01 November 2019

Paracetamol in pregnancy might raise children's odds of ADHD and autism

American research has shown that women who take paracetamol during pregnancy might have an increased likelihood of having a child with ADHD or autism.

Two-thirds of American women take acetaminophen (also known as paracetamol) for the aches and pains of pregnancy, but the medication might not be as benign as thought.

New research shows that women who took acetaminophen, best known as Tylenol, at the end of their pregnancies were much more likely to have child with attention-deficit/hyperactivity disorder (ADHD) or autism.

Increased risk of developmental disabilities

After testing blood from the mother and the umbilical cord soon after birth, the odds of these developmental disorders were more than twice as high in children exposed to acetaminophen near the time of birth. The association was strongest between exposure to acetaminophen and ADHD in the child.

Two previous studies have suggested a connection between acetaminophen in pregnancy and ADHD and autism in children. But those studies were based only on the mothers' memory of taking acetaminophen.

Those studies, when combined with the latest one, show "that prenatal acetaminophen use is consistently associated with an increased risk of developmental disabilities, including ADHD and possibly [autism]," said senior study author Dr Xiaobin Wang. She's the director of the Center on the Early Life Origins of Disease at Johns Hopkins University Bloomberg School of Public Health, in Baltimore.

It's important to note that while the study found an association between an expectant mother's use of acetaminophen and the development of ADHD and possibly autism in her child, it cannot prove a definitive cause-and-effect link.

Acetaminophen crosses placenta

Wang said more research is needed. She said that she was not aware of any safe alternative drugs for pain or fever relief in pregnancy.

Acetaminophen has been shown to cross the placenta during pregnancy. That means if an expectant mom takes acetaminophen, some of the drug gets into the baby's system.

In rats, acetaminophen during pregnancy appeared to affect brain cells and certain hormone levels, which could disrupt brain development, according to background information in the study.

There were almost 1 000 children in this new study. Their average age was 10 and slightly more than half were boys.

Nearly 26% of the children had ADHD only. Close to 7% had autism, while 4% had both ADHD and autism. Just over 30% had another developmental disability. Almost 33% had no developmental concerns.

Hard to counsel pregnant women

Dr Andrew Adesman, chief of developmental and behavioural paediatrics at Cohen Children's Medical Center, in New Hyde Park, New York, is familiar with the findings.

"Although acetaminophen is a very safe and effective medication when taken as recommended in general, it may not be as safe as presumed if it is taken during pregnancy," he said.

"Since we do not know when during pregnancy the neurodevelopmental risks of acetaminophen exposure are greatest, it is hard to counsel pregnant women as to when they may safely take this medication without increasing the likelihood of their child having ADHD or [autism]," he added.

Adesman said pregnant women should talk with their health care provider before taking acetaminophen.

The findings were published online in JAMA Psychiatry.

Image credit: iStock


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ADHD Expert

Dr Renata Schoeman has been in full-time private practice as a general psychiatrist (child, adolescent and adult psychiatry) since 2008, currently based in Oude Westhof (Bellville). Renata also holds appointments as senior lecturer in Leadership (USB) and as a virtual faculty member of USB Executive Development’s Neuroleadership programme. She serves on the advisory boards of various pharmaceutical companies, as a director of the Psychiatric Management Group (PsychMG) and is the co-convenor of the South African Society of Psychiatrist (SASOP) special interest group for adult ADHD, and co-founder of the Goldilocks and The Bear Foundation ( She is passionate about corporate mental health awareness and uses her neuroscience background to assist leaders in equipping them to become balanced, healthy and dynamic leaders that take their own and their team’s emotional, intellectual, social health and physical needs into account. Renata is academically active and enjoys research and collaborative work, has published in many peer-reviewed journals, and has presented at local and international congresses. She is regularly invited to present at conferences and to engage with the media. During her post-graduate studies, she trained at Harvard, Boston in neurocognition and neuroimaging. Her awards include, amongst others, the Young Minds in Psychiatry award from the American Psychiatric Association, the Discovery Foundation Fellowship award, a Thuthuka award from the NRF, and a MRC Fellowship. She also received the Top MBA student award and the Director’s award from USB for 2015. She was a finalist for the Businesswomen’s Association of South Africa’s Businesswoman of the Year Award for 2016, and received the Excellence in Media Work award from SASOP during 2016.

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