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Expert Reaction
These comments have been collated by the Science Media Centre to provide a variety of expert perspectives on this issue. Feel free to use these quotes in your stories. Views expressed are the personal opinions of the experts named. They do not represent the views of the SMC or any other organisation unless specifically stated.
Dr Ian Musgrave is a Senior Lecturer in the Faculty of Medicine, School of Medicine Sciences, within the Discipline of Pharmacology at the University of Adelaide.
Pain during pregnancy is common and can have many causes. Pain itself, and the reasons for pain, can be a potential source of harm for both the mother and the developing child. Paracetamol is one of the few relatively safe drugs for treating pain in pregnancy. We are constantly re-evaluating the safety of our drugs, and paracetamol is no exception.
There have been suggestions from animal experiments, using doses much higher than would be used by humans, that paracetamol given during pregnancy could impact the mental development of the growing child. This study [in humans] by Sznajder et al., suggests that sleep problems and attention problems could be associated with paracetamol use in pregnancy.
The study has a reasonable number of participants (2,423 mother-child pairs) and completed a prenatal stress questionnaire. The children were examined at 3 years of age for behaviour issues and children of mothers who did not take paracetamol compared to those who did.
A big problem in studies like these is the issue of other conditions, the mothers who took paracetamol were taking it for issues like fever, infection and allergies, all of which can potentially affect the mental development of the child (these are termed confounders). For example maternal stress was associated with the child being withdrawn, having sleep problems and attention problems. The authors attempted to control for these confounders, but the association of paracetamol with sleep problems and attention problems after this correction is marginal, and may simply be due to other factors associated with the need to use paracetamol for pain relief.
With this new study, judicious use of paracetamol is still warranted. As always pregnant women should discuss any concerns with their physicians. With any medication, the rule is to give the smallest amount for the shortest period of time to achieve relief.
Dr Gavin Pereira is a Professor of Epidemiology and Biostatistics at Curtin University
It remains unclear whether acetaminophen taken during pregnancy causes attention and sleep problems in offspring. In the US study, these outcomes were assessed by mothers, rather than by a relatively more independent party such as a teacher or clinician. It is possible that mothers with underlying anxiety are more likely to take acetaminophen and report such negative outcomes for their child, whether or not there is an underlying biological effect.
The researchers controlled for prenatal stress, which can, in some situations cause bias rather than control for it. Given these issues, along with the fact that the size of the associations observed by the researchers were small and that the researchers could not establish a dose-response relationship, the findings remain unclear.
What medication should be used for pain relief in pregnancy? The findings of this study certainly do not imply that common alternatives such as non-steroidal anti-inflammatory drugs (NSAIDs) should be used for pain relief in pregnancy instead of acetaminophen. Such alternatives may cause more harm.
