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Home  Developmental Disorders  Autism  Link between Paracetamol Use during Pregnancy, Autism and ADHD Symptoms Supported by...
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Developmental Disorders Autism Magazine July 2021 Vol. 41 No. 7 News

Link between Paracetamol Use during

Pregnancy, Autism and ADHD
Symptoms Supported by New Study
June 1, 2021  1

Source: Photo by Camylla Ba ani on Unsplash

Researchers at the Barcelona Institute for Global Health (ISGlobal) have carried out an
epidemiological study that they claim addresses some weaknesses of previous, similar
studies, and supports a proposed link between maternal use of paracetamol
(acetaminophen) during pregnancy, and symptoms of a ention-deficit/hyperactivity
disorder (ADHD) and autism spectrum conditions (ASC) in their children. The newly
reported study, which included more than 70,000 children in six European cohorts, found
that children exposed to paracetamol before birth were 19% more likely to develop ASC
symptoms and 21% more likely to develop ADHD symptoms than those who were not
exposed.

“Our results address some of the weaknesses of previous meta-analyses,” commented Jordi
Sunyer, PhD, researcher at ISGlobal and co-author of the team’s published paper in the
European Journal of Epidemiology. “Considering all the evidence on the use of paracetamol
and neurological development, we agree with previous recommendations indicating that
while paracetamol should not be suppressed in pregnant women or children, it should be Recently Featured
used only when necessary.”
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The paper is titled, “Prenatal and postnatal exposure to acetaminophen in relation to
autism spectrum and a ention-deficit and hyperactivity symptoms in childhood:
Meta-analysis in six European population-based cohorts.” Proteomic Mapping of Host-
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At some point during pregnancy, an estimated 46-56% of pregnant women in developed
countries use paracetamol, which is considered the safest analgesic/antipyretic for pregnant
women and children. However, mounting evidence has linked prenatal paracetamol
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exposure to poorer cognitive performance, more behavioral problems, and ASC and ADHD
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symptoms, the authors noted.

Previous meta-analyses investigating the link between prenatal paracetamol use and ASC Large GWAS Links Severe
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and ADHD symptoms have been criticized for their heterogeneity with respect to methods Genes
and instruments used to assess outcomes, statistical approaches and confounders.
“Furthermore, these studies did not address relevant unsolved questions regarding the link
between early acetaminophen exposure and ASC and ADHD symptoms,” the team wrote.

The newly reported study aimed to address weaknesses in previous research. “An effort
was made to harmonize the assessment of ADHD and ASC symptoms and the definition of
paracetamol exposure,” explained ISGlobal researcher and lead study author Sílvia
Alemany, PhD. The study included data from six European population-based birth cohorts:
Avon Longitudinal Study of Parents and Children (ALSPAC), DNBC, Gene and
Environment: Prospective Study on Infancy in Italy (GASPII), the Generation R Study,
INMA (including four subcohorts), and the Mother–Child Cohort in Crete (RHEA).
Mother–child pairs were recruited from 1991 through 2008.

“The sample is large, and it includes cohorts from multiple European countries: the United
Kingdom, Denmark, the Netherlands, Italy, Greece and Spain,” said Alemany. “We also
used the same criteria for all of the cohorts, thereby reducing the heterogeneity of criteria
that has hampered previous studies.”

In total, the researchers analyzed 73,881 children for whom data were available on prenatal Read the Digital Edition
or postnatal exposure to paracetamol, at least one symptom of ASC or ADHD, and main
covariates. Depending on the cohort, 14% to 56% of the mothers reported taking
paracetamol while pregnant. The results indicated that children prenatally exposed to
acetaminophen were 19% and 21% more likely to subsequently have ASC and ADHD
symptoms with in the borderline/clinical range , respectively, when compared with non-
exposed children, the authors reported.

The link was only slightly stronger for boys. “When stratifying by sex, these associations
were slightly stronger among boys compared to girls but positive associations with effect
sizes of similar magnitude were observed in both strata, especially in the case of ADHD,”
the team noted. “Our findings suggest that differential sex effects of acetaminophen on ASC
and ADHD symptoms, if any, are modest and may be dependent on the number of cases,
outcome definition and assessment.” Alemany added, “We also found that prenatal
exposure to paracetamol affects boys and girls in a similar way, as we observed practically
no differences.”

The most consistent pa ern of results was observed for the association between prenatal
acetaminophen exposure and ADHD symptoms, the team added. “The positive
associations were observed in all the cohorts and of similar magnitude regardless of the
cohort excluded in the leave-one-out analysis. This finding is in agreement with previous
meta-analysis which reported likelihood increases of 25% and 34% for ADHD in relation to
prenatal acetaminophen exposure.” The association between prenatal acetaminophen use
and ASC symptoms was also consistently positive, even after omi ing the largest cohort.

The study also analyzed postnatal exposure to paracetamol and found no association
between paracetamol use during childhood and ASC symptoms. Nevertheless, the research
team concluded that further studies are needed, given the heterogeneity of postnatal
paracetamol exposure among the various cohorts, which ranged from 6–92.8%.

Acknowledging limitations of the reported research, the investigators nevertheless

concluded that “… the homogeneity of the findings among the different cohorts, the novel
assessment of postnatal acetaminophen exposure, and the use of an harmonized definition
of exposure and outcome as well as of common statistical approaches overcomes the
criticisms of previous meta-analysis.”

The team concluded, “These results replicate previous work and support providing clear
information to pregnant women and their partners about potential long-term risks of
acetaminophen use.” They say that when considering all evidence on the use of
paracetamol and neurodevelopment, they agree with previous recommendations
suggesting that “ … although paracetamol should not be suppressed in pregnant women or
children, it should be used only when necessary.”

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1 COMMENT

Ernest Amoah June 1, 2021 At 8:52 pm

I dont believe this is true.My mom used paracetamol which is wildly used in africa nd
none of her 7 kids is autistic.I think de research is flawed.
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