Researchers from the University of Liverpool have conducted an in-depth evidence review “in direct response to recent announcements” about the safety of using paracetamol, also known as paracetamol, during pregnancy. They found that there was variable quality in existing systematic reviews, as well as in studies that did not adjust for critical parental health and lifestyle factors – resulting in weak associations at best.
“Through this work, we have shown, based on current evidence, that there is no clear link between women taking paracetamol during pregnancy and the diagnosis of autism or ADHD in their children,” said lead researcher Professor Shakila Thangaratinam from the University of Liverpool. “The findings should help healthcare professionals provide evidence-based advice to women, and reassure mothers about the use of paracetamol during pregnancy, when indicated.”
The researchers conducted an umbrella review – a high-level summary of the evidence – of existing reviews to assess their validity in relation to paracetamol and the development of autism or ADHD in offspring. Nine systematic reviews covered forty observational studies on this topic, and four articles included meta-analyses. Using strategies to assess each article for bias, the team rated their confidence in each article as high, moderate, low, or critically low.
The researchers found that overall confidence in the findings was mostly critically low (seven ratings), with two additional ratings rated as low confidence.
Furthermore, only one review included two studies that took into account confounding genetic and environmental factors shared by siblings, and took into account parents’ mental health, background and lifestyle. And in these two studies, the link between acetaminophen and autism/ADHD disappeared, or became much less convincing, once those other influences were included in the results.
This overarching review not only highlights widespread shortcomings in existing research, but also highlights how little research has been done on the topic of pregnancy and common over-the-counter medications.
“Current evidence does not show a clear link between paracetamol use during pregnancy and autism, but our work also shows how poor the data are on drugs during pregnancy,” said Professor Louise Kenny, Pro-Vice-Chancellor and Head of the Faculty of Health and Life Sciences at the University of Liverpool. “This highlights the broader problem of historic and ongoing underinvestment in women’s health research.”
Of course, this study is not without limitations, most notably the difficulty of comparing studies that varied in length, timing, and dose. However, the researchers add that it nevertheless “demonstrates the lack of robust evidence linking paracetamol use during pregnancy and autism and ADHD in offspring.”
The research was published in the journal The BMJ.
Source: University of Liverpool
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