Acetaminophen during Pregnancy Leads to Behavioral Problems in Kids
Prenatal exposure to the drug, acetaminophen, could lead to behavioral problems, such as attention-deficit/hyperactivity disorder (ADHD) and hyperkinetic disorder (HKD)—a severe form of ADHD—in children, a new study suggests. “Because the exposure and outcomes are frequent, these results are of public health relevance,” the investigators write.
Study investigator Jørn Olsen, MD, PhD, of the Institute of Public Health, University of Aarhus, Denmark, told Medscape Medical News, The findings “should inspire much more research and a cautious use of these drugs during pregnancy; they should only be taken when they are really needed.”
Researchers analyzed data on 64,322 children and their mothers enrolled in the Danish National Birth Cohort (1996 – 2002). Exposure to acetaminophen was assessed during pregnancy and 6 months after childbirth. The premise of the study was that acetaminophen acts as a hormone disrupter and, in turn, alters fetal brain development.
Of the data looked at, 56 percent of the women reported using acetaminophen during pregnancy. The children who were exposed to acetaminophen during pregnancy were at higher risk of being diagnosed with HKDs, using ADHD medications, or having ADHD-like behaviors. A stronger effect was seen in children who were exposed to acetaminophen during more than 1 trimester and among those exposed for a greater numbers of weeks.
Researchers noted that results do not seem to be confounded by maternal inflammation or infection during pregnancy, mother’s mental health problems, or any of a number of other factors evaluated. However, they cannot rule out confounding by genetic factors, unmeasured maternal psychopathology, exposure to other medications, or indication for drug use.
There is the potential that acetaminophen can cross the placenta barrier and similar studies suggest that acetaminophen increases the risk of cryptorchidism in boys. “Maternal hormones, such as sex hormones and thyroid hormones, play critical roles in regulating fetal brain development, and it is possible that acetaminophen may interrupt brain development by interfering with maternal hormones or via neurotoxicity such as the induction of oxidative stress that can cause neuronal death,” the researchers noted.
Dr. Olsen and colleagues conclude that if the results reflect causal associations, “acetaminophen should no longer be considered a safe drug for use in pregnancy.” Miriam Cooper, MRCPsych, of the Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, United Kingdom, and coauthors of an editorial write, for now, these “interesting” observations “should be interpreted cautiously and should not change practice.”
The findings “underline the importance of not taking a drug’s safety during pregnancy for granted, and they provide a platform from which to conduct further related analyses exploring a potential relationship between acetaminophen use and altered neurodevelopment,” they write.