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Association Between Prenatal Acetaminophen Exposure and Future Risk of Attention Deficit/Hyperactivity Disorder in
Rebecca M Hoover1, V Autumn Gombert Hayes2, John Erramouspe2
1College of Pharmacy, Idaho State University, Pocatello, ID, USA rhoover@pharmacy.isu.edu.
Insights
Prenatal acetaminophen exposure shows a mild correlation with attention deficit/hyperactivity disorder (ADHD) symptoms in children. However, current evidence is insufficient to confirm a causal link for lifelong ADHD development.
Area of Science:
- Pediatric Neurology
- Developmental Psychology
- Pharmacology
Background:
- Acetaminophen is a common medication used during pregnancy for pain and fever relief.
- Concerns exist regarding potential neurodevelopmental effects of prenatal medication exposure.
- Attention deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder in children.
Purpose of the Study:
- To evaluate the association between prenatal acetaminophen exposure and the subsequent development of ADHD in children.
- To synthesize findings from existing prospective clinical trials on this topic.
Main Methods:
- Comprehensive literature searches were conducted in MEDLINE, International Pharmaceutical Abstracts, and Cochrane Database up to June 2015.
- Included prospective clinical trials comparing maternal acetaminophen use during pregnancy with ADHD or ADHD-like behaviors in offspring (ages 3-12 years).
- Four relevant studies were identified and analyzed.
Main Results:
- Three of the four identified studies indicated a statistically significant correlation between prenatal acetaminophen use and ADHD behaviors.
- One study reported a higher risk of ADHD medication use (HR=1.29) and ADHD-like behaviors (RR=1.13) in children exposed prenatally.
- An earlier study found no association between prenatal acetaminophen exposure and ADHD behaviors.
Conclusions:
- A mild correlation exists between prenatal acetaminophen use and the development of ADHD symptoms.
- Current data are insufficient to establish a causal relationship between prenatal acetaminophen exposure and the long-term development of ADHD.
- Acetaminophen remains a preferred choice for pain and fever management during pregnancy compared to NSAIDs or opioids.
Objective:
To evaluate the effect of prenatal acetaminophen exposure on the future development of attention deficit/hyperactivity disorder (ADHD) in children.
Data Sources:
Literature searches of MEDLINE (1975 to June 2015), International Pharmaceutical Abstracts (1975 to June 2015), and Cochrane Database (publications through June 2015) for prospective clinical trials assessing the relationship of prenatal acetaminophen exposure and the development of attention deficit disorders or hyperactivity.
Study Selection And Data Extraction:
Studies comparing self-reported maternal acetaminophen use during pregnancy to development of ADHD or ADHD-like behaviors in offspring between the ages of 3 and 12 years.
Data Synthesis:
Four studies examining the effects of prenatal acetaminophen exposure on subsequent ADHD behaviors were identified. Of these, one early study found no link to ADHD behaviors while the other studies found statistically significant correlations with the most prominent being a study finding a higher risk for using ADHD medications (hazard ratio = 1.29; 95% CI, 1.15-1.44) or having ADHD-like behaviors at age 7 years as determined by the Strengths and Difficulties Questionnaire (risk ratio = 1.13; 95% CI, 1.01-1.27) in children whose mothers used acetaminophen during pregnancy.
Conclusion:
While there does appear to be a mild correlation between prenatal acetaminophen use and the development of ADHD symptoms in children, current data do not provide sufficient evidence that prenatal acetaminophen exposure leads to development of ADHD symptoms late in life. Acetaminophen is a preferred option for pain management during pregnancy when compared with other medications such as nonsteroidal anti-inflammatory drugs or opioids for pyretic or pain relief.
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