July 1, 2016

expert reaction to study looking at paracetamol in pregnancy and autism spectrum symptoms and hyperactivity in children

Publishing in the International Journal of Epidemiology, researchers reported an association between taking paracetamol during pregnancy and the rate of hyperactive and autistic-like symptoms at age 5 in their children.

Prof Jean Golding, Emeritus Professor of Paediatric and Perinatal Epidemiology, University of Bristol, said:

“In this study in Spain women were asked about their intake of paracetamol during pregnancy, and their infants tested at age 5 for a number of symptoms.

“The authors reported an increased rate of hyperactive and autistic-type symptoms. However there are a number of possible problems with the study which the authors mostly acknowledge. Firstly, they did not record the number of times the mother had taken the paracetamol; clearly a couple of tablets for a headache may have very different effects than taking daily doses for severe chronic pain.

“Secondly, although the authors allowed for a number of confounders, they omitted smoking (it is well-documented that women who smoke tend to have more pain of various sorts, and their children are more likely to have neurocognitive problems such as hyperactivity).

“Finally it is important to note that numbers involved in the study were small – there were only 48 children whose mothers had taken paracetamol at least once in each trimester.

“Obviously if there is an adverse effect on the child’s brain it is important to know this. Consequently it is imperative to assess whether the same effects are shown in children from other longitudinal birth cohorts.”

Prof Alan Cameron, Vice President of Clinical Quality, Royal College of Obstetricians and Gynaecologists (RCOG), said:

“Paracetamol is one of the most common medicines used to reduce a high temperature and ease pain, it is safe and is used routinely during all stages of pregnancy.

“The preliminary results from this study suggest that frequent paracetamol use throughout pregnancy may impact attention function and slightly increase the risk of hyperactivity in the offspring at aged 5 years old. No effect on cognitive, motor or social development was identified.

“It is important to highlight that from these results we cannot determine a direct link between paracetamol usage and any neurodevelopmental problems. Future studies should take into account dosage as well as other possible contributory factors.

“However, women should not be alarmed by the results of this study and we recommend that pregnant women continue to follow current guidance and take the lowest effective dose for the shortest possible time when necessary. If the recommended dose of paracetamol doesn’t control symptoms or pain, please seek advice from your midwife, GP or obstetrician.”

Dr James Cusack, Director of Science, Autistica, said:

“This paper does not provide sufficient evidence to support the claim that there is a strong association between paracetemol use and the presentation of symptoms of autism.

“Rather, the results presented are preliminary in their nature, and so should not concern families or pregnant women.  This is particularly true given the array of environmental factors which have been associated with autism, only to be rejected later.  As the authors correctly state, more research, with careful control for other factors is required to understand whether a link exists at all.”

* ‘Acetaminophen use in pregnancy and neurodevelopment: attention function and autism spectrum symptoms’ by Claudia B. Avella-Garcia et al. was published in the International Journal of Epidemiology on Friday 1 July 2016. 

Declared interests

Prof Jean Golding: “I have no conflicts of interest.”

Prof Alan Cameron: “No interests to declare.”

Dr James Cusack: “I have no conflicts of interest, other than to state my role as Director of Science at Autistica – the UK’s leading autism research charity.”