Should you prescribe acetaminophen during pregnancy?

  • JAMA Psychiatry

  • von Elisabeth Aron, MD, MPH, FACOG
  • Clinical Essentials
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Takeaway

  • Detection of acetaminophen in a newborn's cord blood is associated with increased odds for a later autism or ADHD diagnosis.
  • Acetaminophen half-life in adults is only a few hours, and all samples contained acetaminophen, so implications are unclear.

Why this matters

  • 65% of pregnant women in the United States use acetaminophen during pregnancy.

Key results

  • 25.8% of children in the cohort were diagnosed with ADHD, 6.6% with autism, and 30.5% with other developmental disabilities (DDs).
  • Cord plasma metabolites were associated with an increased risk for ADHD and autism in childhood.
  • For cord acetaminophen values in the third tertile, odds increased that a child would be diagnosed with ADHD (aOR, 2.86; P<.001 or autism p=".002).</li">

Study design

  • Prospective cohort study, Boston Birth Cohort, with 3163 mother-infant dyads enrolled at birth, 1998-2018.
  • Dyads with sufficient cord plasma samples and a diagnosis were enrolled (n=996).
  • Analysis of association of cord plasma acetaminophen metabolites with diagnoses of ADHD, autism, other DDs, or neurotypical development.
  • Funding: NIH.

Limitations

  • One-time measurement of metabolites at birth; acetaminophen half-life is
  • Major metabolite of acetaminophen not measured.
  • No unexposed controlled group for comparison.
  • Excluded children had higher rates of preterm birth, low birth weight.
  • Unmeasured confounders, including of factors independently linked to increased risk for neurodevelopmental conditions in offspring.