Paracetamol (Acetaminophen) is generally considered safe in pregnancy and is used by many pregnant women for pain and fever. Additionally, maternal acetaminophen use at 32 weeks pregnancy was associated with higher risk for emotional symptoms and total difficulties in children.
Acetaminophen, which is also known by the name paracetamol, is found in many different drugs. This means that a pregnant woman who takes an aspirin to reduce a fever during their pregnancy is not putting their child at risk, however, prolonged use of the medication, is more likely to lead to these types of problems.
However, the effect overall was relatively small and Stergiakouli emphasized that pregnant women should not panic if they are taking acetaminophen for pain relief and that avoiding taking the medication can be more unsafe, especially if a woman has a fever. "It still appears to me to be our safest pain medication for use in pregnancy. However, the risk of not treating fever or pain during pregnancy should be carefully weighed against any potential harm to the offspring", Stergiakouli said in a podcast.
For the long-term study, Stergiakouli and her colleagues analyzed data for nearly 8,000 mothers who enrolled in the study between 1991 and 1992, along with their children and partners.
Compared to women who reported no acetaminophen use at 18 weeks of pregnancy, those who took the medication at that point of gestation were 42% more likely to report hyperactivity and 31% more likely to report conduct problems in the children they bore. "However, this was not the case for maternal postnatal acetaminophen use or partner's use". When the children were 7, their mothers answered a questionnaire about their children's behavior, including conduct problems, peer relationships, emotional difficulties, and hyperactivity.
The researchers then looked at other possible prenatal factors which might contribute to attention issues in a child, including smoking, alcohol use, socioeconomics and genetics.
Questionnaires assessed the women's acetaminophen use at 18 and 32 weeks during pregnancy, and again when their children were 5 years of age.
Prof Saunders says the study illustrates a general problem in obstetric practice: there is no regulation of drugs used in pregnancy "and therefore there is no evidence base to guide clinical practice".
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The findings suggest the association may be due to an intrauterine mechanism, she said. Further studies are required to elucidate mechanisms behind this association as well as to test alternatives to a causal explanation.
Still, the study couldn't prove cause-and-effect, and Stergiakouli believes that women should still take the drug if needed.
"Behavioral disorders are multifactorial and very hard to associate with a singular cause, said Lawrence". "The brain does not stop developing until at least 15 months of age, which leaves room for children to be exposed to a number of factors that could potentially lead to behavioural issues".
Among the information collected: Did the women take acetaminophen while pregnant? The FDA have expressed concerns about the use of acetaminophen and other OTC pain relief drugs during pregnancy. This was similar to National Health Service estimates that 2 percent to 5 percent of school-aged British children have ADHD, but far below the 11 percent reported in the United States.
"The takeaways here are that physicians should not change clinical practice until definitive prospective research is done and, most importantly, patients should not be frightened away from the many benefits of acetaminophen", said Lawrence.
However, Evie Stergiakouli of the University of Bristol and coauthors analysed data for almost 8,000 mothers and found use of paracetamol at 18 and 32 weeks of pregnancy was associated with increased risk of conduct problems and hyperactivity symptoms in children. Marcus, who is unaffiliated with the study, cited two main limitations of the study, including Lawrence's criticism that dosages were not reported.
Paracetamol in pregnancy may lead to later behavioural problems, United Kingdom researchers say. The study also relied on parents to accurately recall and report on their acetaminophen use and on any behavior issues observed in their kids. This left the authors to hypothesize prenatal brain development may have been influenced by hormones that had been disrupted by the drug.
