May 25, 2014

Q.

If I take acetaminophen while I’m pregnant, is my baby at risk of developing Attention Deficit Hyperactivity Disorder?

A.

Acetaminophen (Tylenol, Atasol,  store-brands) has generally been regarded as the drug of choice for minor pain and fever relief in pregnancy. Two recent studies from Europe have suggested there may be small increase in risk of ADHD (attention-deficit hyperactivity disorder) or similar conditions in children whose mothers take acetaminophen long-term (6 weeks or more), particularly during the last three months of pregnancy; however, more research is needed to confirm this risk (1,2).

An increase in major birth defects or miscarriage related to acetaminophen has not been shown (3). There may or may not be a link between acetaminophen and wheezing / asthma in the infant – some studies have shown an association but others have not (4).  Overdose or prolonged use of high doses may result in liver damage to the unborn baby and other adverse effects (3).

Acetaminophen still seems safer than other drugs used for treating pain and fever in pregnancy when used in in normal adult doses for short periods of time. It is also a good choice for nursing moms as the amount that babies get from breast milk is less than doses given to babies, and adverse effects are rare. (4)

Keep in mind that it is important to treat fever in pregnancy. Fever during the first trimester has been associated with neural tube defects (e.g. spina bifida) and possibly other birth defects. In addition, fever during labor is a risk factor for seizures, brain disorders, cerebral palsy and death in the newborn. (6)

Prepared by Jean Macpherson, BSP, Medication Information Consultant.
Reviewed by Karen Jensen, BSP, MSc, Medication Information Consultant

Sources

1)       Liew Z, Ritz B, et al.  Acetaminophen use during pregnancy, behavioral problems, and hyperkinetic disorders. JAMA Pediatr. 2014 Apr 1;168(4):313-20. doi: 10.1001/jamapediatrics.2013.4914.

2)       Brandlistuen R, Ystrom E, et al. Prenatal paracetamol exposure and child neurodevelopment: a sibling-controlled cohort study. Int J Epidemiol. 2013 Dec;42(6):1702-13. doi: 10.1093/ije/dyt183. Epub 2013 Oct 24.

3)       Acetaminophen monograph. Micromedex Healthcare Series. DRUGDEX System. Greenwood Village, CO: Truven Health Analytics, 2014. Available at http://www.thomsonhc.com/. Accessed April 17, 2014.

4)       Acetaminophen monograph. Micromedex Healthcare Series. Reprotox. Greenwood Village, CO: Truven Health Analytics, 2014. Available at http://www.thomsonhc.com/ by subscription. Accessed May 15,  2014.

5)       Canadian Pharmacist’s Letter PL - PL Detail-Document, Analgesics in Pregnancy and Lactation. Pharmacist’s Letter/Prescriber’s Letter. April 2014.

6)       3) Jamieson, DJ, Rasmussen, SA. Influenza and pregnancy. In: UpToDate, Barss,V (Ed), UpToDate, Waltham, MA, 2014. Available at www.uptodate.com by subscription. Accessed April 17, 2014.