No link between paracetamol in pregnancy and autism or ADHD in children, review finds | Pregnancy
A large review of pregnant women’s use of paracetamol found no convincing link between the common painkiller and the chances of children being diagnosed with autism and ADHD.
The study’s publication was expedited to provide reliable information to expectant mothers and their doctors after the Trump administration urged pregnant women to avoid acetaminophen (also known as acetaminophen or Tylenol), claiming it contributed to rising rates of autism.
Speaking at the White House in September, the US president said women should talk to their doctors about limiting painkiller use while pregnant, and followed up with much harsher language, telling women to “fight like hell” not to take them.
While autism rates have increased in recent years, many scientists believe this trend is due to greater awareness, advances in diagnosis, and a significant expansion of the criteria doctors use to define the condition.
In an umbrella review published in the journal British Medical Journal On Monday, researchers analyzed previously published scientific reviews on whether paracetamol makes pregnant women more likely to have children diagnosed with autism or ADHD.
They concluded that the quality of the reviews ranged from “low to critically low”, with any apparent link between painkillers and autism likely explained by family genetics and other factors.
Prof Shakila Thangaratinam, consultant obstetrician and senior author on the review at the University of Liverpool, said: “Women should be aware that the current evidence does not really support a link between paracetamol and autism and ADHD.
“If pregnant women need to take paracetamol for fever or pain then we would say please take it, because high fever, especially during pregnancy, can be dangerous for the unborn baby.” Alternative painkillers such as ibuprofen are not recommended during pregnancy.
Researchers examined nine systematic reviews. These included 40 observational studies on paracetamol use during pregnancy, autism, ADHD and other neurodevelopmental conditions in children. All of the reviews reported at least a possible association between a mother’s use of paracetamol during pregnancy and autism or ADHD in her children; however, seven urged caution in interpreting the findings because they did not rule out other factors.
Only one review included two studies that accurately accounted for family genetics and other common factors, such as maternal preexisting health conditions. One, published last yearIt found marginally higher rates of autism, ADHD and intellectual disability in 2.4 million Swedish children whose mothers took paracetamol during pregnancy. However, when the authors compared siblings exposed to painkillers to siblings not exposed to painkillers, they found that the effect disappeared. This suggests that the mother’s genetics, underlying health conditions, or other common environmental factors are responsible, rather than paracetamol.
“If there is a history of autism and ADHD in the family, in parents or siblings, then that’s probably why the child was diagnosed rather than something the mother got during pregnancy,” Thangaratinam said.
Beyond providing an overview of the evidence, the findings should reassure women who feel guilty about taking paracetamol during pregnancy. “They may have an autistic child with ADHD, and we really don’t want them to think it’s because of something they did during pregnancy. That’s a terrible feeling for a mother,” Thangaratinam said. “There is nothing in the current evidence to suggest that mothers taking paracetamol actually causes autism and ADHD.”
Prof Dimitrios Siassakos, honorary consultant in obstetrics and gynecology at University College London, said the review confirmed what experts around the world were saying after Donald Trump’s comments.
“Paracetamol is the safest medication to use during pregnancy and has been used by the majority of pregnant women worldwide for decades without any effects on autism and ADHD,” Siassakos said. “It is also safest to use if the mother has a fever, but untreated high fever is a risk factor for poor pregnancy outcomes, including adverse fetal outcomes. High fever and inflammation have a negative impact on the fetal and neonatal brains, and untreated inflammation can cross the placenta.”
