By Lisandra Pereira-
Existing evidence following a comprehensive review does not show a clear link between taking paracetamol in pregnancy and autism and ADHD in children, an in-depth review has concluded. Researchers trawled all studies on the issue and concluded they were low quality, with “low to critically low” confidence in any findings suggesting a link.
US President Donald Trump said in September there has been a “meteoric rise” in cases of autism and that Tylenol – which is called paracetamol in the UK – was a potential cause.
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He said the painkiller should not be taken during pregnancy, suggesting pregnant women should “tough it out”.His comments were criticised by autism campaigners and scientists in the UK and around the world
Now in a new study, published in the British Medical Journal (BMJ), experts including from the universities of Liverpool and Birmingham concluded that women should continue to be advised to take paracetamol when needed to treat pain and fever in pregnancy. The researchers examined nine systematic reviews including 40 observational studies into paracetamol use during pregnancy and autism, ADHD and other neurodevelopmental conditions in children.
All of the reviews reported at least a possible association between a mother’s paracetamol use in pregnancy and autism or ADHD in their children, but seven urged caution when interpreting the findings because they did not rule out other factors. Only one review included two studies that properly accounted for family genetics and other shared factors such as the mother’s pre-existing health conditions. One, published last year, found rates of autism, ADHD and intellectual disability were marginally higher in 2.4 million Swedish children whose mothers took paracetamol in pregnancy.“
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Prof Shakila Thangaratinam, (pictured) a consultant obstetrician and senior author on the review at the University of Liverpool, said: “Women should know that the existing evidence does not really support a link between paracetamol and autism and ADHD.
“If there’s a family history of autism and ADHD, either in the parents or the siblings, then it is likely that that is the reason a child is diagnosed rather than something the mother took in pregnancy,” said Thangaratinam.“Paracetamol is the safest medication to use in pregnancy, and has been used by the majority of pregnant women globally for several decades without any impact on autism and ADHD,” Siassakos said. “It is also the safest to use if there is maternal fever, whereas untreated high temperature is a risk factor for poor pregnancy outcomes, including adverse foetal outcomes. High temperature and inflammation have a negative impact on foetal and neonatal brains and untreated inflammation can cross the placenta.”
Beyond providing an overview of the evidence, the findings should reassure women who might feel guilty for taking paracetamol during pregnancy. “They might have a child that is autistic with ADHD and we really don’t want them to think it’s because of something they did in pregnancy. That’s a terrible feeling for a mother to have,” said Thangaratinam. “There isn’t anything in the current evidence that suggests mothers taking paracetamol is actually causing autism and ADHD.”
They said there was a “lack of robust evidence linking paracetamol use in pregnancy and autism and ADHD in offspring”.
Furthermore, untreated fever, particularly in the first trimester, has been linked to an increased risk of miscarriage, birth defects and premature birth – underlining the need for women to be able to take paracetamol.
The team also suggested that any apparent link between paracetamol and autism and ADHD in previous studies may be driven by shared genetic and environmental factors within families.US President Donald Trump’s comments were criticised by autism campaigners and scientists in the UK and around the world (PA)
For the latest study, researchers examined nine systematic reviews that included a total of 40 observational studies reporting on paracetamol use during pregnancy and the risk of autism, ADHD, or other neurodevelopmental outcomes.
All reviews reported a possible to strong association between a mother’s paracetamol intake and autism or ADHD, or both, in children, but seven of the nine reviews advised caution when interpreting the findings.
Overall, experts in the BMJ concluded that confidence in the findings of these reviews was low (for two reviews) to critically low (for seven reviews).
They added: “Existing evidence does not show a clear link between in utero exposure to paracetamol and autism and ADHD in offspring.
“Any apparent effect observed after in utero exposure to paracetamol on autism and ADHD in childhood might be driven by familial genetic and environmental factors and unmeasured confounders.”
Dimitrios Siassakos, professor in obstetrics and gynaecology from University College London, said: “The high-quality methodology used in this new umbrella review confirms what experts around the globe have been saying.
“The evidence that links paracetamol use in pregnancy to autism is tenuous and those studies which do report an association are confounded by the association of autism or ADHD with factors shared by families such as genetics and lifestyle.”
Professor Louise Kenny, Pro-Vice-Chancellor and Head of the Faculty of Health and Life Sciences, University of Liverpool said: “Current evidence does not demonstrate a clear link between paracetamol use in pregnancy and autism but our work also demonstrates how poor the data is around medications in pregnancy. This highlights the wider problem of historic and continuing under investment in women’s health research.”
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