A MAJOR national analysis has found no link between prenatal acid-suppressive medication exposure and neuropsychiatric disorders in offspring when family background is properly accounted for, challenging earlier associations and offering new reassurance for expectant parents and prescribing clinicians.
How Acid-Suppressive Medication Became a Prenatal Concern
Acid-suppressive medication is widely prescribed during pregnancy to manage reflux and gastric discomfort, with use rates increasing as maternal age rises. Previous observational studies suggested possible links between prenatal exposure and later childhood diagnoses such as attention-deficit hyperactivity disorder and autism spectrum disorders, raising clinical uncertainty around prescribing decisions. Because neurodevelopmental conditions have multifactorial causes, concerns have centred on whether observed associations truly reflected medication effects or unmeasured genetic and environmental family factors.
The present investigation used comprehensive insurance records from South Korea to examine acid-suppressive medication exposure during gestation and long-term childhood neuropsychiatric outcomes across more than a decade of follow-up.
National Cohort Analysis of Acid-Suppressive Medication Outcomes
The study analysed 2,777 ,19 mother child pairs, including 507,845 exposed to prenatal acid-suppressive medication, followed for a mean of 10.3 years. In the overlap weighted cohort, offspring risks were 4.85% vs 4.25% for ADHD, 1.45% vs 1.33% for ASD, 1.25% vs 1.09% for intellectual disability, 0.94% vs 0.81% for severe neuropsychiatric disorder, and 0.30% vs 0.27% for obsessive-compulsive disorder. Adjusted hazard ratios were 1.14 for ADHD, 1.07 for ASD, 1.13 for intellectual disability, 1.16 for severe neuropsychiatric disorder, and 1.12 for obsessive-compulsive disorder.
However, sibling matched analyses of 157,069 exposed and 164,69 unexposed children showed no significant associations. Adjusted hazard ratios were 0.98 for ADHD, 0.98 for ASD, 1.02 for intellectual disability, 1.00 for severe neuropsychiatric disorder, and 0.95 for obsessive-compulsive disorder.
Implications For Prescribing and Future Monitoring
These findings indicate that apparent risks linked to acid-suppressive medication largely disappear once shared genetic and household factors are controlled. For clinical practice, the results support continued appropriate prescribing when clinically indicated. Future research should examine dose, duration, and specific drug classes to refine prescribing guidance further and strengthen pregnancy care counselling.
Reference
Hong S et al. Prenatal exposure to acid-suppressive medications and risk of neuropsychiatric disorders in children. JAMA. 2026;DOI:10.1001/jama.2025.23956.
