A new study published today in Alimentary Pharmacology and Therapeutics noted an association between prenatal exposure to proton pump inhibitors (PPIs) and childhood asthma. Of the near 200,000 Danish infants tracked between years 1996 and 2008, 12.4% of them developed asthma by year 6. After adjusting for other confounding variables, maternal use of PPIs and/or histamine 2-receptor antagonists (H2RAs) during pregnancy was associated with a 1.4 times higher incidence of childhood asthma.
What is the mechanism?
PPIs have been noted to cause imbalances in our the commensal bacteria residing in our small intestine, most noticeably reduced Actinobacteria and Bifidobacteria species (2). This bacterial shift away from protective bifidobacterium spp. is thought to facilitate increased levels of endotoxin (LPS) harboring, gram negative bacteria and staphylococcus aureus. The main way in which the sterile infant microbiome is colonized is through contact with the mother’s vaginal and intestinal flora during the birthing process and later breast feeding, foundling and kissing (3). Hence the microbiome of the infant closely resembles that of the mother. Therefore if the mother’s microbiome is imbalanced due to use of prescription medications that create intestinal dysbiosis, then this imbalanced gut microflora will ensue in the infant; who’s naive immune system is highly dependent upon healthy microbes -such as Bifidobactia spp- for proper development and restoration of immunological tolerance. For loss of immune tolerance leads immune imbalances and food sensitivities to dietary proteins like gluten.
In conclusion recent data suggests that a dysbiotic maternal gut microbiome can be transferred to her offspring, facilitating childhood immune imbalances such as asthma.
2) Wallace, J. L., Syer, S., Denou, E., De Palma, G., Vong, L., McKnight, W., Jury, J., et al. (2011). Proton Pump Inhibitors Exacerbate NSAID-Induced Small Intestinal Injury by Inducing Dysbiosis. Gastroenterology, 141(4), 1314–1322.e5. doi:10.1053/j.gastro.2011.06.075