The findings of a new study published in JAMA Pediatrics suggest the safety of paracetamol use during pregnancy should be re-evaluated.
The prospective birth cohort study included 394 eligible children, of whom 345 had meconium samples collected at delivery and information on attention-deficit/hyperactivity disorder (ADHD) diagnosis. Mothers were enrolled at their first prenatal care visit or delivery and were followed up when children were aged 6-7 years. When children were aged 9-11 years, resting-state brain connectivity was assessed with MRI.
Among the 345 children, paracetamol was detected in 199 meconium samples (57.7%). ADHD was diagnosed in 33 children (9.6%).
Compared with no paracetamol, detection of paracetamol in meconium was associated with increased odds of ADHD (odds ratio [OR] 2.43; 95% CI 1.41-4.21). A dose-response association was detected; each doubling of exposure increased the odds of ADHD by 10 per cent (OR 1.10; 95% CI 1.02-1.19).
Children with paracetamol detected in meconium showed increased negative connectivity between frontoparietal and default mode network nodes to clusters in the sensorimotor cortices, which mediated an indirect effect on increased child hyperactivity (14%; 95% CI 1%-26%).
Together with the multitude of other cohort studies showing adverse neurodevelopment associated with prenatal paracetamol exposure, this work suggests caution should be used in administering paracetamol during pregnancy.