Pregnant women should NOT routinely take paracetamol, doctors say

Pregnant women should NOT routinely take paracetamol because the cheap painkiller may harm development of babies in the womb, doctors say

  • Expectant mothers should limit paracetamol use, a group of 91 scientists warns
  • Studies suggest use during pregnancy hampers baby’s development
  • They urged health bodies to inform medics and mothers-to-be of possible risks

Pregnant women should only take paracetamol when told to by a doctor, scientists ruled today.

Experts fear the cheap painkiller could hamper a baby’s development in the womb.

Dozens of studies have linked it to attention deficit hyperactivity disorder (ADHD), autism, language delay in girls and decreased IQ.

Danish researchers reviewing the evidence argued there was an ‘increasing amount of research’ about fears paracetamol may hamper foetal development. 

In a call to action, they insisted mothers-to-be only get the ‘lowest effective dose for the shortest possible time’.

Further studies are needed to thoroughly examine exactly how the drug, known as acetaminophen in the US, may affect babies in the womb. 

But other scientists today dismissed the claims, saying the collection of papers that were reviewed were ‘not robust enough to draw any conclusions’. 

And one claimed raising pregnant mothers’ anxiety about the unborn child is ‘often itself unnecessary and has obvious adverse consequences’. 

The NHS says paracetamol is paracetamol is safe to take in pregnancy, describing it as the ‘first choice’ painkiller for mothers-to-be.

Around half of expectant mothers report taking paracetamol during pregnancy, and the figure is as high as 65 per cent in the US.

Health chiefs say only certain people need to take ‘extra care’, such as patients with liver or kidney problems and those on epilepsy drugs. 

Around half of expectant mothers report taking paracetamol during pregnancy, and the figure is as high as 65 per cent in the US 

Experts said an ‘increasing amount of research’ suggests if paracetamol is taken during pregnancy, it affects fetal development, which could increase the risk of brain, reproductive and urogenital disorders in the child once it is born. These include increased incidences of ADHD and autism, as well as early puberty onset

Studies in animals have found that paracetamol may cause reproductive orders for men, such as abnormalities in testicular function and sperm, and women, such as disruption to ovarian development, causing a reduced egg numbers, leading to reduced fertility

The warning on paracetamol in pregnancy was published today in the journal Nature Reviews Endocrinology.

It was supported by a group of 91 international experts. 

The paper claimed an ‘increasing amount of research’ was linking paracetamol to some neurodevelopmental, reproductive and urogenital disorders.

Dr David Kristensen and experts at the University of Copenhagen reviewed human and animal studies that examined paracetamol use in pregnancy.

The research projects were all published between 1995 and 2020.

Writing in the journal, they claimed studies have linked the widespread use of paracetamol to a ‘disturbing rise’ in the number of children with cognitive, learning or behavioural disabilities.

Research has also found that the painkiller is linked with reproductive and urogenital disorders, such as cryptorchidism (undescended testicles) — hypospadias (when the opening of the urethra is not located at the tip of the penis) and testicular cancer.

What is the NHS advice on taking paracetamol when pregnant? 

Paracetamol has been used by pregnant women for years without causing any obvious harmful effects on the developing baby, the NHS says.

So the drug is usually recommended as ‘the first choice of painkiller for pregnant women’, it said. 

Other painkillers have not been shown to be any safer than paracetamol and some are not suitable for use during certain stages of pregnancy, according to the health service.

It is not possible to say that any medicine is absolutely safe to use in pregnancy, but there is ‘currently no good evidence that paracetamol will harm your baby’, the NHS said.

However, expectant mothers are advised to use the lowest dose of paracetamol that works and only for as long as they need to take it. 

The pain killer is sold on its own as well as in combination with other drugs, such as in cold and flu medicines.

The NHS said it is important that any medicines taken together are combinations that are suitable for pregnancy and expectant mothers do not exceed the daily recommended dose of paracetamol.

Rates of early puberty, decreased sperm counts, and decreased fertility have also been linked with the painkiller, they said.

And being exposed to paracetamol before birth is also associated with girls starting puberty earlier.

Meanwhile, studies in animals have found that the drug may also cause reproductive orders for men, such as abnormalities in testicular function and sperm.

Animal studies have also associated paracetamol in pregnancy with disruption to women’s ovarian development, causing reduced egg numbers, leading to reduced fertility.

Other affects in women that have been recorded in animal studies include altered brain function and behaviour.

And any negative effects from a mother taking paracetamol in pregnancy increased if the drug was taken in higher doses and for longer periods, the scientists said.   

Therefore, expectant mothers should be told in their pregnancy how to limit its use and dosage, according to their report.

They said pregnant women should be told to ‘forego paracetamol unless its use is medically indicated; consult with a physician or pharmacist if they are uncertain whether use is indicated and before using on a long-term basis; and minimise exposure by using the lowest effective dose for the shortest possible time.’ 

Medics also called for the European Medicines Agency (EMA) and US Food and Drug (FDA) Administration to ‘review all available data’ so their advice is up-to-date.

The FDA and EMA said studies have failed to demonstrate any risks of birth defects from paracetamol.  

Dr Sarah Stock, a fetal medicine expert at the University of Edinburgh, said: ‘This paper doesn’t change recommendations on paracetamol use in pregnancy.’

She said the team had ‘done a good job of bringing together existing evidence’.

But Dr Stock added: ‘Unfortunately, much of that evidence is not robust enough to draw any conclusions that paracetamol use in pregnancy, especially occasional use, causes developmental problems in humans.

‘Paracetamol is effective at reducing pain and fever, and so continues to be an important medicine that pregnant people should use if needed.

‘Of course, pregnant or not, no-one should take a medication unnecessarily, for longer than necessary or at a higher dose than needed.’ 

Professor Stephen Evans, an experts in pharmacoepidemiology at the London School of Hygiene and Tropical Medicine, said: ‘Avoidance of unnecessary drugs is to be encouraged at all times, and most pregnant women are aware of this. 

‘At the same time raising anxiety about their unborn child is often itself unnecessary and has obvious adverse consequences.

‘This paper and the consensus statement could be used to raise anxiety, almost undoubtedly unnecessarily.’

Larger studies tend to find ‘no adverse effect’ on a child from their mothers taking paracetamol  and those that do find some links are inconsistent, so ‘their findings may be due to chance or bias, he said.

And there is no ‘obvious drug’ that could be suggested as an alternative to paracetamol, so the report is ‘not very helpful’.

Professor Evans added: ‘It might be reasonable to suggest that regulatory authorities re-examine the issues, but it is not a message for current or prospective pregnant mothers.’

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