Prada Diddier, Ritz Beate, Bauer Ann Z, Baccarelli Andrea A
Department of Population Health Science and Policy - Department of Environmental Medicine and Climate Science, Icahn School of Medicine at Mount Sinai, Institute for Health Equity Research, New York City, NY, USA.
School of Public Health, Environmental Health Department, University of California, Los Angeles, CA, USA.
Environ Health. 2025 Aug 14;24(1):56. doi: 10.1186/s12940-025-01208-0.
Acetaminophen is the most commonly used over-the-counter pain and fever medication taken during pregnancy, with > 50% of pregnant women using acetaminophen worldwide. Numerous well-designed studies have indicated that pregnant mothers exposed to acetaminophen have children diagnosed with neurodevelopmental disorders (NDDs), including autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD), at higher rates than children of pregnant mothers who were not exposed to acetaminophen.
We applied the Navigation Guide methodology to the scientific literature to comprehensively and objectively examine the association between prenatal acetaminophen exposure and NDDs and related symptomology in offspring. We conducted a systematic PubMed search through February 25, 2025, using predefined inclusion criteria and rated studies based on risk of bias and strength of evidence. Due to substantial heterogeneity, we opted for a qualitative synthesis, consistent with the Navigation Guide's focus on environmental health evidence.
We identified 46 studies for inclusion in our analysis. Of these, 27 studies reported positive associations (significant links to NDDs), 9 showed null associations (no significant link), and 4 indicated negative associations (protective effects). Higher-quality studies were more likely to show positive associations. Overall, the majority of the studies reported positive associations of prenatal acetaminophen use with ADHD, ASD, or NDDs in offspring, with risk-of-bias and strength-of-evidence ratings informing the overall synthesis.
Our analyses using the Navigation Guide thus support evidence consistent with an association between acetaminophen exposure during pregnancy and increased incidence of NDDs. Appropriate and immediate steps should be taken to advise pregnant women to limit acetaminophen consumption to protect their offspring's neurodevelopment.
对乙酰氨基酚是孕期最常用的非处方止痛和退烧药，全球超过50%的孕妇使用过对乙酰氨基酚。众多精心设计的研究表明，接触过对乙酰氨基酚的孕妇所生子女被诊断患有神经发育障碍（NDDs）（包括自闭症谱系障碍（ASD）和注意力缺陷多动障碍（ADHD））的比例高于未接触过对乙酰氨基酚的孕妇所生子女。
我们将导航指南方法应用于科学文献，以全面、客观地研究产前接触对乙酰氨基酚与后代NDDs及相关症状之间的关联。我们使用预定义的纳入标准，在PubMed上进行了系统检索，截至2025年2月25日，并根据偏倚风险和证据强度对研究进行评级。由于存在大量异质性，我们选择了定性综合分析，这与导航指南对环境卫生证据的关注一致。
我们确定了46项研究纳入分析。其中，27项研究报告了正相关（与NDDs有显著关联），9项显示无关联（无显著关联），4项表明负相关（保护作用）。质量较高的研究更有可能显示正相关。总体而言，大多数研究报告了产前使用对乙酰氨基酚与后代ADHD、ASD或NDDs之间的正相关，偏倚风险和证据强度评级为整体综合分析提供了参考。
因此，我们使用导航指南进行的分析支持了与孕期接触对乙酰氨基酚和NDDs发病率增加之间关联相一致的证据。应立即采取适当措施，建议孕妇限制对乙酰氨基酚的摄入量，以保护其后代的神经发育。
