January 15, 2022

Take special care with paracetamol during pregnancy – but don’t let the pain or fever get out of hand

With pregnancy comes pain and increased anxiety about what we are putting into the body.

A new article published in Nature Endocrinology Reviews urged caution about taking paracetamol during pregnancy. The document is a “consensus statement” that brings together analysis from a group of experts that reviewed the evidence from human and animal studies on the use of paracetamol during pregnancy.

According to the authors, the use of paracetamol during pregnancy can alter the development of the fetus, with lasting effects on the health of the child. The authors call for better education of healthcare professionals and patients, less use of paracetamol during pregnancy, and more research.

Alert but not alarmed

At first glance, calls to minimize the use of paracetamol during pregnancy are alarming. For those who have taken paracetamol (commonly marketed in Australia as Panadol, Herron Paracetamol, Panamax, Chemist Own, or Dymadon) during pregnancy, it could cause anxiety.

This new consensus statement calls for caution, but not for concern. The proposed recommendations are largely in line with the current advice offered to pregnant women in Australia.

With any medication during pregnancy, there must be a careful balance between treating a maternal illness and protecting the unborn child. A trusted healthcare provider can help you make an informed decision. Paracetamol is no different.

Paracetamol is the active ingredient in hundreds of prescription and over-the-counter medications.
Shutterstock

What are the concerns?

Worldwide, more than 50% of pregnant women use paracetamol to treat pain and / or fever. Paracetamol is the active ingredient in hundreds of prescription and over-the-counter products. It has been widely considered for many years safe to use during pregnancy.

Some, but not all, observational studies in humans suggest that the use of paracetamol during pregnancy may impair fetal development. The new statement notes that paracetamol has been linked to an increased risk of certain neurodevelopmental, reproductive and urogenital disorders.

But these studies have limits. Researchers struggled to distinguish the effects of paracetamol from the effects of an underlying disease. And there are potential inaccuracies in recording how much and when to use paracetamol throughout pregnancy, as the accompanying document points out. editorial.

The possible risks of using paracetamol during pregnancy are supported by a number of animal studies, according to the authors. For this reason, caution regarding the use of paracetamol has been recommended until a definitive link can be proven or disproved.

It should be noted that the available evidence suggests that all possible harm from paracetamol is likely to be dose related. As the review article points out, most of the increased risks have been linked to use during pregnancy for more than two or four weeks. Current evidence suggests limited risks to unborn babies when paracetamol is taken short-term.

Timing is also important. Taking paracetamol in the first trimester has been associated with an increased risk of reproductive and urogenital disorders. Neurodevelopmental disorders have been linked to use in the second or third trimester.



Read more: Domperidone May Increase Breast Milk Production – Here’s What You Need To Know


When the benefits outweigh the risks

The potential benefits of taking medication should be weighed against the possible risks. Paracetamol is recognized as an important medicine for treating pain and fever during pregnancy.

If left untreated, these conditions could harm the fetus or the pregnant person (Nature editorial and declaration state that the expert opinion is “relevant to all people who wish to become pregnant, including transgender people, non-binary people and intersex people”).

The authors of the review recognize the potential benefits of using paracetamol and note that untreated pain has been linked to increased risks of depression or anxiety as well as high blood pressure during pregnancy. Fever during pregnancy is a risk factor for multiple newborn and child disorders, including some birth defects and miscarriages. There is some evidence to suggest that the use of paracetamol may reduce these risks.



Read more: Cannabis use during pregnancy could be bad news for your baby: new research


What are the alternatives ?

Optimal management of pain or fever during pregnancy has not been well studied and treatment options remain limited.

Nonsteroidal anti-inflammatory drugs (such as ibuprofen) have been associated with miscarriage when used in the first trimester, while use after 30 weeks of gestation may have a negative impact kidney and heart / lung function in the fetus. For this reason, nonsteroidal anti-inflammatory drugs are it is better to avoid unless otherwise advised by a healthcare professional. The same goes for strong pain relievers like opioids, which should be reserved for the management of severe pain. Paracetamol remains the best choice for the short-term treatment of pain and / or fever during pregnancy.

It is also important to identify the cause of the pain or fever, especially during pregnancy. Discussions about the use of paracetamol may lead to further investigation, recommendations for non-drug treatments, or the need for different drugs.

pregnant woman with back pain
Safe options for pain management during pregnancy are limited.
Shutterstock


Read more: Pregnancy Weight Gain: How Much Is Too Much?


The bottom line

The new consensus statement does not modify existing recommendations regarding the use of paracetamol during pregnancy. But it does underscore the importance of thinking carefully before using medications during pregnancy and heightens awareness of the difficulty of making informed decisions about medication use.

Better evidence is needed to support decision making during pregnancy and reduce unnecessary anxiety and worry.

The use of paracetamol during pregnancy should be discussed with a healthcare practitioner and used at the lowest effective dose for the shortest time possible. Non-drug therapies to treat pain or fever should be tried before or in addition to paracetamol. When indicated, short-term use of paracetamol remains the safest drug for the treatment of pain and / or fever during pregnancy.


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