Acetaminophen in Pregnancy and Attention-Deficit and Hyperactivity Disorder and Autism Spectrum Disorder
- PMID:39637384
- DOI: 10.1097/AOG.0000000000005802
Acetaminophen in Pregnancy and Attention-Deficit and Hyperactivity Disorder and Autism Spectrum Disorder
Abstract
Acetaminophen is a common over-the-counter medication that recently gained substantial media attention regarding its use by pregnant individuals. In this clinical perspective, we discuss the strengths and limitations of the published literature on the effect of maternal acetaminophen use in pregnancy on the child's risk of developing attention-deficit and hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Studies included were specifically selected on the basis of the quality and validity of ADHD or ASD outcome definitions. From a total of 56 identified studies, commentaries, and editorials of relevance, we critically reviewed nine studies with original data that satisfied our inclusion criteria and three meta-analyses. Most studies that have reported positive findings are difficult to interpret because they have important biases, notably a high degree of selection bias, variability in selection and adjustment for various potential confounders, and unmeasured familial confounding. When unobserved familial confounding through sibling analysis was controlled for, associations weakened substantially. This suggests that residual confounding from shared genetic and environmental factors may have caused an upward bias in the original observations. According to the current scientific evidence, in utero exposure to acetaminophen is unlikely to confer a clinically important increased risk of childhood ADHD or ASD. The current level of evidence does not warrant changes to clinical guidelines on the treatment of fever or pain in pregnancy. Prospective research designed to account for familial and psychosocial environmental factors related to both maternal use of acetaminophen and children's neurodevelopment should be undertaken.
Copyright © 2024 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.
Conflict of interest statement
Financial Disclosure Sarah G. Običan has served as an expert witness in a legal case involving acetaminophen. Christina Chambers received research funding for her institution from Amgen, Bristol Myers Squibb, UCB, GSK, Pfizer, Sanofi, Leo, Sun, Regeneron, Janssen, Takeda, Gilead, Novartis, Gerber Foundation. The other authors did not report any potential conflicts of interest.
References
- Hutson JR, Smith GN, Codsi E, Garcia-Bournissen F; Society of Obstetricians and Gynaecologists of Canada (SOGC). Statement on the use of acetaminophen for analgesia and fever in pregnancy. Accessed July 18, 2023.https://sogc.org/en/en/content/featured-news/Statement_on_the_use_of_ace...
- Society for Maternal-Fetal Medicine SMFM Publications Committee. Prenatal acetaminophen use and outcomes in children. Am J Obstet Gynecol 2017;216:B14–5. doi: 10.1016/j.ajog.2017.01.021 - DOI
- American College of Obstetricians and Gynecologists.ACOG response to consensus statement on paracetamol use during pregnancy. Accessed July 18, 2023.https://acog.org/news/news-articles/2021/09/response-to-consensus-statem...
- Interrante JD, Ailes EC, Lind JN, Anderka M, Feldkamp ML, Werler MM, et al. Risk comparison for prenatal use of analgesics and selected birth defects, National Birth Defects Prevention Study 1997-2011. Ann Epidemiol 2017;27:645–53.e2. doi: 10.1016/j.annepidem.2017.09.003 - DOI
- U.S. Food and Drug Administration.FDA warns that using a type of pain and fever medication in second half of pregnancy could lead to complications. Accessed July 18, 2023.https://fda.gov/news-events/press-announcements/fda-warns-using-type-pai...