According to researchers from the Penn State College of Medicine, the use of APAP during pregnancy is correlated with sleep and behavior issues consistent with attention-deficit/hyperactivity disorder (ADHD).

In the study published in PLOS ONE, researchers sought to examine the correlations between prenatal APAP exposure and offspring neurobehavioral issues at age 3 years, with a focus on the potentially confounding effects of prenatal stress.

The researchers used data from the First Baby Study, a prospective cohort study conducted in Pennsylvania involving 2,423 mother-child pairs. Women reported medication usage and completed a prenatal stress inventory during their third trimester. Child behavioral problems were measured at age 3 years, using the seven syndrome scale scores from the Child Behavior Checklist (CBCL) for ages 1.5 to 5 years.

The researchers found that among participants, 1,011 women (41.7%) reported using APAP during pregnancy. There was a significant association between exposure to APAP during pregnancy and higher scores on three of the seven CBCL syndrome scales, including withdrawn, sleep problems, and attention problems. There was a significant correlation observed between all seven of the CBCL syndrome scales and prenatal stress. Only sleep problems (adjusted odds ratio, 1.23) and attention problems (adjusted odds ratio, 1.21) remained considerably greater in children exposed to APAP when adjusting for prenatal stress and other confounders.

The results confirm the findings of previous studies that suggest that prenatal APAP use could lead to attention issues, while also demonstrating that sleep may also be affected. Among women who used APAP during pregnancy, 22.7% described their child as having sleep problems and 32.9% described their children as having attention problems. Of the participants who did not report using APAP while pregnant, 18.9% reported their child had sleep problems while 28.0% reported their child had attention problems.

The authors noted that it is still not clear what processes in prenatal development may be disrupted by prenatal APAP exposure; however, some possibilities include APAP damaging the placenta and thereby disrupting fetal development or APAP damaging hepatic cells in the fetus, then disrupting gut health and affecting neurodevelopment.

Kristin Sznajder, assistant professor of public health sciences and lead author stated, “We should interpret these results with some degree of caution. Although acetaminophen is generally considered safe for use during pregnancy, data from multiple studies suggest that there could be effects on childhood development by its use. It’s important we learn as much as we can about this subject so we can give expecting mothers data-driven recommendations to care for their children and themselves.”

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