Avoid paracetamol during pregnancy, women told, amid ‘risks’ to child health

Women should avoid taking paracetamol during pregnancy whenever possible, because it increases the risk of the child developing health problems in later life, according to experts.

The common form of pain relief is taken by more than half of pregnant women worldwide to relieve mild pain and also reduce fever. However, some studies have claimed previously that it can cause infertility, undescended testicles, ADHD and a lower IQ in the foetus.

An international team reviewed studies in labs and on animals dating back 26 years which assessed the pros and cons of APAP – the active compound in paracetamol.

In an article published Thursday in Nature Reviews Endocrinology, the authors write: “We summarise the epidemiological research and animal studies that have examined neurological, urogenital and reproductive outcomes that have been associated with maternal and perinatal use of APAP.

“Based on this research, we believe we know enough to be concerned about the potential developmental risks associated with prenatal APAP exposure and therefore call for precautionary action.”

They add that the “potential for harm” from not restricting the use of paracetamol during pregnancy now “exceeds the harm that might arise” from restricting its use.

The academics are calling for more research into the impact of the drug, by both scientists, governments and regulatory bodies.

Lowest dose possible

In their article, they say that pregnant women should forego paracetamol use unless medically told to take it, and they should also minimise their risk by using the lowest effective dose for the shortest possible time.

This aligns closely with the NHS guidance on the topic, which states: “Paracetamol is the first choice of painkiller if you're pregnant or breastfeeding.

“It's been taken by many pregnant and breastfeeding women with no harmful effects on the mother or baby.”

However, it advises that people taking paracetamol while pregnant or breastfeeding should “take the lowest dose of paracetamol that works for you for the shortest possible time”.

Paracetamol was marketed in the UK for the first time in 1956 and was first marketed under the brand name Panadol. It was only available on prescription until 1959.

It was initially thought to be harmless and without side-effects, but some recent studies have indicated otherwise and linked it to long-term problems for the unborn child.

Endocrine disrupting chemicals

However, experts are divided on the credibility of such findings, and if the drawbacks and potential hazards outweigh the benefits of paracetamol.

Professor Shanna Swan, of Icahn School of Medicine at Mount Sinai, New York, an author of the study, said: “We know now that APAP is an endocrine disrupting chemical and it was not considered that for a long time, in fact, it has not been tested very thoroughly.

“But now we know that it lowers testosterone and has actions similar to other endocrine disrupting chemicals and should be regulated as such.

Fertility

“There is now a significant body of evidence that suggests that APAP disrupts the reproductive development of animals and humans.

“While data are not completely consistent, there is enough evidence to find an increased risk of undescended testicles, and also a shortening of the anal-genital distance, which is a measure predictive of later decreased sperm count and decreased fertility.

“In females, we also see impaired ovarian function which has consequences for later fertility, although females have been less studied.

“The concerns about these urogenital and reproductive developments have not been investigated by regulatory agencies.”

Co-author Ann Bauer from the University of Massachusetts Lowell added: “The weight of the evidence suggests APAP in pregnancy may increase the risk of neurodevelopmental disorders in the foetus.

“The identified disorders were primarily ADHD, but also include autism spectrum disorder, language delays, decreased IQ and conduct disorders.”

“This is particularly concerning because a large amount of women take APAP. Exposure is so widespread that even a small increase in risk could translate into a large number of affected children.”

The figures below are from 2019:

Unnecessary anxiety

However, while the academics are calling for more research, and that women should be told of potential risks and avoid taking too many paracetamol, other experts disagree.

Prof Stephen Evans, professor of Pharmacoepidemiology, London School of Hygiene & Tropical Medicine, said: “This paper and the consensus statement could be used to raise anxiety, almost undoubtedly unnecessarily.

“It is clear that paracetamol usage is extremely common and, as with all medicines able to be bought without a prescription, studying their effects is hard to do and hence can be subject to a number of biases.

“It might be reasonable to suggest that regulatory authorities re-examine the issues, but it is not a message for current or prospective pregnant mothers.

No 'epidemic of malformations'

“There is no obvious drug that could be suggested as an alternative to paracetamol, so this is not very helpful. There is no epidemic of malformations that might be caused by paracetamol.”

Dr Sarah Stock, reader and consultant in maternal and fetal medicine, at the University of Edinburgh Usher Institute, commended the researchers for pulling together the best studies on the topic.

“But unfortunately, much of that evidence is not robust enough to draw any conclusions that paracetamol use in pregnancy, especially occasional use, causes developmental problems in humans,” she said.

“Paracetamol is effective at reducing pain and fever, and so continues to be an important medicine that pregnant people should use if needed.”