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Paper Chase #5 - In Utero Acetaminophen and Development Disorder Risk

Roy Benaroch, MD and Geoffrey R. Simon, MD
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The authors argue cord biomarkers of acetaminophen exposure was associated with an increased risk of both ADHD and autism spectrum disorders. There are however methodological concerns and the Benaroch would not draw any conclusions from this study. 

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Arsany B. -

Hello all,

This has been a very interesting segments and I appreciate your comments and thoughts. I also just came across a study from 2017 published in Pediatrics and then used AAP Grand Rounds February 2018 with more details. I would love to hear your feedback given the summation of the 2 studies.

Study: https://pediatrics.aappublications.org/content/140/5/e20163840?ijkey=5a468a97567e7c5981d860f9b26a1b66e148db88&keytype2=tf_ipsecsha

AAP Grand Rounds: https://aapgrandrounds.aappublications.org/content/39/2/17

Thank you.
Arsany Basily from Seattle, WA.

Solomon B., MD -

Hi Arsany- thx for writing in! Here is what our paper chaser Roy had to say about this: Roy says:
this is an observational study, so it can pick up potential associations, but cannot be used to infer causality. They've tried to adjust for confounders, but as always with these studies if you miss one more more confounders, you can reach the wrong conclusions. The authors of this study claim in their conclusion that though the short-term use of acetaminophen was negatively associated with later ADHD (meaning it was associated with a DECREASED risk), long term use was associated with an increased risk. There are some odd things, though. The risk from acetaminophen used for 3 or 4 weeks was substantially more than the risk from longer term use, which is biologically implausible. Also, the risk found based on paternal use was actually in the same ballpark as maternal use, which also makes no sense if the medication itself were modulating the effect via placental transfer.

So, bottom line, I'm not sure what to make of this. I would say at this point there isn't convincing evidence of harm from APAP during pregnancy and the risk of ADHD.

Hope this helps (and thank you to Roy!)

Arsany B. -

Thank you so much. I appreciate the feedback.

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Peds RAP April 2020 Written Summary 211 KB - PDF

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