Caution needed in paracetamol use in pregnancy —Experts

PARACETAMOL is regarded by many as a safe and effective painkiller to take during pregnancy. Now, researchers in a new study warn that paracetamol also known as acetaminophen is not considered safe in pregnancy because of the risk it could pose to the unborn baby.

The researchers, in a study in the journal Nature Reviews Endocrinology, said mounting studies show that taking paracetamol when pregnant has potential risks to alter the development of the unborn baby, causing birth defects.

They said that paracetamol is an endocrine disruptor and it is known to “readily cross the placenta and blood-brain barrier,” making its way to the unborn baby, thereby posing a potential danger.

More recently, there have been several studies, starting in the 1990s, designed to monitor mothers during pregnancy and then follow up their children. They noted which drugs were taken in pregnancy, whether prescribed or bought over the counter and followed up with the children.

In a review of the 29 most recent literature, the researchers said that paracetamol use during pregnancy may increase the risk of reproductive abnormalities, including a higher risk of undescended testicles in boys, a condition linked to infertility and cancer in later life. In girls, it is associated with early puberty.

In both sexes, studies suggest taking the medicine might increase the risk of attention deficit hyperactivity disorder (ADHD), autism spectrum disorder, language delay and decreased intelligence quotient (IQ).

It’s uncertain at what dosage paracetamol is harmful, but the strongest negative effects were observed with long-term use of paracetamol (more than 2 weeks). But taking it once or twice during pregnancy at the minimum dose is much less likely to cause drastic repercussions.

A consensus statement signed by 91 scientists from across the U.S., the U.K., Canada, Australia, Brazil, Scotland and Europe, published in the same journal, recommended that “pregnant women should forgo paracetamol use unless medically indicated.”

It also calls on regulatory agencies, obstetrics and gynaecological associations and healthcare providers to review the most recent research and reconsider their recommendations.

More research is needed to assess the timing, duration and dosage of acetaminophen usage, but numerous animal studies also back up these findings.

“Some of these risks have not been replicated in humans; some of these findings are antidotal or spontaneous. The recommendation is that just like any other drugs in pregnancy, you should not use it except when it is indicated” Dr Olayinka Ogunbode, a consultant obstetric and gynaecologist, University College Hospital (UCH), Ibadan, stated.

He added, “even if you are going to use paracetamol, it is advisable that the pregnant woman use it for a short time, pending when the evidence on the causative link between paracetamol and these conditions are authenticated.

“But I don’t think that there is strong evidence suggesting a link between paracetamol and attention-deficit/hyperactivity disorder (ADHD) in children. In medicine, if you notice any observation, then we will escalate the reaction to the highest level to actually be able to say that it is the cause.”

Dr Ogunbode said that paracetamol is present in over 600 formulations, including cough syrups, flu medicines, allergy medicines and sleep aids. “The observations made by these studies may be due to other active agents in the drugs,” he said.

He declared that although the advertisement indicates that paracetamol can be used for two days and if the pain persists to see the doctor, this is only in the case of a febrile illness and not when a pregnant woman’s discomfort is unbearable.

According to Dr Ogunbode, “If a pregnant woman has discomfort that is manageable, she should go immediately to see the doctor. But, if the discomfort is severe, she can take paracetamol and then go and see the doctor afterwards. It is just for a short time to provide relief before seeing the doctor.”

When thinking about using paracetamol or any other medication during pregnancy, it’s all about the risk-benefit analysis. But being more informed about the risks can make a significant difference when weighing the scales.

But other pain management options are limited—or nonexistent. In a study, researchers said that Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen come with an increased potential risk of miscarriage in the first half of pregnancy, as well as birth defects. Aspirin carries a risk of bleeding risks, and opioids come with serious risks of birth defects in the brain, spine or spinal cord.

Meanwhile, there are a few alternative remedies safe for pregnancy that can be used for mild pain. In some cases, a headache is the body’s way of signalling dehydration. Try increasing water intake. Neck and shoulder massage can help to release tension and reduce the resulting headaches. Also, deep-breathing techniques may help reduce stress-based headaches.

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