August 11, 2022

Experts warn against paracetamol in pregnancy warning


Research suggests that prenatal exposure to paracetamol may increase the risk of neurodevelopmental, reproductive, and urogenital disorders.

Paracetamol is one of the few drugs available that can be used to reduce fever during pregnancy.

The authors of a new Consensus statement Posted in Nature Endocrinology Reviews called for a targeted research effort to study how paracetamol affects fetal development and proposed that precautionary measures be taken in the meantime.

The call follows a review of research related to the use of paracetamol during pregnancy that suggests prenatal exposure to paracetamol may affect fetal development, which may increase the risk of certain neurodevelopmental, reproductive, and urogenital disorders. .

To draw their conclusions, the authors of the article reviewed experimental research on animals and cells, as well as human epidemiological research related to the use of paracetamol during pregnancy published between January 1, 1995 and January 25. October 2020.

However, Dr Alex Polyakov of the Department of Obstetrics and Gynecology at the University of Melbourne believes that “several points” should be raised in relation to the findings and recommendations of the review.

“, [the paper] contains no new research results, but rather a review of the evidence currently available, ”he said.

“It is possible and even probable that paracetamol, if used in excessive amounts and for a long time during pregnancy, could have undesirable consequences for the offspring.

‘[But] It should be noted that treating fever and pain during pregnancy is a challenge, as most other treatment options have proven risks to be significantly higher than paracetamol. The current recommendation for all medicines used during pregnancy is to use them judiciously, for specific indications, at the lowest possible effective dose and for the shortest period of time.

“These general principles certainly apply to paracetamol.”

Dr Ian Musgrave, senior lecturer at the Faculty of Medicine, University of Adelaide, came to a similar conclusion.

“We should periodically reassess the safety of drugs, especially drugs for pregnancy, as the developing child is vulnerable,” he said.

“However, we also need to be careful not to cause undue anxiety, and the use of any medication is a balance between potential benefits and harms.

“For example, fever is a recognized risk factor for harm to the developing child, and paracetamol is one of the few drugs available that can be used to reduce fever during pregnancy.”

Although the recommendations suggested by the authors do not differ significantly from current general advice on medication for pregnancy, they believe that risk communication specific to paracetamol is warranted for both healthcare professionals and pregnant women due to high rates of use and perceptions of negligible risk.

But Dr Polyakov says the studies used to form these conclusions are also subject to interpretation and, in many cases, have flaws.

“There are many reports that support the idea that paracetamol can act as an endocrine disrupting compound and cause various abnormalities in animals, mainly rodents,” he said.

“The main limitation of these studies is that rodents are not human and have different physiology, and therefore the application of these results to humans should be done with caution.

“It should also be noted that animal studies typically use high doses of the study drug, often an order of magnitude higher than that typically used in humans.

“Therefore, although animal studies may demonstrate an undesirable result and help explain its mechanism, they are generally not directly transferable to humans.”

Dr Musgrave also said the observational studies used in the review are difficult to interpret.

“While suggestive, the same effects have been variously attributed to other environmental influences, from perfluoroalkyls to a range of other environmental endocrine disruptions,” he said.

“Unmasking any effect of paracetamol will require further studies, as the authors suggest. Again, as with animal studies, not all studies show the same effects.

“With the current evidence, the judicious use of paracetamol is justified. As always though, [patients] should discuss any concerns with their doctor.

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