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?
- 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.
- 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.
- 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.
- 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.
- Blaser JA, Allan GM. Acetaminophen in pregnancy and future risk of ADHD in offspring. Can Fam Physician. 2014;60(7):642-642.
- 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.