Acetaminophen During Pregnancy Linked to Childhood ADHD

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August 31, 2016 | 60,715 views

Story at-a-glance

  • A recent study of women who used acetaminophen while pregnant reproduced results from other studies. Still, the drug continues to be promoted as safe
  • Children born to mothers who used acetaminophen, a common over-the-counter analgesic for pain and fever, had a higher risk of ADHD and autism
  • Unless absolutely necessary, it is best to limit any medication during pregnancy, using other natural means of reducing pain and inflammation instead

By Dr. Mercola

Acetaminophen, also known as paracetamol (International Nonproprietary Name),1 may be one of the more dangerous drugs you can purchase. This may surprise you since most households carry one or two variations of the product to treat headaches, fever or cold symptoms.

Acetaminophen is classified as an analgesic, or a medication acting to relieve pain. According to the American Association of Poison Control Centers, analgesics are the No. 1 reason people call a poison control center.2 

The U.S. Food and Drug Administration (FDA) links 980 deaths per year to acetaminophen and the Centers for Disease Control and Prevention (CDC) determined that, beginning in 2006, the number of people who died after accidentally taking too much acetaminophen exceeded the number who purposely overdosed on acetaminophen.3

However, these numbers may be deceiving, as other researchers have found 56,000 emergency room visits and 26,000 hospitalizations can be attributed to acetaminophen.4

Although frighteningly high for a drug most people routinely keep in their homes, this isn't the only damage acetaminophen may cause.

A recent study published in the Journal of the American Medical Association (JAMA) Pediatrics has linked taking acetaminophen during pregnancy with conduct disorders and hyperactivity in children.5

Acetaminophen During Pregnancy Linked to Hyperactivity and Conduct Disorders

The objective of this British study was to examine the association between behavioral problems in children and mothers who took acetaminophen during pregnancy and/or during the postpartum months, or partners who took acetaminophen.6

The researchers concluded: "Children exposed to acetaminophen prenatally are at increased risk of multiple behavioral difficulties."7 The researchers did find that these results were not explained by social factors or other behavioral challenges linked to increased use of acetaminophen.

As compared to individuals who did not use acetaminophen during their pregnancy, those who took the drug during weeks 18 and 32 had a 31 percent increased risk of hyperactivity and a 42 percent higher relative risk of conduct disorders in their children.8

This study controlled for a number of different variables that could have affected the results, such as genetics, smoking and alcohol use.9 There were over 7,700 participants.

Not everyone was convinced by the results of the study. Even lead author, epidemiologist Evie Stergiakouli, PH.D., of the University of Bristol, stepped around the issue, saying:10

"Observational associations do not necessarily mean that there is a causal association between the risk factor and the health outcome."

However, the researchers also noted (quoted from Medical News Today):11

"Children exposed to acetaminophen use prenatally are at increased risk of multiple behavioral difficulties … Given the widespread use of acetaminophen among pregnant women, this can have important implications on public health advice."

Other Studies Confirm Results and Identify More Risk

While recent, this is not the only study associating acetaminophen with dangerous side effects to your health and the health of your children.

A recent study from the Center for Research in Environmental Epidemiology (CERAL), Barcelona, Spain, found a link between acetaminophen use during pregnancy and hyperactivity and autism.12

Researchers discovered more symptoms of autism in boys whose mothers took acetaminophen during pregnancy, than in girls.

They found that all children exposed to acetaminophen during pregnancy were 30 percent more likely by age 5 to demonstrate attention impairments linked with hyperactivity disorder or autism.13

A study found an association between the drug and children later diagnosed with attention deficit hyperactivity disorder (ADHD).14

Children whose mothers used acetaminophen during pregnancy were at higher risk for hyperkinetic disorder, use of ADHD medications or having ADHD-like behavior by age 7. There was a stronger association when mothers took the drug in more than one trimester.

