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Common painkiller used by mums-to-be linked to children’s behavioural issues

Paracetamol associated with heightened risk of conduct problems and hyperactivity

Caroline White

Tuesday, 16 August 2016

Taking paracetamol (acetaminophen) during pregnancy is associated with a heightened risk of multiple behavioural problems in the subsequent children born, indicates research* published online in JAMA Pediatrics.

Paracetamol is generally considered safe in pregnancy and is used by many pregnant women to relieve pain and fever.

Researchers at the University of Bristol analysed data for nearly 8,000 mothers enrolled in the Avon Longitudinal Study of Parents and Children between 1991 and 1992, along with their children and partners.

They wanted to see if there were any associations between reported behavioural problems in children and prenatal and postnatal use of paracetamol, as well as their partners’ use of the painkiller.

Participants were asked about their use of paracetamol at 18 and 32 weeks of pregnancy and when their children were five years old. Behavioural problems in children reported by mothers were assessed by questionnaire when the children were seven years old.

At 18 weeks of pregnancy, 4,415 mothers (53%) said they took paracetamol and 3,381 mothers (42%) said they did so at 32 weeks. Some 6,916 mothers (89%) and 3,454 partners (84%) used the painkiller after their child’s birth.

One in 20 of the children had behavioural problems.

Mums-to-be use of paracetamol at both 18 and 32 weeks of pregnancy was associated with a heightened risk of conduct problems and hyperactivity symptoms in children, while use at 32 weeks of pregnancy was also associated with a heightened risk of emotional symptoms and multiple difficulties in their children.

Taking paracetamol after the birth and partners’ use of the painkiller were not associated with behavioural problems.

This is an observational study, so no firm conclusions can be drawn about cause and effect, added to which the researchers were not able to obtain any information on the doses taken or how long pregnant women took paracetamol. 

But they conclude: “Children exposed to acetaminophen use prenatally are at increased risk of multiple behavioral difficulties. … Our findings suggest that the association between acetaminophen use during pregnancy and offspring behavioural problems in childhood may be due to an intrauterine mechanism. 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 they caution: “The risk of not treating fever or pain during pregnancy should be carefully weighed against any potential harm of acetaminophen to the offspring.”

Commenting on the findings, Dr Tim Overton, spokesperson for the Royal College of Obstetricians and Gynaecologists (RCOG) and expert in foetal medicine, said: “It is important to highlight that from these results we cannot determine a direct link between paracetamol usage and any behavioural problems. A major limitation of this study is that neither dosage nor duration of use were measured, as well as other possible contributory factors, such as reasons for use.  

“Women should not be alarmed by the results of this study, and we recommend that pregnant women continue to follow current guidance and take the lowest effective dose for the shortest possible time when necessary. If the recommended dose of paracetamol doesn't control symptoms or pain, please seek advice from your midwife, GP or obstetrician.” 

* Stergiakouli E, et al. Association of Acetaminophen Use During Pregnancy With Behavioral Problems in Childhood. JAMA Pediatr. Published online August 15, 2016. doi:10.1001/jamapediatrics.2016.1775

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