Endocrine Abstracts

JOINT582

Introduction: Acetaminophen (paracetamol) is traditionally considered a safe medication for the management of fever and pain in pregnant women and in children. Although several studies have reported that postnatal exposure to acetaminophen in susceptible children is associated with neurodevelopmental disorders, data on its neurodevelopmental impact after prenatal exposure are controversial. This review presents an update on the association of prenatal and postnatal exposures to acetaminophen and neurodevelopmental disorders.

Methods: A systematic search of literature was conducted using the search terms acetaminophen, endocrine-disrupting chemicals, prenatal exposure, postnatal exposure, and neurodevelopmental disorders.

Results: Acetaminophen, a widely used over-the-counter medication, is a non-opioid antipyretic and analgesic drug. It is used by more than 50% of pregnant women for the treatment of fever and pain. Neurodevelopmental disorders can affect all types of populations and cause high cost to the economy. Although some studies have suggested that prenatal exposure to acetaminophen is associated with high incidence of neurodevelopmental disorders in the offspring (e.g., autism spectrum disorder and attention-deficit/hyperactivity disorder), a sibling control analysis of a large population of children exposed to acetaminophen through pregnancy (n = 185,909) showed that there is no significantly increased risk of autism, attention-deficit/hyperactivity disorder, and intellectual disability in children exposed prenatally. In contrast, most studies of postnatal exposure to acetaminophen have reported that the use of acetaminophen in susceptible infants and children is associated with multiple neurodevelopmental disorders. Acetaminophen intake during pregnancy has also been reported in association with increased male reproductive and urogenital disorders (e.g., cryptorchidism and hypospadias) likely due to the endocrine-disrupting properties of the medication. These findings have important implications for the management of fever and pain in pregnant women and in children. Because of the economic and psychological burden of neurodevelopmental disorders, it is urgent to conduct more high-quality studies with adequate control to assess the association of prenatal use of acetaminophen and neurodevelopmental disorders before proposing clinical guidelines. However, until proven otherwise, pregnant women should have limited use of acetaminophen (e.g., lowest effective dose for the shortest possible time).

Conclusion: It is well established that the postnatal exposure to acetaminophen can increase the risk of neurodevelopmental disorders in children. However, the neurodevelopmental consequences of prenatal exposure to acetaminophen are not clearly established and require further investigations. Until proven otherwise, it is recommended that the intake of acetaminophen during pregnancy be reduced as much as possible.