Paracetamol in pregnancy could later…
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Bristol – Paracetamol use in mid to late pregnancy, which is generally considered safe, was shown in a prospective observational study in Pediatric and Perinatal Epidemiology (2019; doi: 10.1111 / ppe.12582) associated with later behavioral disorders in children, but not with cognitive and memory disorders.
Although acetaminophen crosses the placental barrier and therefore acts on the fetus and its brain, it is considered safe. Increased malformations were not observed. It is a popular pain reliever for pregnant women. Of the approximately 14,000 pregnant women who participated in the Avon Longitudinal Study of Parents and Children (ALSPAC), 44% said they had taken paracetamol in a questionnaire in the 32nd week.
Previous research, including an analysis of the ALSPAC data, had paracetamol use with various behavioral disorders, including autism and the
Attention Deficit Hyperactivity Disorder has been linked to ADHD.
Jean Golding from the Bristol Universitywho co-founded the ALSPAC study in the early 1990s, and coworkers have now performed another thorough analysis. The researchers used the “Exposom” technique. The first step was to look for factors that influence the use of paracetamol.
This included, for example, various illnesses (colds, flu-like infections, but also headaches) that triggered the use of the agent. But also previous illnesses (asthma, migraines), lifestyle (alcohol, unhealthy diet) and “social” factors (frequent use of chemicals in the household, previous pregnancies) were associated with more frequent use of paracetamol.
These factors were then assessed as potential confounders in the 2nd phase of the study. In this 2nd phase, the effects of paracetamol intake on the development of the children were investigated. The behavior of the children was carefully examined in the course of the ALSPAC study: the children took part in intelligence tests several times, the parents and later the teachers filled out questionnaires on temperament, behavior and possible psychological abnormalities.
Of 135 individual aspects of cognition, temperament and behavior, 56 were initially associated with the use of paracetamol. After taking the “confounders” into account, there were still 12 endpoints left. This did not include cognition and memory. The use of paracetamol was therefore not associated with a low IQ in the children.
The associations were limited to the level of temperament and behavior. For example, children whose mothers had taken paracetamol during pregnancy later showed hyperactive or less attentive behavior. At the age of 6 months they were less flexible (“adaptability”), at the age of 24 months they showed less stamina (“persistence”) and at the age of 42 and 47 months they appeared more hyperactive to the mothers and less attentive to the teachers. In the IQ test at the age of 8, there was an increased “distractibility”.
The study cannot conclusively prove that these characteristics, which seem to disappear with old age, are actually due to the ingestion of paracetamol by the mothers, as some commentators opposed Science Media Center objected in London and Golding himself admits in the study. It remains possible that the disorders the women were taking paracetamol to treat may be responsible for the disorders.
The experts pointed out the strengths (prospective design of the study, detailed studies), but also the weaknesses of the publication (no reliable exclusion of all “confounders”, lack of evidence of a mechanism).
It is striking how many women use paracetamol during pregnancy. This does not seem to be an English peculiarity, as earlier studies had found similarly high intake frequencies for Spain, Denmark and France. In general, pregnant women are advised to only take medication during pregnancy if they have serious symptoms and to avoid toxins such as smoking and alcohol altogether. © rme / aerzteblatt.de
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