Prenatal and postnatal exposure to acetaminophen in relation to autism spectrum and attention-deficit and hyperactivity symptoms in childhood: Meta-analysis in six European population-based cohorts

Research output: Contribution to journalJournal articleResearchpeer-review

  • Silvia Alemany
  • Claudia Avella-Garcia
  • Zeyan Liew
  • Raquel Garcia-Esteban
  • Kosuke Inoue
  • Tim Cadman
  • Monica Lopez-Vicente
  • Llucia Gonzalez
  • Isolina Riano Galan
  • Ainara Andiarena
  • Maribel Casas
  • Katerina Margetaki
  • Deborah A. Lawlor
  • Hanan El Marroun
  • Henning Tiemeier
  • Carmen Iniguez
  • Adonina Tardon
  • Loreto Santa-Marina
  • Jordi Julvez
  • Daniela Porta
  • Leda Chatzi
  • Jordi Sunyer

The potential etiological role of early acetaminophen exposure on Autism Spectrum Conditions (ASC) and Attention-Deficit/Hyperactivity Disorder (ADHD) is inconclusive. We aimed to study this association in a collaborative study of six European population-based birth/child cohorts. A total of 73,881 mother-child pairs were included in the study. Prenatal and postnatal (up to 18 months) acetaminophen exposure was assessed through maternal questionnaires or interviews. ASC and ADHD symptoms were assessed at 4-12 years of age using validated instruments. Children were classified as having borderline/clinical symptoms using recommended cutoffs for each instrument. Hospital diagnoses were also available in one cohort. Analyses were adjusted for child and maternal characteristics along with indications for acetaminophen use. Adjusted cohort-specific effect estimates were combined using random-effects meta-analysis. The proportion of children having borderline/clinical symptoms ranged between 0.9 and 12.9% for ASC and between 1.2 and 12.2% for ADHD. Results indicated that children prenatally exposed to acetaminophen were 19% and 21% more likely to subsequently have borderline or clinical ASC (OR = 1.19, 95% CI 1.07-1.33) and ADHD symptoms (OR = 1.21, 95% CI 1.07-1.36) compared to non-exposed children. Boys and girls showed higher odds for ASC and ADHD symptoms after prenatal exposure, though these associations were slightly stronger among boys. Postnatal exposure to acetaminophen was not associated with ASC or ADHD symptoms. These results replicate previous work and support providing clear information to pregnant women and their partners about potential long-term risks of acetaminophen use.

Original languageEnglish
JournalEuropean Journal of Epidemiology
Pages (from-to)993–1004
Number of pages12
Publication statusPublished - 2021

    Research areas

  • Acetaminophen, Paracetamol, Pregnancy, Autism, Attention-deficit, hyperactivity disorder, WELL-BEING ASSESSMENT, BEHAVIORAL-PROBLEMS, PARACETAMOL, DISORDERS, PREGNANCY, CHILDREN

Number of downloads are based on statistics from Google Scholar and

No data available

ID: 271753636