#113 Acetaminophen in pregnancy and future risk of ADHD for the unborn.

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- Danish prospective cohort of 64,322 pregnancies.1 Acetaminophen use in pregnancy associated with statistically significantly:
- Higher scores for behavioural problems on the Strengths & Difficulties Questionnaire (at seven years): Risk Ratio 1.13 (1.01-1.27).
- From a government central registry (over ~11 years):
- Diagnosed hyperkinetic disorder: Hazard Ratio 1.37 (1.19-1.59).
- Prescription of ≥2 ADHD medications: Hazard Ratio 1.29 (1.15-1.44).
- Norwegian prospective cohort of 48,631 pregnancies.2 Focus on 2,919 same-sex sibling pairs:
- Acetaminophen use ≥28 days in pregnancy correlated significantly with maternally-assessed child behaviour at three years for:
- Reduced gross motor skills, delay in walking, increased activity, reduced communication skills, attention/aggression behaviours.
- Correlation Beta-coefficients around 0.2-0.26, approximately equivalent to a 50-60% relative increase.
- Strength: Sibling pairs (eliminating differences in mother/families).
- Weakness: Shorter duration and only maternal assessment.
- Acetaminophen use ≥28 days in pregnancy correlated significantly with maternally-assessed child behaviour at three years for:
- Both studies suggest (results inconsistent) longer use and use later in pregnancy may have stronger association.1,2
- Older cohort of 355 children found no association between maternal use of acetaminophen in the first five months of pregnancy and attention testing at age four.3
- Cohort studies show associations (things happening together) but not causation. They are subject to ‘confounding’ risk.
- Women who used acetaminophen may be different: having more pain or headaches and perhaps this contributes to ADHD.
- Based on 5.3% worldwide prevalence of ADHD4 and a possible 13-37% relative increase,1 absolute increase might be 0.7%-2%, if real.
- Acetaminophen is used by 55-65% of pregnant women.1,5,6
- Acetaminophen is generally felt to be safe in pregnancy7 (not teratogenic) and recommended first-line for pain due to safety.8,9
- These statements precede this recent research.