Common painkiller acetaminophen could alter fetal development, researchers warn

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A group of researchers is calling for greater caution in the use of paracetamol during pregnancy.

Paracetamol, commonly known as acetaminophen or APAP, is the most common drug ingredient in America, according to The Acetaminophen Awareness Coalition.

In the study, “Paracetamol use during pregnancy — a call for precautionary action,” the scientists, clinicians and epidemiologists summarized evidence for concerns about the alternation of fetal development and increased risk of certain disorders by conducting reviews of animal- and human epidemiological-based research spanning more than two decades. 

They used only studies that investigated APAP as an independent exposure, searching experimental and epidemiological literature in English available on PubMed, including systematic reviews using the search terms “acetaminophen” or “paracetamol,” “endocrine,” “reproduction,” “urogenital,” “neurodevelopment,” “attention deficit disorder,” “autism spectrum disorder,” “hypospadias,” “anogenital distance” and “cryptorchidism.”

In human observational studies, conclusions suggested that prenatal APAP exposure might be associated with both reproductive and neurobehavioral abnormalities in both sexes and in animal studies in vivo, in vitro and ex vivo studies showed that APAP “directly perturbs hormone-dependent processes, which leads to disrupted reproductive development and neurodevelopment in both sexes.”

The statement noted that the human studies have limitations, including potential confounding and exposure or outcome misclassification, and called for further human studies to be carried out “before any firm conclusions can be drawn.”

The study recommends that pregnant women should be cautioned at the beginning of pregnancy to forego APAP unless it is medically indicated, as supported by 91 scientists, clinicians and public health professionals.

The authors wrote that the potential for harm from inaction exceeds the harm that might arise from precautionary action and that they believe APAP-specific risk communication between health professionals and pregnant women is warranted.

Although the consensus statement calls for caution – and warning labels on the packaging of all APAP-containing medications – the group said that APAP remains the safest available drug to treat pain and fever in pregnant people.

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