Concern likely as paracetamol in pregnancy, behavioural problems linked

Use of paracetamol during pregnancy has been associated with an increased risk for multiple behavioural problems in children, an article published online by JAMA Pediatrics says.

And pharmacists are likely to have to field questions about the link, one expert says.

Researchers from the UK’s University of Bristol analysed data for 7,796 mothers enrolled in the Avon Longitudinal Study of Parents and Children between 1991 and 1992, along with their children and partners.

They examined associations between behavioural problems in children and their mothers’ prenatal and postnatal paracetamol use, as well as paracetamol use by their partners.

At 18 weeks of pregnancy, 53% of mothers reported using the medicine, and at 32 weeks, 42%.

The study reported that 5% of children had behavioural problems including conduct problems.

The children of mothers who used paracetamol at 18 and 32 weeks of pregnancy were more likely to have conduct problems and hyperactivity symptoms, while the children of mothers who took paracetamol at 32 weeks were also more likely to have emotional symptoms and total difficulties.

Postnatal maternal paracetamol use and paracetamol use by partners were not associated with behavioural problems.

Because the associations were not observed in these instances, the authors suggest that this may indicate that behavioural difficulties in children might not be explained by unmeasured behavioural or social factors linked to paracetamol use.

“Our findings suggest that the association between acetaminophen use during pregnancy and offspring behavioural problems in childhood may be due to an intrauterine mechanism,” the authors write.

“Further studies are required to elucidate mechanisms behind this association as well as to test alternatives to a causal explanation. Given the widespread use of acetaminophen among pregnant women, this can have important implications on public health advice.”

But the authors also caution: “However, the risk of not treating fever or pain during pregnancy should be carefully weighed against any potential harm of acetaminophen to the offspring.”

Dr Luke Grzeskowiak, an NHMRC Early Career Research Fellow at the Robinson Research Institute, University of Adelaide and a Specialist Pharmacist at Flinders Women & Children, told the AJP today that depending how the research is reported today, pharmacists may see an increase in patients who are concerned that paracetamol use could harm their unborn child.

“There is a public health perspective given the large number of women who are using paracetamol in pregnancy, but at the same time it’s important to think at an individual level,” Dr Grzeskowiak told the AJP.

“We are still talking about a relatively small risk, even if there was a true risk there.”

He says that the journal article may be widely reported, given that paracetamol is “something 50% of women take,” and that consumers often have trouble interpreting their relative risk of health outcomes.

“Pharmacists are the most accessible of the health care professionals, rather than GPs, so I suspect they will get some more queries.

“What I hope is that this doesn’t shift women into using other, less preferred, forms of treatment.”

Women who become concerned about the paracetamol study may be more inclined to take an anti-inflammatory or an opioid.

“We wouldn’t want women jumping onto the other classes as we know there are specific risks associated with those, “ Dr Grzeskowiak says.

“Pharmacists might be stuck between a rock and a hard place when they’re trying to make sense of the information as best as they can themselves, and prepare for women coming in asking for advice.

“My personal opinion would be at this point the same as it would for any other medication: you wouldn’t recommend it unless it’s necessary and you think it’s going to be effective, and you’d advise the patient to use the lowest dose for the shortest possible duration – as with anything.”

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  1. Drugby

    The key thing to recognise is that this is an observational study. It only showed an association, and association does not equal causality.

    See Dr Justin Coleman’s blog –

  2. Drugby

    Great critique in The Conversation on this paper

    The short answer is NO.

    The authors provide a good lesson in critical evaluation of the literature.

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