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New research finds acetaminophen use during pregnancy is associated with ADHD in offspring

November 4th, 2014

By: Jeremy Flikkema Cedarville University PharmD Student

Acetaminophen is a commonly recommended over the counter medication given to pregnant women for treating mild pain. Recently however, the safety of this medication was put under investigation after JAMA Pediatrics published a study that found links between acetaminophen use and attention deficit/hyperactivity disorder (ADHD).1 This is alarming because acetaminophen is preferred over other pain killers. Non-steroidal inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, and aspirin are not recommended during pregnancy due to potential birth defects in the offspring.2

ADHD is characterized as a behavioral disorder affecting 5-10% of the school age population.1 Symptoms include inability to concentrate, impulsivity, and/or hyperactivity all of which can impact performance at work and school. Acetaminophen use during pregnancy led to an increase probability of their offspring taking ADHD medications and developing a hyperkinetic disorder.3 To clarify, hyperkinetic disorders are a more severe form of ADHD.

The recently published Danish prospective cohort interviewed 64,322 live-born children and mothers from 1996-2002.1 They did three telephone interviews during pregnancy followed by a fourth interview six months after giving birth. In this study, over half of the women had admitted to taking acetaminophen at some point during pregnancy. The characteristics of interest were hyperkinetic disorders, use of ADHD medications, and/or having ADHD-like behaviors at age 7. All three of these variables were found to be significantly increased due to acetaminophen use. Increased frequency of use and long duration (more than 1 trimester) both increase the associations that were observed. This study’s strength was the large sample size, prospective study design that eliminated recall bias by the mothers, and because it measured more than one variable. However, the limitation of this study was the design type.3 Cohort studies only infer association not causation. Therefore, results must be interpreted cautiously until further research is done.

Additional research has been done regarding this topic. A Norwegian prospective cohort found that acetaminophen use for more than 28 days or more correlated with reduced gross motor skills, delay in walking, increased activity, reduced communication skills, and attention-seeking behavior.4 This study supports the association between acetaminophen use and ADHD. Another study tested the effect of other drugs (aspirin, antacids, and antibiotics) and found no correlation in regards to behavioral difficulties at age 7.3 These strengthen the evidence that acetaminophen use increases the risk of ADHD.

Before this research, acetaminophen was considered safe to use throughout all trimesters of pregnancy for pain, fever, and colds and was used by 55 to 65% of pregnant women.5 These new research findings suggest potential changes to the standard of care, further prospective research is required to determine if acetaminophen is the true cause. Until then acetaminophen during pregnancy should be used with caution and only when necessary. There are many different ways to relieve pain in a non-pharmacological manner such as; sleeping with lots of pillows for support, drinking lots of water, gentle exercise, massages, and taking warm baths, music, and yoga can increase the health of your baby.6 There are many harmful effects that medications can have on our bodies that may still be unknown. If however, the medication is used, it is of uttermost importance to limit the duration and frequency.

Knowing the potential risk with Acetaminophen use and ADHD, do you think the risk outweighs the benefit?

 

Bibliography:

  1. Liew Z, Ritz B, Rebordosa C, Lee PC, Olsen J. Acetaminophen use during pregnancy, behavioral problems, and hyperkinetic disorders. JAMA Pediatr. 2014;168(4):313-320.
  2. CAZACU I, FARCAŞ A, MOGOŞAN C, BOJIŢĂ M. Safety of over-the-counter medication in pregnancy. sometimes a dilemma. Clujul Medical. 2011;84(3):348-354.
  3. Thompson JMD, Waldie KE, Wall CR, Murphy R, Mitchell EA. Associations between acetaminophen use during pregnancy and ADHD symptoms measured at ages 7 and 11 years. PLoS ONE. 2014;9(9):1-6.
  4. Brandlistuen RE, Ystrom E, Nulman I, Koren G, Nordeng H. Prenatal paracetamol exposure and child neurodevelopment: A sibling-controlled cohort study. Int J Epidemiol. 2013;42(6):1702-1713.
  5. Blaser JA, Allan GM. Acetaminophen in pregnancy and future risk of ADHD in offspring. Can Fam Physician. 2014;60(7):642-642.
  6. Pritham U, McKay L. Safe Management of Chronic Pain in Pregnancy in an Era of Opioid Misuse and Abuse. JOGNN: Journal Of Obstetric, Gynecologic & Neonatal Nursing [serial online]. September 2014;43(5):554-567. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed November 3, 2014.

 

 

4 Responses to “New research finds acetaminophen use during pregnancy is associated with ADHD in offspring”

  1. Stephanie Cailor Says:

    For my pregnant patients, I would stress the non-pharmacological methods that you mentioned in your writing. I would also be okay with recommending acetaminophen to these patients if the non-pharmacological methods did not provide them with enough relief. But now I know that I should stress the importance of using this medication minimally while pregnant, just in case there is an association present with ADHD or any other health problems.

  2. Lauren Haines Says:

    I think that acetaminophen is still a better option for pain relief for pregnant women than other NSAIDs, such as ibuprofen, naproxen, and aspirin. However, I also agree that non-pharmacological methods are the best options for pregnant women because there is no harm to the developing baby. I think that the use of non-pharmacological treatment is always the first-line treatment because it is very natural and causes no medicinal changes to the body. However, for pregnant women in severe pain, I think the use of acetaminophen is an okay option because other research has shown its use to be safe. I think for us to draw a firm conclusion that ADHD and other health problems are caused from acetaminophen use during pregnancy would require more research.

  3. Logan Conkey Says:

    Very interesting article Jeremy. If there is evidence that APAP can cause significant birth defects in children then this should be studied more intensively. I think we should recommend alternative methods of pain relief before suggesting medication. As far as the study goes I would have said recall bias was a limitation but the article addressed this and the survey was given within months of having birth so I would say this bias was minimized.

  4. Joshua N Willoughby Says:

    This is a very important topic for our day and age, with many children being placed on ADHD medications. After, reading this article, I think I would only recommend APAP as a last resort for pain. The non-pharmaceutical recommendations would most certainly be first line. That being said, more evidence is needed to verify that APAP is the singular cause of ADHD through use by pregnant mothers. Since ADHD is a relatively new health issue, their is much opportunity for future studies to delve deeper into this pressing issue.

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