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New research has urged caution for pregnant women using paracetamol, but Australian experts warn not to panic just yet.
Caitlin Chang

16 Aug 2016 - 12:45 PM  UPDATED 16 Aug 2016 - 1:02 PM

Nothing can ever really prepare you for pregnancy. There are the changes to your body, the food aversions, the cravings, the all-day nausea, the aches and pains. Then there’s all the advice around the foods you can or can’t eat, not to mention the seemingly innocuous everyday products you can’t use. Hell, even the label of my chemist-bought shampoo reads ‘not recommended during pregnancy’. There are so many health warnings, it’s enough to make you want to shut yourself away in a room for 40 weeks until the danger period is over.

The latest health research causing worry in pregnant women is a study published in the journal JAMA Pediatrics today, which has linked paracetamol use during pregnancy and behavioural problems in children.

The study examined 8,000 pregnant women and their children, and found that using paracetamol at 18 to 32 weeks of pregnancy was associated with an increased risk of hyperactivity. Researchers found that five per cent of the children born to participants had behavioural problems by the age of seven. Of these mothers, 53 per cent used paracetamol at 18 weeks of pregnancy, and 42 per cent used it at 32 weeks.

The most such a study can establish is an association.

With paracetamol being one of the few painkillers considered safe during pregnancy, the research will unsurprisingly cause concern among pregnant women. However, according to Professor Norman Saunders, a professor of pharmacology and therapeutics at the University of Melbourne, there are limitations to the author’s claims. “The most such a study can establish is an association,” he tells SBS. “It certainly cannot demonstrate an increased risk of behavioural difficulties in the children, as claimed by the authors.”

While the study authors do recognise some limitations in their research, such as a lack of information on dosage or duration, there are other factors they fail to consider. “They have not distinguished between different reasons why the patients were taking paracetamol,” Prof. Saunders explains. What’s more, “The authors did not analyse separately possible associations with the different reasons why the paracetamol had been taken; for example, this might have revealed an association with infections such as flu or cold, which would have been an alternative explanation for the problems identified in the children,” he says.

Relying on pregnant women to recall details of their paracetamol use three months later is also problematic, as anyone who has suffered so-called ‘baby brain’ can attest. According to Prof. Saunders, “the authors relied on patient recall in the three-month period prior to the time in pregnancy when the patients were questioned. This is likely to be unreliable.”

Further studies are still needed before we jump to changing clinical practice recommendations.

It’s a stretch to call for greater restrictions on pregnant women using paracetamol, simply on the basis of this study. “But in general because so little is known, apart from anecdotal reports, about adverse effects on the foetus of drugs administered in pregnancy I suggest the advice is, where reasonable, to avoid taking drugs,” says Prof Saunders.

Bottom line: this research is not strong enough to prevent pregnant women from using paracetamol if they need it to treat pain or fever. In an editorial corresponding with the study, Dr Luke Grzeskowiak, a research fellow at the Robinson Research Institute at the University of Adelaide writes, “further studies are still needed before we jump to changing clinical practice recommendations. Paracetamol is useful in treating fever and different types of pain and it still remains our first choice for treating these conditions during pregnancy.”

However, pregnant women should always talk to their doctor or pharmacist for advice on when to take paracetamol and for how long. Dr Grzeskowiak advises, “The key message from this study is only to take paracetamol when absolutely necessary and to take it for the shortest possible duration, not to avoid it completely.”

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