voice disappears. No yelling, no slammed doors. Just… gone. You’re left holding the conversational steering wheel while they’ve quietly climbed into the trunk. If you’ve never lived with high-functioning autism, this can be tragically misconstrued as stonewalling or contempt. It isn’t. It’s just neurology pulling the emergency brake. Why This Happens: The Science Without the Lab Coat Smell For autistic adults, losing speech under stress is often a shutdown—a form of nervous system overload that knocks language production offline. Think of it like your phone freezing: all the apps are still there, but none of them open when you tap. Research calls this autistic burnout when it happens in a longer, chronic cycle—linked to masking (Hull et al., 2017; Raymaker et al., 2020). Masking is the art of “performing normal” so well that non-autistic people think you’re fine. The issue is that it eats through your energy reserves like a car idling in traffic with the A/C on full blast (Mantzalas et al., 2022). Eventually, one hard conversation can tip you from functional to frozen. And here’s where couples therapy meets neuroscience: physiological flooding—the body’s fight/flight/freeze switch—is a known relationship killer (Malik et al., 2019; Gottman Institute, 2024). In other words, for some autistic partners, flooding may tend to show up sooner, last longer, and is more likely to pull the plug on speech entirely. The Danger Loop in Marriage Autistic partner goes non-verbal — brain says “nope.” Non-autistic partner reads it as avoidance — brain says “attack.” Pressure increases — “Just say something.” Shutdown deepens — and now you’ve both lost. Do that a few hundred times and you’ll start conflating a physiological response into a moral failing. That’s the real marriage-killer. The Protocol: Three Phases, Zero Guesswork This is where we get practical. You can’t “love away” a temporary shutdown, but you can stop it from turning into World War III. Before: Build the Net Name the state. Agree on a phrase or signal ( I call this a couple code)—such as “words offline,” “shutdown,” a hand over the heart. The point is to make the invisible visible. The Shutdown Card. A literal card that says: I can’t speak right now. Please lower lights, reduce sound, give me X minutes. I promise I will circle back. The Pause Rule. Require a minimum of 20 minutes before resuming any tough talk. Autistic partner may need 90+. Agree ahead of time. Downgrade Kit. the usual gear; earplugs, soft light, weighted blanket, fidget, a quiet room. You know, human decency in object form. Reduce Daily Load. Avoid heavy talks right after work or big social events. Chronic overload makes a nervous shutdown more probable. During: Do Less, Better Autistic Partner: Give the signal. Exit stimulation. Switch channels if possible (text, notes app, yes/no cards). Send a short pre-written message: “Safe, can’t talk, back at 8:15.” Non-Autistic Partner: Acknowledge once—“Got it, I’m with you.” Hold the pause boundary. Lower stimuli. Go regulate your own nervous system—walk, journal, pet the dog. Don’t rehearse comebacks. Both: Avoid sarcasm, interrogation, ultimatums. Nothing lengthens a shutdown like moral outrage. After: Close the Loop Check in: “Are you ready to talk, or should we start in text?” Debrief: Identify triggers and what helped. Solve the actual problem. No conflict gets left to rot in the corner. Spot burnout early. If shutdowns start clustering, it’s time to reduce demands, not double them. How This Isn’t Stonewalling Stonewalling is a choice. Shutdown is a lockout. Stonewalling says, “I won’t talk to you.” Shutdown says, “I can’t talk to you yet, but I will.” The key difference? Repair intention. A shutdown protocol builds that right into the process. The Ten-Minute At-Home Drill Co-create your signal and card. Agree on a pause window. Pack the downgrade kit. Rehearse the exchange (“Got it, I’m with you.”). Check in weekly to tweak the system. Remember, you’re not aiming for zero shutdowns. You’re aiming for shorter, kinder, safer ones. Why This Works Because it matches lived autistic experience (Raymaker et al., 2020; Lewis et al., 2023). Because it honors nervous system limits instead of punishing them (Malik et al., 2019). Because it lets both partners keep their dignity and still solve the problem. In other words: you’re building a marriage that can survive the occasional moments when the words are gone for the time being. Be Well, Stay Kind, and Godspeed. REFERENCES: Hull, L., Mandy, W., Lai, M.-C., Baron-Cohen, S., Allison, C., Smith, P., & Petrides, K. V. (2017). “Putting on my best normal”: Social camouflaging in adults with autism spectrum conditions. Autism, 21(5), 611–622. https://doi.org/10.1177/1362361316671012 Raymaker, D. M., Teo, A. R., Steckler, N. A., Lentz, B., Scharer, M., Delos Santos, A., … & Nicolaidis, C. (2020). “Having all of your internal resources exhausted beyond measure and being left with no clean-up crew”: Defining autistic burnout. Autism in Adulthood, 2(2), 132–143. https://doi.org/10.1089/aut.2019.0079 Mantzalas, J., Richdale, A. L., Adikari, A., Lowe, J., & Dissanayake, C. (2022). What Is Autistic Burnout? A thematic analysis of posts on two online platforms. Autism in Adulthood, 4(1), 52–65. https://doi.org/10.1089/aut.2021.0079 Lewis, L. F., et al. (2023). The lived experience of meltdowns for autistic adults. Autism, 27(7), 1787–1799. https://doi.org/10.1177/13623613221145783 Malik, J., et al. (2019). Emotional flooding in response to negative affect in romantic relationships. Journal of Couple & Relationship Therapy, 18(4), 327–349. https://doi.org/10.1080/15332691.2019.1641188 Gottman Institute. (2024, March 4). Making sure emotional flooding doesn’t capsize your relationship. Retrieved from https://www.gottman.com/blog/making-sure-emotional-flooding-doesnt-capsize-your-relationship/

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