A study published in 2009 found mothers who used acetaminophen in the third trimester were at higher risk for preterm birth.15 

A study published in 2013 found children exposed to acetaminophen during pregnancy developed motor skills, communication and language skills more slowly than those children who were not exposed.16

Use of acetaminophen during pregnancy also appears to be linked to pre-eclampsia and thromboembolic diseases,17 and taking the drug for more than four weeks during pregnancy, especially during the first and second trimester, moderately increases the risk of undescended testicles in boys.18

Acetaminophen Use and Toxicity

In this short video, CBS News explains the statistics and risks associated with acetaminophen use. The drug works by blocking feelings of pain and reduces fever without addressing the source of the issue. As your body metabolizes the drug, it may damage your liver. In 2009 the FDA issued this warning:19

"Liver warning: This product contains acetaminophen. Severe liver damage may occur if you take more than 4,000 mg of acetaminophen in 24 hours; with other drugs containing acetaminophen [or three] or more alcoholic drinks every day while using this product."

In 2014, the FDA updated their warning to include:20

"FDA is recommending health care professionals discontinue prescribing and dispensing prescription combination drug products that contain more than 325 milligrams (mg) of acetaminophen per tablet, capsule or other dosage unit."

Unfortunately, there are times you may be taking more acetaminophen than you realize as the drug is a common addition to other pain and over-the-counter cold remedies.

Vicodin and Percocet are two common prescription pain medications that include acetaminophen, increasing your risk of acetaminophen poisoning, one of the more common forms of toxicity, according to the National Institutes of Health (NIH).21

Other common brand name over-the-counter medications that include acetaminophen in their active ingredients include:22

Actifed

Alka Seltzer Plus

Anacin

Cepacol

Contac

Coricidin

Dayquil

Dimetapp

Dristan

Excedrin

Feverall

Formula 44

Liquiprin

Midol

Mucinex

Nyquil

Panadol

Robitussin

Saint Joseph Aspirin-Free

Singlet

Sinutab

Sudafed

Theraflu

Triaminic

Vanquish

Vicks

As the drug is a common ingredient in other over-the-counter medications, and has a narrow therapeutic index, it is easy to accidentally overdose or take enough to cause significant liver damage.23 Doses over 5,000 mg per day if you don't consume alcohol, and 4,000 mg if you do consume alcohol, can trigger significant liver damage. There's 4,000 mg of acetaminophen in just eight extra strength tablets.

While other countries have placed a limit on how much consumers may purchase and have restricted sales to pharmacies, no such limits are placed in the U.S.24 From 2001 to 2010, the related deaths attributed to acetaminophen were twice that of all other over-the-counter pain relievers combined.

Number of Children With ADHD Rising

In both private insurance and Medicaid populations, the number of children being treated with drugs for ADHD continues to rise. According to the CDC, approximately 3 out of 4 children between age 2 and 5 receive medication for ADHD, but only half of those receive any form of psychological services.25

In 2011, approximately 11 percent of children between the ages of 4 and 17 were diagnosed with ADHD. This is a significant rise from 7.8 percent in 2003.26 The rate of diagnosis of ADHD also varies by state in the U.S., with the highest being Kentucky at 18.7 percent and the lowest being Nevada at 5.6 percent.

According to the National Survey of Children's Health, the average age of diagnosis is 6.2 years; 3.5 million children are taking medication for treatment, and boys continue to be twice as likely as girls to be diagnosed with ADHD.27

Medications used to treat this hyperactivity disorder are stimulants, which come with their own list of side effects and dangers. Common side effects include headaches, upset stomach and increased blood pressure. Less commonly, children may experience loss of appetite, weight loss, insomnia and tics.28

Natural Alternatives for Pain, Fever and Anti-Inflammatory Treatment

Although the American College of Obstetrics and Gynecology (ACOG) continues to recommend acetaminophen for treatment of minor discomfort, fever and pain during pregnancy,29 the choice is ultimately yours. It will be you, your child and your family who experience the repercussions from using medication that may affect your child's neurological development.

