Paracetamol use in pregnancy linked to ADHD

By , 3 March 2014

Paracetamol use in pregnancy linked to ADHD

Although media outlets like to lead with attention-grabbing headlines, we need to be careful not to jump to conclusions prematurely... 

An interesting article published recently in JAMA Pediatrics which observed an association between paracetamol use in pregnancy and neurodevelopment disorders such as ADHD. 

However, it is important to remember that statistical associations do not prove causation. Although this is a very large, prospective study, it is non-randomised and so not all potential confounders (i.e. things that can influence results other than a true causal relationship between paracetamol and ADHD) cannot be accounted for. The researchers were careful to control their data for things like fevers and infections (as recalled by the women), but can't account for all reasons why women might take paracetamol, and therefore can't account for the potential interactions between these and risk of ADHD; development of ADHD is complex and may involve genetic predisposition, non-inhereited factors and, potentially, environmental exposures. Other conditions that have similarly complex causes, such as predisposition to migraines or pain syndromes (which could not all be accounted for in a study of this design) are also reasons why women may take paracetamol. And so true relationships become a little difficult to prove.

An important lesson in effects of study design was demonstrated by the Womens' Health Initiative HRT trials - while observational data suggested HRT use may protect women from heart disease, follow-up data from randomised trials showed the opposite - HRT increased cardiovascular risk. Additionally, conditions for which paracetamol is used, such as fever, are known to be harmful to developing babies. 

So, while this study has provided some important information, more study will be required, along with subsequent risk-benefit analyses, before we can unequivocally recommend avoiding paracetamol in pregnancy.

 

Paracetamol use in pregnancy linked to ADHD
 

About Dr David Moore

Paracetamol use in pregnancy linked to ADHD

David is a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, and undertook his specialist training in Queensland.  He is highly skilled in the management of complex and high-risk pregnancies, and has special training in minimally-invasive surgery, endometriosis, pelvic floor and incontinence surgery.  David has completed a Master of Reproductive Medicine and is skilled in the assessment and management of fertility problems, and can offer the full range of assisted reproductive treatments.  He is a Senior Lecturer with The University of Queensland Medical School, and has published both medical journal and textbook contributions.

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