Childhood asthma and use during pregnancy of acetaminophen. A critical review

Area of Science:

• Perinatal epidemiology
• Developmental toxicology
• Pediatric respiratory health

Background:

• Acetaminophen (analgesic/antipyretic) use in pregnancy is common.
• Concerns exist regarding potential depletion of glutathione in fetal lungs, leading to oxidative stress and inflammation.
• Previous epidemiological studies show conflicting results on the association with childhood asthma.

Purpose of the Study:

• To investigate the potential causal association between acetaminophen use during pregnancy and the development of childhood asthma.
• To address limitations in previous studies, such as confounding by indication and unreliable endpoints.

Main Methods:

• Review of epidemiological studies from eight centers.
• Discussion of methodological challenges including confounding by indication and the use of wheezing as an endpoint.
• Proposal for a placebo-controlled randomized trial to resolve causality.

Main Results:

• Epidemiological studies have yielded conflicting results regarding acetaminophen use and childhood asthma.
• Wheezing in early childhood, often used as an endpoint, is a poor predictor of asthma.
• Confounding by indication is a significant issue, as acetaminophen use may indicate underlying maternal conditions.

Conclusions:

• Current evidence is inconclusive regarding a causal link between acetaminophen use in pregnancy and childhood asthma.
• Methodological limitations in existing studies hinder definitive conclusions.
• A placebo-controlled randomized trial is recommended to clarify the potential causal relationship.