There are other choices for treatment. Dr. Aisling Murphy, assistant clinical professor at University of California Los Angeles Obstetrics and Gynecology, admitted to CNN:30

"Minor aches and pains (e.g., headaches or mild backache), are common in pregnancy and often are a reason for patients to take acetaminophen. The practice is very common."

However, she also counsels her patients to use other methods first, and avoid any unnecessary medication during pregnancy, including acetaminophen. These alternative modalities may include:

[+]Sources and References [-]Sources and References

  • 1, 23 Acetaminophen - New World Encyclopedia. (2016). Newworldencyclopedia.org. Retrieved 19 August 2016
  • 2 Pressroom. (2016). Aapcc.org. Retrieved 19 August 2016
  • 3 T. Christian Miller, J. (2013). Behind the Numbers. ProPublica. Retrieved 19 August 2016
  • 4 Nourjah P, e. (2006). Estimates of acetaminophen (Paracetomal)-associated overdoses in the United States.
  • 5, 6, 7 Use During Pregnancy With Behavioral Problems in Childhood: Evidence Against Confounding.
  • 8 Bakalar, N. (2016). Tylenol in Pregnancy Tied to Behavior Problems in Children.
  • 9 Does prenatal exposure to acetaminophen later affect the child?. (2016). STAT. Retrieved 19 August 2016
  • 10 U.S. News August 15, 2016
  • 11 Is acetaminophen in pregnancy linked to behavioral problems in offspring?. (2016). Medical News Today.
  • 12, 13 Acetaminophen use in pregnancy linked to autism, ADHD in offspring. (2016). Medical News Today.
  • 14 Behavioral Problems, and Hyperkinetic Disorders. JAMA Pediatrics, 168(4), 313-320. Retrieved
  • 15 Use of acetaminophen during pregnancy and risk of adverse pregnancy outcomes. (2009). Oxford University Press.
  • 16 Prenatal paracetamol exposure and child neurodevelopment: a sibling-controlled cohort study.
  • 17 Use of acetaminophen during pregnancy and risk of preeclampsia, hypertensive and vascular disorders: a birth cohort study.
  • 18 Maternal use of acetaminophen, ibuprofen, and acetylsalicylic acid during pregnancy and risk of cryptorchidism.
  • 19 Notice to Industry: Final Guidance for Over-the-Counter Products that Contain Acetaminophen. (2016).
  • 20 Recommendation to Discontinue Prescribing and Dispensing. (2014). Fda.gov. Retrieved 19 August 2016
  • 21 Another Nail in the Acetaminophen (Tylenol) Coffin: New Study Links its Use to Attention Deficit Disorder with HyperactivityDr. Michael Murray.
  • 22 Common Medicines With Acetaminophen. (2016). KnowYourDose.org. Retrieved 20 August 2016
  • 24 Tylenol is Killing Americans. (2013). Health Impact News. Retrieved 20 August 2016
  • 25, 26 Data and Statistics | ADHD | NCBDDD | CDC. (2016). Cdc.gov. Retrieved 20 August 2016
  • 27 General Prevalence of ADHD | CHADD. (2016). Chadd.org. Retrieved 20 August 2016
  • 28 Stimulant Drugs to Treat ADHD. (2016). WebMD. Retrieved 20 August 2016
  • 29 News, A. (2016). Acetaminophen Use While Pregnant Linked to Childhood Behavioral Problems. ABC News.
  • 30 Susan Scutti, C. (2016). Acetaminophen during pregnancy linked to ADHD. CNN. Retrieved 20 August 2016
  • 31 Is it safe to use a heating pad for sore muscles during pregnancy? | BabyCenter. (2016). BabyCenter. Retrieved 20 August 2016
  • 32 10 Amazing Benefits Of Ginger Tea During Pregnancy. (2016). Momjunction.com. Retrieved 20 August 2016
  • 33 Safety | National Association for Holistic Aromatherapy. (2016). Naha.org. Retrieved 20 August 2016
  • 34 Pregnancy and Essential Oils: a Guest Post by Dr. Lindsey Elmore. (2016). Young Living Blog. Retrieved 20 August 2016