Evaluation of Acetaminophen impact on neurodevelopmental disorders in children

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Created On: 03/02/2025

This national cohort study investigated the relationship between prenatal Acetaminophen (also called Paracetamol) and the risk of autism spectrum disorder, attention deficit disorder (ADHD) and cognitive impairment in the pediatric population.

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Key take away

Healthcare providers should be cautious about assuming a causal link between the use of Acetaminophen during gestation and neurodevelopmental conditions, as genetic confounders likely play a key role.

Background

Method

A population-based sample of 2,480,797 Swedish children (born between 1995 and 2019) was examined based on the sibling control analysis. The follow-up was done till Dec 31, 2021.

Acetaminophen usage during gestation was documented prospectively from the antenatal and prescription chronologies. Autism spectrum disorder, ADHD, and intellectual disability were identified as the main outcomes using the ICD-9 and ICD-10 codes from health registers.

Result

Overall, 7.49% (185,909 kids) received Acetaminophen during gestation. The 10-year absolute risks for autism, ADHD, and intellectual disability were slightly higher for those exposed to Acetaminophen (1.53%, 2.87%, and 0.82%, respectively) compared to those not exposed (1.33%, 2.46%, and 0.70%, respectively).

In unadjusted models, Acetaminophen during pregnancy was linked with marginally increased risks for autism (hazard ratio [HR], 1.05), ADHD (HR, 1.07), and intellectual disability (HR, 1.05).

However, sibling control analyses, which addressed unobserved confounding, showed no significant association between Acetaminophen use and these disorders. Additionally, no dose-response relationship was found in sibling control analyses, with similar results for different levels of Acetaminophen use on a daily basis.

Conclusion

Sibling control analysis found no link between Acetaminophen use during pregnancy and the risk of ADHD, autism or cognitive impairment in children, implying that the associations seen in other models may be due to familial confounding.