Summary: A new study reveals a link between prolonged acetaminophen use in pregnancy and an increased risk of offspring being diagnosed with ADHD or ASD. Researchers report children of mothers who had prolonged exposure to the pain killer during pregnancy had a 30% increased risk of developing ADHD and a 20% increased risk of being diagnosed with ASD.
Source: The Hebrew University of Jerusalem.
A study from the Hebrew University of Jerusalem sheds new light on the possible relationship between prolonged use of acetaminophen (paracetamol) during pregnancy and the risk of neurodevelopmental disorders in childhood.
Acetaminophen is one of the most common medications used for treatment of pain and fever reduction during pregnancy and is considered safe in humans. However, evidence of neuro-disruptive properties is accumulating: past studies have shown that long-term administration of low doses of acetaminophen may affect the development of the fetal nervous system, and that this effect is often seen years after exposure during childhood.
Now, researchers led by Dr. Ilan Matok at the Institute for Drug Research in the School of Pharmacy at the Hebrew University’s Faculty of Medicine, together with doctoral student Reem Masarwa, have conducted a systematic review and meta-analysis to assess the possible association between prolonged exposure to acetaminophen during pregnancy and the risk for attention deficit hyperactivity disorder (ADHD) and autistic spectrum disorder (ASD).
The analysis, which appears in the American Journal of Epidemiology, shows that prolonged exposure to acetaminophen during pregnancy is associated with a 30% increase in relative risk for ADHD (compared to those who did not take acetaminophen during pregnancy) and a 20% increase in relative risk for ASD.
This is the first meta-analysis and the most comprehensive study ever conducted on the possible association between prolonged use of acetaminophen during pregnancy and risk of autism spectrum disorder (ASD) or attention deficit hyperactivity disorder (ADHD). The research data covered 132,738 mother and child pairs with a follow-up period of 3-11 years.
Given the significant limitations of existing studies, the researchers believe the results should be interpreted with caution, as they may cause unnecessary anxiety among pregnant women. It is important to understand that pain and fever during pregnancy can have a detrimental effect on the developing fetus and that acetaminophen is still considered a safe drug for use during pregnancy. Therefore, if a pregnant woman has fever and/or pain, acetaminophen can be taken for a short period, and if the fever or pain continue beyond that, she should consult her physician regarding further treatment.
Dr. Amichai Perlman and Dr. Hagai Levine of the Hebrew University of Jerusalem and Hadassah Medical Center participated in the research.
“Our study provides the first comprehensive overview of developmental outcomes following prolonged acetaminophen use during pregnancy,” said Dr. Ilan Matok, Head of the Pharmacoepidemiology Research Lab, Institute for Drug Research, School of Pharmacy, Hebrew University Faculty of Medicine. “Our findings suggest an association between prolonged acetaminophen use and an increase in the risk of autism and ADHD. However, the observed increase in risk was small, and the existing studies have significant limitations. While unnecessary use of any medication should be avoided in pregnancy, we believe our findings should not alter current practice and women should not avoid use of short term acetaminophen when clinically needed.”
Source: Dov Smith – The Hebrew University of Jerusalem
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Original Research: Abstract for “Prenatal Exposure to Acetaminophen and Risk for Attention Deficit Hyperactivity Disorder and Autistic Spectrum Disorder: A Systematic Review, Meta-Analysis, and Meta-Regression Analysis of Cohort Studies” by Reem Masarwa, Hagai Levine, Einat Gorelik, Shimon Reif, Amichai Perlman, and Ilan Matok in American Journal of Epidemiology. Published April 24 2018.
Prenatal Exposure to Acetaminophen and Risk for Attention Deficit Hyperactivity Disorder and Autistic Spectrum Disorder: A Systematic Review, Meta-Analysis, and Meta-Regression Analysis of Cohort Studies
Acetaminophen is the most commonly used analgesic and antipyretic during pregnancy. Evidence of neuro-disruptive properties is accumulating. Therefore, we sought to evaluate the risk for attention deficit hyperactivity disorder (ADHD) and autistic spectrum disorder (ASD) in the offspring of women exposed to acetaminophen during pregnancy. We searched MEDLINE, EMBASE, and Cochrane up to January 2017. Data were independently extracted and assessed by two researchers. Seven eligible retrospective cohorts included 132,738 mother and child pairs and with a follow-up period of 3-11 years. Pooled risk ratio (RR) for ADHD was (RR=1.32, 95% CI 1.18,1.45, I2=61%), for ASD (RR=1.23, 95% CI1.13,1.32, I2=17%), and for hyperactivity symptoms (RR=1.23, 95% CI 1.01,1.49, I2=94%). In meta-regression analysis, the association between exposure and ADHD increased with childs’ age upon follow-up and with the mean duration of exposure (β=0.0354, 95% CI 0.001,0.07), (β=0.006, 95% CI 0.009,0.01). The available data is of observational nature only. Studies differed gravely in exposure and outcome assessment. Acetaminophen use during pregnancy is associated with an increased risk for ADHD, ASD and hyperactivity symptoms. These findings are concerning, however, results should be interpreted with caution as the available evidence consists of observational studies and susceptible to several potential sources of bias.