Rebordosa Cristina, Kogevinas Manolis, Bech Bodil H, Sørensen Henrik T, Olsen Jørn
Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.
Int J Epidemiol. 2009 Jun;38(3):706-14. doi: 10.1093/ije/dyp151. Epub 2009 Mar 30.
Acetaminophen use during pregnancy has been associated with a reduced risk of stillbirth and preterm birth, but findings are based on few studies with small numbers of exposed women.
To examine whether prenatal exposure to acetaminophen reduces the risk of adverse pregnancy outcomes, we used data from the Danish National Birth Cohort. We also examined the combined potential effects of acetaminophen, coffee and tobacco use on pre-eclampsia and preterm birth. The study population consisted of women who provided information on acetaminophen use during pregnancy and gave birth to singletons (n = 98 140). The cohort was linked to the Danish National Hospital Registry and the Medical Birth Registry, which covers all Danish hospitals, miscarriages and births in Denmark.
Women using acetaminophen during the third trimester of pregnancy had an increased risk of preterm birth [adjusted hazard ratio (HR) = 1.14, 95% CI: 1.03-1.26]. The risk of preterm birth was increased in mothers with pre-eclampsia (HR = 1.55, 95% CI: 1.16-2.07) but not in women without pre-eclampsia (HR = 1.08, 95% CI: 0.97-1.20). Tobacco smoking and coffee consumption did not modify the effect of acetaminophen in any consistent pattern. No association was found between acetaminophen use and risk of preterm complications, miscarriages, stillbirths, low birth weight or small size for gestational age.
Findings do not provide strong support for a change in clinical practice regarding use of acetaminophen during pregnancy, but the increased risk of preterm birth among women with pre-eclampsia should be further investigated.
孕期使用对乙酰氨基酚与死产和早产风险降低有关，但研究结果基于少数针对少量暴露女性的研究。
为了研究孕期暴露于对乙酰氨基酚是否会降低不良妊娠结局的风险，我们使用了丹麦国家出生队列的数据。我们还研究了对乙酰氨基酚、咖啡和烟草使用对先兆子痫和早产的综合潜在影响。研究人群包括在孕期提供了对乙酰氨基酚使用信息并生育单胎的女性（n = 98140）。该队列与丹麦国家医院登记处和医疗出生登记处相关联，后者涵盖丹麦所有医院、流产和分娩情况。
在妊娠晚期使用对乙酰氨基酚的女性早产风险增加[调整后风险比（HR）= 1.14，95%置信区间：1.03 - 1.26]。先兆子痫母亲的早产风险增加（HR = 1.55，95%置信区间：1.16 - 2.07），但无先兆子痫的女性中未增加（HR = 1.08，95%置信区间：0.97 - 1.20）。吸烟和喝咖啡并未以任何一致模式改变对乙酰氨基酚的作用。未发现对乙酰氨基酚使用与早产并发症、流产、死产、低出生体重或小于胎龄儿风险之间存在关联。
研究结果并不强烈支持在孕期使用对乙酰氨基酚的临床实践发生改变，但先兆子痫女性中早产风险增加这一情况应进一步研究。
