Foetal exposure to acetaminophen tied to increased risk for ADHD, autism

Foetal acetaminophen exposure may increase a child’s risk for attention‐deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), according to a new study.

Researchers analysed data from 996 mother-infant dyads, which were a subset of the Boston Birth Cohort, from October 1998 and June 2018 and measured three cord acetaminophen metabolites — unchanged acetaminophen, acetaminophen glucuronide, and 3-[N-acetyl-L-cystein-S-yl]-acetaminophen — in archived cord plasma samples collected at birth.

Included in the final sample were 257 children (25.8 percent) with ADHD only, 66 (6.6 percent) with ASD only, 42 (4.2 percent) with both ADHD and ASD, 304 (30.5 percent) with other developmental disabilities, and 327 (32.8 percent) who were neurotypical. Unchanged acetaminophen levels were detected in all cord plasma samples. [JAMA Psychiatry 2019;doi:10.1001/jamapsychiatry.2019.3259]

Being in the second and third tertiles of cord acetaminophen burden was associated with higher odds of ADHD diagnosis (odds ratio [OR] for second tertile, 2.26, 95 percent confidence interval [CI], 1.4–3.69; OR for third tertile, 2.86, 95 percent CI, 1.77–4.67), and ASD diagnosis (OR for second tertile, 2.14, 95 percent CI, 0.93–5.13 and OR for third tertile, 3.62, 95 percent CI, 1.62–8.6).

There were consistent associations between acetaminophen burden and ADHD and acetaminophen burden and ASD which persisted across strata of potential confounders, such as child age and sex, preterm birth, substance use, and maternal indication.

“We identified a significant positive association between cord plasma acetaminophen metabolites and the risk for ADHD diagnosis and the risk for ASD in childhood,” said Yuelong Ji, a post-doctoral fellow at Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, US. “The significant positive associations between cord acetaminophen and ADHD and the cord acetaminophen and ASD were observed across strata of pertinent covariates, including maternal fever during pregnancy, which is an indicator for acetaminophen use”.