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The following is a summary of “Acetaminophen in Pregnancy and Attention-Deficit and Hyperactivity Disorder and Autism Spectrum Disorder,” published in the February 2025 issue of Obstetrics and Gynecology by Damkier et al.
Acetaminophen is widely used as an over-the-counter medication, but recent public discourse has raised concerns about its safety during pregnancy, particularly regarding potential associations with neurodevelopmental disorders in offspring. This clinical perspective critically examines the strengths and limitations of the existing literature on the relationship between maternal acetaminophen use during pregnancy and the risk of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in children. A comprehensive review of 56 relevant studies, commentaries, and editorials was conducted, with a focused analysis of nine original studies that met rigorous inclusion criteria, along with three meta-analyses.
A key limitation observed in studies reporting positive associations was the presence of substantial biases, including selection bias, variability in the choice and adjustment of confounding factors, and unmeasured familial confounding. In studies that employed sibling-controlled analyses to mitigate shared genetic and environmental confounding, previously observed associations were significantly attenuated. This suggests that residual confounding from genetic predisposition and environmental factors may have led to an overestimation of risk in prior observational studies. Based on the current body of scientific evidence, prenatal exposure to acetaminophen does not appear to confer a clinically meaningful increase in the risk of ADHD or ASD in children.
Consequently, the available data do not support modifying current clinical guidelines regarding the use of acetaminophen for the management of fever or pain during pregnancy. Moving forward, prospective research that carefully accounts for familial, genetic, and psychosocial environmental influences associated with both maternal acetaminophen use and childhood neurodevelopmental outcomes is necessary to refine the understanding of this relationship.
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