Accessible Unlicensed Requires Authentication Published by De Gruyter October 1, 2017

Is acetaminophen safe in pregnancy?

Katsuhiro Toda

Graphical Abstract

Abstract

Acetaminophen is thought to be the safest analgesic and antipyretic medicine for pregnant women, and it is widely used all over the world. However, prenatal acetaminophen was reported to be associated with asthma, lower performance intelligence quotient (IQ), shorter male infant anogenital distance (predicting poor male reproductive potential), autism spectrum disorder, neurodevelopmental problems (gross motor development, communication), attention-deficit/hyperactivity disorder, poorer attention and executive function, and behavioral problems in childhood. Each article has poor power to show risks of acetaminophen, however, the integration of the articles that showed adverse effects of acetaminophen may have power to show them. Acetaminophen use in childhood was associated with autism spectrum disorder, asthma symptoms, wheezing, and allergic disease. Acetaminophen is the safest medicine as analgesics for nociceptive pain and antipyretics in childhood and pregnancy. There is no alternative medication of acetaminophen. Acetaminophen should not be withheld from children or pregnant women for fears it might develop adverse effects. Acetaminophen should be used at the lowest effective dosage and for the shortest time. When we know the possible, rare but serious complications, we should use acetaminophen in pregnancy only when needed and no safer option for pain or fever relief is available. Health care providers should help inform the general lay public about this difficult dilemma.


Department of Rehabilitation, Kitahiroshima Town Toyohira Hospital, 4705 Azaka, Kitahiroshima Town, Yamagata-Gun, Hiroshima 731-1222, Japan

  1. Conflict of interest: No conflict of interest.

References

[1] Food and Drug Administration, Department of Health and Human Services. Drug Safety Communications. FDA has reviewed possible risks of pain medication during pregnancy 2015; 2017. [Retrieved September 22].Search in Google Scholar

[2] Society for Maternal-Fetal Medicine Publications Committee.Prenatal acetaminophen use and outcomes in children. Am J Obstet Gynecol 2017;216:B14–5.Search in Google Scholar

[3] Liew Z, Ritz B, Rebordosa C, Lee PC, Olsen J. Acetaminophen use during pregnancy, behavioral problems, and hyperkinetic disorders. JAMA Pediatr 2014;168:313–20.Search in Google Scholar

[4] 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;42:1702–13.Search in Google Scholar

[5] Sordillo JE, Scirica CV, Rifas-Shiman SL, Gillman MW, Bunyavanich S, Camargo Jr CA, Weiss ST, Gold DR, Litonjua AA. Prenatal and infant exposure to acetaminophen and ibuprofen and the risk for wheeze and asthma in children. J Allergy Clin Immunol 2015;135:441–8.Search in Google Scholar

[6] Magnus MC, Karlstad O, Haberg SE, Nafstad P, Davey Smith G, Nystad W. Prenatal and infant paracetamol exposure and development of asthma: the Norwegian Mother and Child Cohort Study. Int J Epidemiol 2016;45: 512–22.Search in Google Scholar

[7] Eyers S, Weatherall M, Jefferies S, Beasley R. Paracetamol in pregnancy and the risk ofwheezing in offspring: a systematic review and meta-analysis. Clin Exp Allergy 2011;41:482–9.Search in Google Scholar

[8] Vlenterie R, Wood ME, Brandlistuen RE, Roeleveld N, van Gelder MM, Nordeng H. Neurodevelopmental problems at 18 months among children exposed to paracetamol inutero: apropensityscore matchedcohort study. IntJ Epidemiol 2016;45:1998–2008.Search in Google Scholar

[9] Liew Z, Ritz B, Virk J, Arah OA, Olsen J. Prenatal use ofacetaminophen and child IQ: a Danish Cohort study. Epidemiology 2016;27:912–8.Search in Google Scholar

[10] Fisher BG, Thankamony A, Hughes IA, Ong KK, Dunger DB, Acerini CL. Prenatal paracetamol exposure is associated with shorter anogenital distance in male infants. Hum Reprod 2016;31:2642–50.Search in Google Scholar

[11] Eisenberg ML, Hsieh MH, Walters RC, Krasnow R, Lipshultz LI. The relationship between anogenital distance, fatherhood, and fertility in adult men. PLOS ONE 2011;6:e18973.Search in Google Scholar

[12] Schultz ST, Gould GG. Acetaminophen use for fever in children associated with autism spectrum disorder. Autism Open Access 2016;6:170 [Epub ahead of print].Search in Google Scholar

[13] Heintze K, Petersen KU. The case of drug causation of childhood asthma: antibiotics and paracetamol. EurJ Clin Pharmacol 2013;69:1197–209.Search in Google Scholar

[14] Etminan M, Sadatsafavi M, Jafari S, Doyle-Waters M, Aminzadeh K, Fitzgerald JM. Acetaminophen use and the risk of asthma in children and adults: a systematic reviewand metaanalysis. Chest 2009;136:1316–23.Search in Google Scholar

[15] Moraes LS, Takano OA, Mallol J, Sole D. Risk factors associated with wheezing in infants. J Pediatr (Rio J) 2013;89:559–66.Search in Google Scholar

[16] Bercedo-Sanz A, Lastra-Martinez L, Pellegrini-Belinchon J, Vicente-Galindo E, Lorente-Toledano F, Garcia-Marcos L. Wheezing and risk factors in the first yearoflife in Cantabria, Spain. The EISL study.Allergol Immunopathol (Madr) 2015;43:543–52.Search in Google Scholar

[17] Amberbir A, Medhin G, Hanlon C, Britton J, Davey G, Venn A. Effectsofearlylife paracetamol use on the incidence of allergic disease and sensitization: 5 year follow-up of an Ethiopian birth cohort. PLOS ONE 2014;9:e93869.Search in Google Scholar

[18] Tamay Z, Akcay A, Ergin A, Guler N. Prevalence of allergic rhinitis and risk factors in 6- to 7-yearold children in Istanbul, Turkey. Turk J Pediatr 2014;56: 31–40.Search in Google Scholar

Received: 2017-07-06
Revised: 2017-09-05
Accepted: 2017-09-09
Published Online: 2017-10-01
Published in Print: 2017-10-01

© 2017 Scandinavian Association for the Study of Pain