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Maternal acetaminophen use and cognitive development at 4 years: the Ontario Birth Study
Jennifer M Lye1, Julia A Knight1,2, Jasleen Arneja2
1Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute of Sinai Health, Toronto, ON, Canada.
Insights
Maternal acetaminophen use during pregnancy was not associated with adverse cognitive development in 4-year-old children. This study found no link between prenatal acetaminophen exposure and lower cognition scores in offspring.
Area of Science:
- Obstetrics and Gynecology
- Pediatric Neurology
- Developmental Psychology
Background:
- Emerging evidence suggests potential links between prenatal acetaminophen use and adverse child developmental outcomes.
- A significant knowledge gap exists regarding the impact of acetaminophen on overall cognitive development, particularly concerning the timing of use during pregnancy.
Purpose of the Study:
- To investigate the relationship between maternal acetaminophen use and child cognitive development at four years of age.
- To characterize the impact of acetaminophen exposure timing during pregnancy on offspring cognition.
Main Methods:
- Prospective cohort study (Ontario Birth Study) with data from 2013-2019.
- NIH Toolbox Early Childhood Cognition battery used to assess cognitive development in 4-year-old children (n=436).
- Poisson regression with robust error variance analyzed the association between maternal acetaminophen use and cognitive composite scores.
Main Results:
- No significant association was observed between maternal acetaminophen intake (any time before or during pregnancy) and low cognition composite scores in offspring.
- Incidence Rate Ratios (IRRs) for suboptimal overall cognition ranged from 0.80 to 1.56 across different timing windows of maternal acetaminophen use.
- Specific IRRs for maternal acetaminophen use before, early, late, or overall pregnancy were 1.38 (0.78-2.45), 1.22 (0.67-2.22), 0.80 (0.44-1.47), and 1.56 (0.74-3.29), respectively.
Conclusions:
- Current findings do not support a relationship between maternal acetaminophen use during pregnancy and adverse cognitive effects in children at four years of age.
- The study utilized a validated, standardized cognitive assessment tool for children, minimizing reliance on subjective parent or teacher reports.
Background:
Studies have suggested a link between prenatal maternal acetaminophen use and adverse developmental outcomes in children. However, there exists a knowledge gap regarding overall cognitive development and use of acetaminophen, especially concerning the timing of use in pregnancy. This study aimed to characterize the relationship between maternal acetaminophen use and cognitive development at 4 years.
Methods:
This analysis included data collected throughout pregnancy and delivery from women in the Ontario Birth Study prospective cohort from 2013 to 2019 and from the NIH Toolbox Early Childhood Cognition battery administered to 4-year-old children between 2018 and 2021 (n = 436). The exposure was maternal acetaminophen use and the primary outcome was a cognition composite score. The relationship between exposure and outcome was determined using Poisson regression with a robust error variance.
Results:
We did not observe any association between maternal acetaminophen intake any time before or during pregnancy and low cognition composite score of offspring. The IRR of suboptimal overall cognition was 1.38 (0.78-2.45), 1.22 (0.67-2.22), 0.80 (0.44-1.47), and 1.56 (0.74-3.29) for maternal use of acetaminophen before, in early, late, or overall pregnancy, respectively.
Conclusion:
Current data do not provide evidence to support a relationship of maternal acetaminophen use during pregnancy with adverse cognitive effects at 4 years.
Impact:
Acetaminophen use during pregnancy may influence the risk of child neurocognitive disorders, but there is conflicting evidence of its relationship to sub-clinical measures of cognitive development such as executive function. The study design allowed us to examine the role of timing of acetaminophen use in its relationship with cognitive development, based on a validated and standardized tablet-administered instrument for children, instead of a teacher or parent report. We did not observe a clear relationship between maternal acetaminophen use at different timepoints during pregnancy and child cognitive development.
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