Does prenatal use of Acetaminophen raise infants' neurodevelopmental disorder risk?

Acetaminophen is commonly used for pain and fever during pregnancy, considered low risk by FDA and EMA. Previous studies linking it to neurodevelopmental disorders may be influenced by biases, like confounding by indication, where reasons for use (e.g., fever, pain) could also be risk factors for these disorders. Confounding by parental health and genetics is likely because neurodevelopmental disorders are highly heritable and those who used acetaminophen during pregnancy reported higher prevalence of multiple health conditions associated with neurodevelopmental disorders compared with nonusers.

This study included all singleton liveborn children from 1995 to 2019. Early drug exposure information was prospectively collected during the 8-10 weeks gestation period. Later medication use in pregnancy was also prospectively documented. Children were followed up from birth, using the age of the child as the time scale, until the earliest date of diagnosis of a neurodevelopmental disorder, death, emigration, or end of follow-up.

The results found no evidence that acetaminophen use during pregnancy was associated with children’s risk of autism, ADHD, or intellectual disability. This suggested that the small increase in children’s risk of neurodevelopmental disorders associated with acetaminophen use observed in statistical models may have been due to unmeasured confounding. Further, the findings indicated that the association between acetaminophen use during pregnancy and neurodevelopmental disorders is a noncausal association.

Reference: Viktor H. Ahlqvist, PhD; Hugo Sjöqvist, MSc; Christina Dalman, MD, PhD; et al; Acetaminophen Use During Pregnancy and Children’s Risk of Autism, ADHD, and Intellectual Disability; Journal: JAMA Network Open; doi:10.1001/jama.2024.3172