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Paracetamol use in pregnancy tied to offspring behavioural problems during early childhood

Pearl Toh
18 Sep 2019

Maternal intake of paracetamol during mid-pregnancy was associated with hyperactivity and attention problems in their offspring up to preschool age, although the association was diminished as the children grew older, according to the ALSPAC* study.

“Our findings add to a series of results concerning evidence of the possible adverse effects of taking paracetamol during pregnancy such as issues with asthma or behaviour in the offspring. It reinforces the advice that women should be cautious when taking medication during pregnancy and to seek medical advice where necessary,” said lead author Professor Jean Golding from the University of Bristol in Bristol, UK.

The longitudinal cohort study included 14,062 children whose mothers reported on their use of paracetamol during pregnancy at 18–32 weeks of gestation, of which 43.9 percent of them reported using the medication. Their children were assessed on cognitive and behavioural outcomes, starting from 6 months until 17 years. 

Of the behavioural traits studied, the researchers found significant associations between paracetamol use and behavioural features of hyperactivity and attention problems. For instance, temperament variables such as adaptability at 6 months (mean difference [MD], 0.33, 95 percent confidence interval [CI], 0.05–0.60) and persistence at 24 months (MD, 0.36, 95 percent CI, 0.12–0.60) were significantly poorer in children born to mothers who used paracetamol during mid-pregnancy than their counterparts who did not.

Stratifying the analysis by sex revealed that boys were more susceptible than girls, with maternal paracetamol use being associated with three additional behavioural variables in boys —distractibility (MD, 0.40, 95 percent CI, 0.02–0.78), approach (MD, 0.44, 95 percent CI, 0.03–0.86), and measure of a difficult baby (MD, 1.35, 95 percent CI, 0.15–2.54) at 6 months. In contrast, only the association for persistence at 24 months remained significant among girls.

In addition, children whose mothers used paracetamol during mid-pregnancy scored higher on the hyperactivity scale and total behaviour difficulties at 42 and 47 months than children of nonusers during mid-pregnancy (p<0.05 for all). Attention measures in offspring of users were also poorer during age 7–8 years, as reported by their teachers.    

Paracetamol use during mid-pregnancy was also associated with poorer conduct as assessed on the SDQ** and DAWBA*** questionnaires at age 42, 47, and 81 months. Again, the association was attenuated in girls but persisted up to 115 months in boys. 

“We repeated the analyses separately for the two sexes and found that the associations with hyperactive and conduct behaviour were more likely to be found among the boys where there were 14 significant adjusted associations, in contrast with the girls with only six significant adjusted associations,” observed Golding and co-authors.

However, all the associations disappeared towards the end of primary school years, when the children reached age 10–11 years.  

“Given the increase in these behaviours [during the early years,] it will be important to assess whether they are accompanied by difficulties in scholastic achievements, or whether any adverse effects survive puberty,” the researchers pointed out.

“It is important that our findings are tested in other studies — we were not in a position to show a causal link, rather an association between two outcomes. It would also be useful now to assess whether older children and adults are free of difficult behavioural problems if their mother had taken paracetamol,” said Golding.

 

 

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