Behavioral effects of pain medications

Increased risk of adverse neurodevelopmental outcomes following prenatal non-prescription paracetamol exposure

2018 Study Highlights

  • All nine studies suggest prenatal APAP is associated with adverse neurodevelopment.
  • These neurodevelopmental endpoints include ADHD, ASD and lower IQ.
  • Associations were strongest for hyperactivity and attention-related outcomes.
  • Controlling for indication for use, when possible, did not explain associations.
  • Given these findings, pregnant women should be cautioned against indiscriminate APAP use.

Abstract

Background
The non-prescription medication paracetamol (acetaminophen, APAP) is currently recommended as a safe pain and fever treatment during pregnancy. However, recent studies suggest a possible association between APAP use in pregnancy and offspring neurodevelopment.

Objectives
To conduct a review of publications reporting associations between prenatal APAP use and offspring neurodevelopmental outcomes.

Methods
Relevant sources were identified through a key word search of multiple databases (Medline, CINAHL, OVID and TOXNET) in September 2016. All English language observational studies of pregnancy APAP and three classes of neurodevelopmental outcomes (autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), and intelligence quotient (IQ)) were included. One reviewer (AZB) independently screened all titles and abstracts, extracted and analyzed the data.

Results
64 studies were retrieved and 55 were ineligible. Nine prospective cohort studies fulfilled all inclusion criteria. Data pooling was not appropriate due to heterogeneity in outcomes. All included studies suggested an association between prenatal APAP exposure and the neurodevelopmental outcomes; ADHD, ASD, or lower IQ. Longer duration of APAP use was associated with increased risk. Associations were strongest for hyperactivity and attention-related outcomes. Little modification of associations by indication for use was reported.

Conclusions
Together, these nine studies suggest an increased risk of adverse neurodevelopmental outcomes following prenatal APAP exposure. Further studies are urgently needed with; precise indication of use and exposure assessment of use both in utero and in early life. Given the current findings, pregnant women should be cautioned against indiscriminate use of APAP. These results have substantial public health implications.

Long-Term Use of Paracetamol during Pregnancy may be linked to Autism

Too much Tylenol in pregnancy could affect development

Prenatal paracetamol exposure and child neurodevelopment: a sibling-controlled cohort study
International Epidemiological Association, promoting epidemiological research and teaching in all fields of health

Expectant mothers often take Tylenol, with the active ingredient acetaminophen, to deal with back pain, headaches or mild fevers during pregnancy. Is it safe to take Tylenol during pregnancy? This question has been asked by millions of pregnant women. Typically, they hear from their doctor that Tylenol during pregnancy is completely safe for both the mother and her developing baby.

However, a new Norwegian study has found symptoms aligned with autism spectrum disorder (ASD) in Tylenol-exposed children.  Children exposed to long-term use of paracetamol during pregnancy had substantially adverse developmental outcomes at three years of age.

Read Too much Tylenol in pregnancy could affect development
by Kathryn Doyle, 22 Nov 2013

Read Tylenol Use During Pregnancy May be Linked to Autism
by Dr. Brent Hunter, 25 Nov 2013

Sources: Prenatal paracetamol exposure and child neurodevelopment: a sibling-controlled cohort study
International Epidemiological Association, 24 Oct 2013