A new study links the increased use of paracetamol during pregnancy, particularly in the second trimester, to a modest but noticeable increase in attention and behavior problems in 2-, 3-, and 4-year-olds. The study adds to a growing body of evidence linking frequent use of the compound in pregnancy to developmental problems in offspring.
The results of research were published in Neurotoxicology and Teratology.
Paracetamol during pregnancy: here's what the research says
The research is part of the Illinois Kids Development Study at the University of Illinois Urbana-Champaign, which explores how environmental exposures affect child development. The study tracked hundreds of children, collecting data on their prenatal chemical exposures and asking caregivers to rate their behaviors and traits at ages 2, 3, and 4.
While acetaminophen is considered the safest pain reliever and fever reducer available during pregnancy, previous studies have found evidence of a range of possible negative outcomes for babies exposed to the drug during gestation, said Megan Woodbury, who led research as a graduate student at the U. of I. with Professor Emerita of Comparative Biosciences Susan Schantz, the principal investigator of Illinois' IKIDS program.
Woodbury is now a postdoctoral researcher at Northeastern University in Boston. Schantz is a faculty member of the Beckman Institute for Advanced Science and Technology at the U. of I.
A recent study by Woodbury and Schantz linked increased exposure to acetaminophen in pregnancy to language delays in children.
Some previous studies have found no relationship between the use of paracetamol in pregnancy and attention and behavior during childhood, while other, usually larger studies have found relationships between more frequent use of the drug during pregnancy and behavioral and attention-related problems in offspring.
Most of the latter studies were conducted on older children and asked pregnant participants about their use of acetaminophen at most once per trimester. The new study asked pregnant parents about their use of acetaminophen six times throughout their pregnancy, roughly once every four to six weeks, offering a more accurate picture of the extent and timing of exposures to the drug.
“Our most important finding was that as pregnant participants increased their use of acetaminophen, especially during the second trimester, their babies showed more attention-related problems and ADHD-type behaviors, which we call “ externalizing behaviors,” at each age measured.” Woodbury said.
“The types of behaviors reported by caregivers included things like the child speaking out of turn, not paying attention, not being quiet when they should have been quiet, not sitting when they should have been sitting, and being a little aggressive. with other children,” Schantz said.
The findings do not indicate that the children have attention-deficit/hyperactivity disorder or that they will be diagnosed with ADHD later, Schantz said. However, children appear to have more attention problems than peers of the same age who were less exposed or not exposed to acetaminophen in the womb.
Woodbury, who is pregnant, says she doesn't want to scare others away from using acetaminophen during pregnancy when needed. Extreme headaches or other painful episodes and fevers can be debilitating and even dangerous, requiring the use of the drug. She said that so far she has switched to paracetamol once a quarter. But she also chooses not to use it for minor aches, pains or mild fevers.
More research is needed to examine whether more frequent use of acetaminophen during the second trimester of pregnancy may be particularly problematic for brain development, the researchers said. The study is also limited as participants were mostly white, non-Hispanic, and of higher economic status. Schantz and her team are working to broaden the pool of IKIDS participants to include pregnant people from a greater diversity of social, economic and racial backgrounds.
Researchers at Northeastern University are contributing to the discussion, finding a relationship between increased acetaminophen use during pregnancy and language delays in early childhood.
“We saw that in individuals who took more acetaminophen during pregnancy, their children tended to have more delayed language development in early childhood, particularly in male children, and this is especially true with use of the drug in the third trimester. ,” says postdoctoral researcher Megan Woodbury. associated with Northeastern.
Woodbury cautions, however, that researchers could not determine whether acetaminophen use was directly causing the delay in language development.
“We're not entirely sure if it's the acetaminophen that's causing this effect,” says Woodbury. “Is this really due to the use of acetaminophen or does it have something to do with fever during pregnancy or illness during pregnancy or other variables?”
Acetaminophen is one of the most commonly used medications worldwide, and the American College of Obstetricians and Gynecologists considers it safe to use during pregnancy to treat fever and pain. However, research has suggested associations between use of the drug and attention and behavior problems in children, possibly due to the drug affecting prenatal neurodevelopment.
Woodbury says researchers have not examined whether increased use of acetaminophen might affect language development. Additionally, previous studies have only collected data on acetaminophen use at a couple of points in pregnancy, or even just after the baby was born.
This study, however, uses data collected from 532 infants who participated in the Illinois Kids Development Study at the University of Illinois Urbana-Champaign between December 2013 and March 2020. The data measured acetaminophen use six times during a pregnancy (approximately every four to six weeks). This allowed the researchers to break down the data by quarter. The children were assessed for language skills at just over two years of age and at age 3, and the data was then compared with data from peers.
Woodbury and collaborators at the
University of Illinois found no association between increased first-trimester acetaminophen use and delayed language development.
Increased drug use during the second trimester, however, was related to lower language scores for the offspring compared to their peers at age 3, as well as smaller vocabulary size and length of sentences. shorter sentences at age 2 compared to peers.
“We estimate that if a pregnant person took acetaminophen 13 times, or once a week during the third trimester, a child's vocabulary could be 26 words smaller than his or her peers at age 2 and would be more likely than 91% of having less complex words.” language skills by age 2,” Woodbury says.
So, does this mean that paracetamol is dangerous to use during pregnancy? Well, Woodbury noted that she is in the second trimester of pregnancy and took acetaminophen the night before.
“Basically what I said when I talked about it with my obstetrician and other researchers is that if you absolutely need to take acetaminophen – the pain is too much, nothing else works or will work, you have a fever to break – then take it: it won't ruin your child's life,” Woodbury says. “Just try not to take it constantly.”
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