Acetaminophen Increasingly Seen as Risky in Pregnancy

By John Henry Dreyfuss, MDalert.com staff.

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  • A mother’s use of acetaminophen during pregnancy increased the risk of hyperactivity by 31% by the child’s age 7 years.
  • Children exposed to acetaminophen prenatally are at increased risk of multiple behavioral difficulties.
  • A mother’s use of acetaminophen during pregnancy raised the risk of her child developing asthma by 13%.

Children who were exposed to acetaminophen during pregnancy (Figure 1) are at increased risk of asthma and multiple behavioral difficulties, according to 2 recent studies. “The associations [with behavioral difficulties] do not appear to be explained by unmeasured behavioral or social factors linked to acetaminophen use insofar as they are not observed for postnatal or partner’s acetaminophen use,” according to a recent publication in JAMA Pediatrics.

 

Figure 1. Bronze figure of a pregnant naked woman
by Danny Osborne, Merrion Square, Dublin, Ireland.
(Sources: Wikipedia/Image by William Murphy posted to Flickr/Creative Commons.)

This study in British children found that a mother’s use of acetaminophen in during pregnancy increased her child’s risk of hyperactivity (Figure2) by 31% by the time the child was 7 years of age.

A study published recently in the International Journal of Epidemiology suggests that prenatal and infant exposure to acetaminophen are independently associated with the development of asthma in children. Results of this study in Norwegian women and children found that prenatal acetaminophen use increased 7-year-olds’ risk of asthma by 13%.

 

Figure 2. Image of PET brain scan showing decreased neural activity of a subject
with attention deficit hyperactivity disorder (left) compared to control (right).
(Sources: Wikipedia/Zemetkin et al/Public Domain.)

JAMA Pediatrics

The study published in JAMA Pediatrics examined the prenatal use of acetaminophen among British women. The authors report that a mother’s use of the pain reliever in midpregnancy increased 7-year-olds’ risk of hyperactivity by 31%. Women experience a variety of types of pain during pregnancy for which they seek pharmacologic relief. Carpel tunnel syndrome (Figure 3) is a common cause of pain during pregnancy.

The researchers collected and analyzed data from the Avon Longitudinal Study of Parents and Children (ALSPAC), a prospective birth cohort, from February 2015 to March 2016. The study included 7796 mothers enrolled in ALSPAC between 1991 and 1992 along with their children and partners. Acetaminophen use was assessed by questionnaire at 18 and 32 weeks of pregnancy and when the child was aged approximately 5 years.

“Maternal prenatal acetaminophen use at 18 (n = 4415; 53%) and 32 weeks of pregnancy (n = 3381; 42%) was associated with higher odds of having conduct problems (risk ratio [RR], 1.42; 95% CI, 1.25-1.62) and hyperactivity symptoms (RR, 1.31; 95% CI, 1.16-1.49), while maternal acetaminophen use at 32 weeks was also associated with higher odds of having emotional symptoms (RR, 1.29; 95% CI, 1.09-1.53) and total difficulties (RR, 1.46; 95% CI, 1.21-1.77).

 

Figure 3. Carpel tunnel syndrome is a common source of pain in pregnant women.
(Sources: Wikipedia/By Blausen.com staff. Blausen gallery 2014.
Wikiversity Journal of Medicine
/Creative Commons.)

“This was not the case for maternal postnatal (n = 6916; 89%) or partner’s (n = 3454; 84%) acetaminophen use. We found the associations between maternal prenatal acetaminophen use and all the [Strengths and Difficulties Questionnaire; SDQ] domains unchanged even after adjusting for maternal postnatal or partner’s acetaminophen use,” the authors explained.

“Children exposed to acetaminophen prenatally are at increased risk of multiple behavioral difficulties, and the associations do not appear to be explained by unmeasured behavioral or social factors linked to acetaminophen use insofar as they are not observed for postnatal or partner’s acetaminophen use,” the authors concluded.

International Journal of Epidemiology

This study examined the link between prenatal and infant acetaminophen exposure and the development of asthma (Figure 4) early in the child’s life.

The Analysis

The authors of this trial used information from the Norwegian Mother and Child Cohort Study. The trial included 53,169 children who were evaluated for current asthma at 3 years, 25,394 who were evaluated for current asthma at 7 years, and 45,607 who received asthma medications at 7 years, as recorded in the Norwegian Prescription Database. The authors calculated adjusted relative risks (adj. RR) and 95% confidence intervals (CI) using log-binomial regression.

 

 

Figure 4. The pathophysiology of asthma.
(Sources: Wikipedia/By United States-National Institute of Health:
National Heart, Lung, Blood Institute
/Public Domain.)

“There were independent modest associations between asthma at 3 years with prenatal paracetamol exposure (adj. RR 1.13; 95% CI: 1.02–1.25) and use of paracetamol during infancy (adj. RR 1.29; 95% CI: 1.16–1.45). The results were consistent for asthma at 7 years. The associations with prenatal paracetamol exposure were seen for different indications (pain, respiratory tract infections/influenza and fever). Maternal pain during pregnancy was the only indication that showed an association both with and without paracetamol use. Maternal paracetamol use outside pregnancy and paternal paracetamol use were not associated with asthma development. In a secondary analysis, prenatal ibuprofen exposure was positively associated with asthma at 3 years but not asthma at 7 years,” the authors explained

“This study provides evidence that prenatal and infant [acetaminophen] exposure have independent associations with asthma development. Our findings suggest that the associations could not be fully explained by confounding by indication,” the researchers concluded.


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