Association Between Prenatal Acetaminophen Exposure and Future Risk of Attention Deficit/Hyperactivity Disorder in Children

Abstract

While there does appear to be a mild correlation between prenatal acetaminophen use and the development of ADHD symptoms in children, current data do not provide sufficient evidence that prenatal acetaminophen exposure leads to development of ADHD symptoms late in life. Acetaminophen is a preferred option for pain management during pregnancy when compared with other medications such as nonsteroidal anti-inflammatory drugs or opioids for pyretic or pain relief.

Acetaminophen use in pregnancy: Examining prevalence, timing, and indication of use in a prospective birth cohort

“…1 It has been previously reported that between 40% and 65% of pregnant women use acetaminophen, [1][2][3][4][5][6][7] with estimates of 3%-20% of women reporting use in all three trimesters. 3,8 An emerging set of studies have signalled modest, yet concerning associations between acetaminophen and select pregnancy and childhood adverse outcomes, including preeclampsia, 9,10 preterm birth, 9 asthma (review and meta-analysis 11 ), and neurodevelopmental disorders [3][4][5][6][7][8][12][13][14] (review and meta-analysis 15 ). However, interpretation of these findings as causally related to prenatal acetaminophen exposure has been problematic.…”

Prenatal acetaminophen use and outcomes in children

“…The most common uses are for headache and fever. 2 Acetaminophen crosses the placenta relatively easily and has been reported in umbilical cord blood after maternal administration in labor. 3 While largely considered to be safe during pregnancy, a few recently published observational studies have reported an association between prenatal acetaminophen use and potential increased risk for adverse neurological outcomes in childhood.…”

“…10 Two systematic reviews of the existing studies have both determined that evidence is insufficient to conclude that there is an association between maternal acetaminophen use and ADHD in offspring. 2,11 While correlating exposures during pregnancy with childhood outcomes is problematic, it is especially difficult with regard to neurobehavioral disorders. The definition and diagnosis of these illnesses, especially ADHD, continues to evolve.…”

“…The definition and diagnosis of these illnesses, especially ADHD, continues to evolve. 2 Furthermore, because the cause or causes of ADHD are unknown, there is the potential for other prenatal and postnatal confounders, such as environmental exposures and genetic predisposition, that these retrospective analyses are not able to measure. [12][13][14] Finally, drawing conclusions on teratogenicity of a drug or other exposure based on retrospective cohorts or birth defect registries requires extreme caution.…”

Use of Acetaminophen (Paracetamol) During Pregnancy and the Risk of Autism Spectrum Disorder in the Offspring

“…1 In contrast, it is not commonly known that acetaminophen (paracetamol), a medication that is available over the counter in most countries and that is widely regarded as a safe drug for use during pregnancy, 2,3 has also been associated with neuropsychiatric risks, with neurodevelopmental delay, 4 ASD, 5 and even attention-deficit/hyperactivity disorder (ADHD) 6 described as possible consequences of prenatal use. This article examines the possible association between prenatal use of acetaminophen and ASD in the offspring.…”