Use of acetaminophen during pregnancy associated with sleep, attention problems in children

Acetaminophen use during pregnancy is associated with sleep and behavior problems consistent with attention deficit hyperactivity disorder (ADHD), according to a study by researchers at Penn State College of Medicine.

Acetaminophen is a common medication used to treat a variety of problems, including fever, infection, muscle aches, headaches, migraine, colds, and allergies. Traditionally, the drug has been considered by medical professionals to be safe during pregnancy. However, according to Kristin Sznajder, assistant professor of public health sciences and lead author, emerging studies support the idea that this drug may affect child development and may be associated with attention problems.

Sznajder said their new study confirms these trends and was also the first to observe an association between acetaminophen use during pregnancy and child sleep problems.

“Pregnant women experience pain, fever, and other ailments that could be alleviated by the use of acetaminophen,” said Sznajder, a researcher at the Huck Institutes of the Life Sciences. “While the drug may provide relief in the moment, research increasingly indicates that there may be downstream effects that could harm a child’s development. Further research is needed for appropriate recommendations to be made. can be made to pregnant women.”

The researchers used data from a study of more than 2,400 women who had never given birth before and followed them and their children from the third trimester of pregnancy to 3 years postpartum. The women were asked once during their pregnancy about their medication use, frequency and level of stress. Of these, 41.7% of women reported using acetaminophen during pregnancy.

Participants were then interviewed at 1, 6, 12, 18, 24, 30 and 36 months after the birth of their child. At the 36-month interview, participants were asked to rate their child using a three-point scale to describe how often they exhibit a wide variety of neurodevelopmental and behavioral outcomes (very often true, somewhat or sometimes true and not true) such as ‘can’t sit still or restless’, ‘avoids eye contact’ and ‘doesn’t want to sleep alone’. Scores for each behavior were then tabulated to determine whether the children scored high in the areas of emotional reaction, anxiety or depression, withdrawal, sleep problems, and aggressive behavior.

Using responses from the 99-point Child Behavior Checklist, the researchers then assessed whether children of mothers who used acetaminophen during pregnancy were more likely to have attention problems. , sleep or other neurobehavioral problems. Because women who used acetaminophen during pregnancy were more likely to have been diagnosed with anxiety or depression before becoming pregnant and to report high levels of stress during pregnancy, the team at research controlled for stress, depression during pregnancy, and previous diagnoses of depression or anxiety in their statistical analyses.

After adjusting for confounding variables, children of women who used acetaminophen were significantly more likely to have sleep problems and attention problems than children of those who did not use acetaminophen during pregnancy. .

The results support findings from previous studies that suggest prenatal acetaminophen use may lead to attention problems, while showing that sleep may also be affected. Of the women who used acetaminophen during pregnancy, 22.7% described their child as having sleep problems and 32.9% described their child as having attention problems. Among participants who did not report using acetaminophen during pregnancy, 18.9% said their child had sleep problems while 28.0% said their child had attention problems . The results were published in PLOS One on September 28.

According to the study team, more research is needed to understand these relationships. Survey responses lacked data on trimester of use, frequency of use, and dose. According to Sznajder, these are factors that could impact the outcome. She noted that a study is underway that will attempt to dive deeper into trimester, frequency and dosage and how this affects results. She also said that using a child development expert to assess children’s behaviors could help ensure more accurate results.

According to the researchers, it is unknown which prenatal developmental processes may be disrupted by prenatal acetaminophen use. But they said some possibilities include acetaminophen damaging the placenta and thereby disrupting fetal development, or acetaminophen damaging liver cells in the fetus, in turn disrupting gut health and impacting neurodevelopment.

We must interpret these results with some caution. Although acetaminophen is generally considered safe during pregnancy, data from several studies suggest that its use may have effects on child development. It is important that we learn as much as possible about this topic so that we can give future mothers data-based recommendations for caring for their children and themselves.”

Kristin Sznajder, lead author

Douglas Teti of Penn State College of Health and Human Development and Kristen Kjerulff of Penn State College of Medicine also contributed to this research. The researchers declare no conflict of interest associated with this study. This research was supported by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health.


Penn State College of Medicine

Journal reference:

Sznajder, KK, et al. (2022) Maternal Acetaminophen Use During Pregnancy and Neurobehavioral Problems in Offspring at 3 Years: A Prospective Cohort Study. PLOS ONE.

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