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    Does prenatal exposure to acetaminophen increase risk for ADHD?

    According to a study published in Pediatrics, a pregnant woman’s use of acetaminophen may be associated with increased risk of her child developing attention-deficit/hyperactivity disorder (ADHD). The authors believe that duration of acetaminophen usage during pregnancy plays a major role in the rate of ADHD.

    Using the Norwegian Mother and Child Cohort Study, the researchers looked at a sample of 112,973 offspring born between 1999 and 2009. Both mothers and fathers completed questionnaires at 18 weeks’ gestation and the mothers completed follow-up questionnaires after delivery and when their child reached 6 months, 18 months, and 3 years of age.  To control for potential confounders, questions on the survey also included various medical conditions for which acetaminophen was indicated.

    From that sample, 2246 (2%) children were diagnosed with ADHD and 52,707 (46.7%) mothers reported some acetaminophen use during pregnancy. Compared with mothers who reported no acetaminophen exposure, the unadjusted hazard rate (HR) of ADHD in children after 1, 2, or 3 trimesters of prepartum exposure was 17%, 39%, and 46%, respectively. When the authors adjusted for parental ADHD symptoms, the risk associated with acetaminophen reduced slightly from an HR of 1.26 to 1.20. Use of acetaminophen for any one, any two, or all three trimesters was associated with an HR of 1.07, 1.22, and 1.27, respectively.

    When the pregnant mother took acetaminophen between 1 and 7 days for any indication, the HR was 0.90. In general, longer use was associated with a steady increase in risk. Acetaminophen usage for 29 days or longer carried an HR of 2.20. When the mother indicated acetaminophen use for fever and infections for 22 to 28 days, the HR spiked to 6.15, but dropped to 2.40 with use of 29 days or longer. The researchers found no association between acetaminophen use in the 6 months prior to pregnancy and ADHD in the child. But paternal use of acetaminophen for 29 days or longer had an HR of 2.06.

    The authors claimed this study could have an impact on prescribing habits as they estimated that approximately 65% to 70% of pregnant women in the United States and approximately 50% to 60% of pregnant women in western and northern Europe use acetaminophen. But the authors noted some limitations to this study. These include the inability to adjust for the severity of the indications leading to maternal acetaminophen use and the accuracy of clinician ADHD diagnoses. In addition, the indication that paternal use of acetaminophen also having an effect on ADHD likelihood makes the researchers question the causal role of acetaminophen in the etiology of ADHD.

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    Judith M. Orvos, ELS
    Judith M. Orvos, ELS, is a a BELS-certified medical writer and editor and an editorial consultant for Contemporary OB/GYN.
    Ben Schwartz
    Ben Schwartz is Associate Editor, Contemporary OB/GYN.

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