Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland.
Department of Obstetrics and Gynecology, Kuopio University Hospital, Puijonlaaksontie 2, 70210, Kuopio, Finland.
BMC Pregnancy Childbirth. 2021 Jan 6;21(1):24. doi: 10.1186/s12884-020-03490-x.
The maternal use of paracetamol during pregnancy has been associated with the development of preeclampsia. This study aims to clarify whether the connection is causal or whether it is due to reverse causation.
This study is a continuation of the retrospective case cohort study examining 2,508 pregnant women using a variety of drugs and the development of preeclampsia (1,252 women with preeclampsia and 1,256 controls). For the purposes of this study, more precise data was collected from several hospital databases of the women among this cohort who had reported taking paracetamol during pregnancy (indications, gestational period etc.); this was evaluated in association with the development of preeclampsia.
5.5% (100 cases and 37 controls) of all the study population (2,508) had clearly reported paracetamol use. Women with preeclampsia had used significantly more often paracetamol during pregnancy compared to controls (cases 8.0%, controls 2.9%, p < 0.001). The difference was most evident in the third trimester (after the 29th GW) and the use of paracetamol was associated with both mild and severe preeclampsia. Headache and "general pain" were the most common indications for medication among all paracetamol users.
The use of paracetamol in the third trimester of pregnancy was associated with preeclampsia. This observation indicates that association between paracetamol use and preeclampsia is probably due to reverse causation, i.e. women with preeclampsia experience more headaches due to preeclampsia symptoms since this association was not detected with the use of paracetamol in earlier stages of pregnancy.
母亲在怀孕期间使用扑热息痛与子痫前期的发生有关。本研究旨在阐明这种联系是因果关系还是由于反向因果关系。
本研究是对 2508 名使用各种药物的孕妇进行回顾性病例队列研究的延续，研究子痫前期的发生（1252 名子痫前期患者和 1256 名对照）。为此，从该队列中报告在怀孕期间使用扑热息痛的女性的几个医院数据库中收集了更精确的数据（用药指征、妊娠期等）；并评估其与子痫前期的发生的相关性。
在所有研究人群（2508 人）中，有 5.5%（100 例和 37 例对照）明确报告了扑热息痛的使用。与对照组相比，子痫前期患者在怀孕期间使用扑热息痛的频率明显更高（病例 8.0%，对照组 2.9%，p<0.001）。这种差异在孕晚期（29 周后）最为明显，扑热息痛的使用与轻度和重度子痫前期均有关。头痛和“一般性疼痛”是所有扑热息痛使用者最常见的用药指征。
妊娠晚期使用扑热息痛与子痫前期有关。这一观察结果表明，扑热息痛的使用与子痫前期之间的关联可能是由于反向因果关系，即患有子痫前期的女性由于子痫前期症状而经历更多的头痛，因为这种关联在妊娠早期使用扑热息痛时并未被发现。
