In utero paracetamol exposure increases risk of ADHD and autism

Abstract

In utero exposure to paracetamol (acetaminophen) appears to increase the risks of attention-deficit hyperactivity disorder (ADHD) and autistic disorder in children, according to findings of a US study published in JAMA Psychiatry. Data from the Boston Birth Cohort at Boston Medical Center (October 1998–June 2018) were used to investigate the association between cord plasma metabolites of paracetamol during 996 pregnancies and the risks of ADHD, autism spectrum disorder (ASD) and developmental disabilities. Infants were enrolled at birth and followed up for a mean duration of 9.8 years. Overall, 25.8% of children were diagnosed with ADHD only, 6.6% developed ASD only, 4.2% developed ADHD and ASD, 30.5% were diagnosed with other developmental disabilities, and 32.8% were neurotypical. Paracetamol metabolites were detectable in all cord plasma samples. Compared with the first tertile of cord paracetamol burden (including all paracetamol metabolites), the second tertile was associated with a significantly increased risk of ADHD (odds ratio [OR] 2.26; 95% CI 1.40, 3.69) and ASD (OR 2.14; 95% CI 0.93, 5.13), and the third tertile was associated with an even greater risk of ADHD (OR 2.86; 95% CI 1.77, 4.67) and ASD (OR 3.62; 95% CI 1.62, 8.60). In sensitivity analyses and subgroup analyses, consistent associations were found between cord paracetamol burden and both ADHD and ASD across potential confounders such as maternal fever during pregnancy, substance abuse, preterm birth, and sex. In this study, cord biomarkers of fetal exposure to acetaminophen were associated with significantly increased risk of childhood ADHD and ASD in a doseresponse fashion. Our findings support previous studies regarding the association between prenatal and perinatal acetaminophen exposure and childhood neurodevelopmental risk and warrant additional investigations, concluded the authors.