A recent study published in JAMA explored the potential link between acetaminophen (commonly known as paracetamol) use during pregnancy and the risk of neurodevelopmental disorders in children. The study, conducted in Sweden and spanning from 1995 to 2019, aimed to shed light on whether prenatal acetaminophen exposure could be associated with conditions like autism, attention-deficit/hyperactivity disorder (ADHD), and intellectual disability.

The study involved a massive cohort of 2,480,797 children, with data collected from nationwide health registers. Researchers examined the use of acetaminophen during pregnancy, recorded from both antenatal and prescription records. The outcomes of interest were autism, ADHD, and intellectual disability, identified through the International Classification of Diseases codes in health registers.

The findings revealed that out of the total children studied, 185,909 were exposed to acetaminophen during pregnancy. Crude absolute risks at 10 years of age for autism, ADHD, and intellectual disability were slightly higher in children exposed to acetaminophen compared to those not exposed. However, when analysing the data without sibling controls, the study found marginally increased risks of autism, ADHD, and intellectual disability associated with acetaminophen use during pregnancy.

To delve deeper and address potential confounding factors, the researchers conducted analyses using matched full-sibling pairs. This approach found no evidence linking acetaminophen use during pregnancy with an increased risk of autism, ADHD, or intellectual disability. Additionally, there was no observed dose-response pattern in sibling control analyses, suggesting that varying levels of acetaminophen exposure did not influence the risk of neurodevelopmental disorders.

Dr. Viktor H. Ahlqvist, one of the lead authors of the study, emphasised the significance of these findings, stating, "Acetaminophen use during pregnancy was not associated with children's risk of autism, ADHD, or intellectual disability in sibling control analysis." He further noted, "This suggests that associations observed in other models may have been attributable to familial confounding."

The study's co-author, Dr. Christina Dalman, echoed these sentiments, highlighting the importance of considering familial factors in studies examining prenatal exposures. "Our findings underscore the importance of utilising robust methodologies, such as sibling control analyses, to account for familial confounding," she stated.

The implications of this research are substantial, particularly for pregnant individuals and healthcare providers. If acetaminophen use during pregnancy posed a significant risk to neurodevelopmental outcomes in children, it would have warranted reconsideration of its use for pain and fever management during pregnancy. However, the study's findings provide reassurance that such concerns may not be warranted.

Dr. Renee M. Gardner, another co-author of the study, emphasised the need for continued research in this area. "While our study contributes valuable insights, further research is needed to fully understand the potential effects of prenatal acetaminophen exposure on child neurodevelopment," she remarked.

The study's sibling control analyses suggest that acetaminophen use during pregnancy is not associated with an increased risk of autism, ADHD, or intellectual disability in children. These findings offer valuable reassurance to pregnant individuals and healthcare providers, emphasising the importance of robust methodologies in assessing prenatal exposures and their potential effects on child health.