Paracetamol use during pregnancy linked to childhood behavioral problems

A new study by researchers at the University of Bristol has found further evidence linking paracetamol intake during pregnancy with potential adverse behavioral and cognitive outcomes during childhood.

Lead author, Jean Golding, says the findings reinforce the advice that women should be cautious when taking medication during pregnancy.

Paracetamol is often used to alleviate pain during pregnancy and is the treatment of choice recommended by the NHS.

Most epidemiological studies assessing the potential adverse effects of taking paracetamol during pregnancy have focused on childhood asthma and results from several of them have confirmed a robust association, say Golding and team.

Recently, a few cohort studies have also looked at whether the use of the medication is associated with certain neurocognitive outcomes and several of those have implicated hyperactivity. However, to confirm these findings, further information and results are needed, says the team.

Investigating the association between paracetamol and behavioral issues

As recently reported in the journal Paediatric and Perinatal Epidemiology, the researchers investigated whether paracetamol intake during mid-pregnancy (18 to 32 weeks gestation) was associated with any cognitive and behavioral outcomes among a large cohort of children aged between 6 months and 11 years. The children also had their memory and IQ tested until they reached the age of 17.

The team used data collected by the Avon Longitudinal Study of Parents and Children (ALSPAC) at 32 weeks gestation that referred to the 18 to 32 weeks gestation period. Also known of as the “Children of the 90s” study, ALSPAC is a world-leading birth cohort study that monitored the health of 14,500 families in the Bristol area.

At 32 weeks, 43.9% of women were identified as having taken paracetamol “sometimes” or on a more frequent basis during the previous three months.

First, the team used an exposome analysis to determine any background factors that were associated with women taking the medication and those factors were then adjusted for while any associations with child outcomes were assessed using regression analysis. The researchers used the results of memory, IQ and pre-school development tests, as well as measures of temperament and behavior.

Discovering a link

The study identified an association between maternal paracetamol use and childhood difficult behaviors such as hyperactivity and attention problems, based on behaviors reported by mothers when the children were aged 42 and 47 months.

However, few associations with behavioral or neurocognitive outcomes were observed after the children reached 7 to 8 years of age, whether they were based on reports by the mother or a teacher.
This suggests that paracetamol use during mid-pregnancy would no longer have an adverse effect on cognitive and behavioral outcomes by the time children reached the end of primary school.

The study suggests women should be cautious when taking paracetamol during pregnancy

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 behavior in the offspring. It reinforces the advice that women should be cautious when taking medication during pregnancy and to seek medical advice where necessary.”
Jean Golding, Lead Author

She highlights the importance of ensuring the results are tested in further studies using other datasets or methodologies since the team was not in a position to show a causal link, only an association.
The researchers say that if paracetamol use in mid‐to‐late pregnancy has an adverse effect on child neurocognitive outcomes, it appears to mainly relate to the pre‐school period.

“It would also be useful now to assess whether older children and adults are free of difficult behavioral problems if their mother had taken paracetamol,” concludes Golding.

NHS states that taking paracetamol during pregnancy is safe

The NHS advises that if a mother is experiencing pain during pregnancy, that paracetamol is usually a safe painkiller to take. However, women should seek medical advice from their midwife or GP before taking the medicine.

For pregnant mothers experiencing pain during any stage of pregnancy, paracetamol is the treatment of choice for relieving mild or moderate pain and for reducing fever.

However, as is the case with any medication taken during pregnancy, the lowest effective dose should be used over the shortest possible period. If the recommended dose is not sufficient to alleviate symptoms, further advice should be sought from the GP or midwife.

Combined paracetamol and caffeine tablets

The NHS does not recommend using a table that combines paracetamol and caffeine. As well as increasing the risk for miscarriage, a high caffeine intake can result in a low birth weight, which is associated with an increased risk for health problems later in life. Caffeine intake does not need to be avoided completely, but the NHS recommends limiting it to 200 mg per day.

What about ibuprofen?

The recommendations regarding the use of ibuprofen are different and depend on the stage of pregnancy.

Medications should be avoided in general

Ideally, the use of any medication during pregnancy should be avoided during pregnancy, especially during the first trimester. Minor aches and pains or colds do not usually require medication, but women who feel they need to take it should consult their GP, midwife or local pharmacy first. Advice can also be sought by calling the emergency services.

Journal reference:

Golding, J., et al. (2019). Associations between paracetamol (acetaminophen) intake between 18 and 32 weeks gestation and neurocognitive outcomes in the child: A longitudinal cohort study. Pediatric and Perinatal Epidemiology. doi.org/10.1111/ppe.12582.