Acetaminophen Use in Pregnancy: A Comparison of Self-Reported Intake with Maternal and Newborn Biomarker Measures
Introduction
Acetaminophen (N-acetyl-p-aminophenol (APAP)), also known as paracetamol, is the most common over-the-counter medication taken during pregnancy to relieve fever, pain, or discomfort.1 In the USA and Europe, it was estimated that 50–65% of women reported using APAP at least once during pregnancy, with about 20% taking APAP in all three trimesters.2 Despite the high prevalence of APAP intake in pregnancy, long-term safety data concerning offspring health are limited. The exact mechanism explaining the therapeutic effects of APAP is not fully understood.3 APAP may act upon the inhibition of cyclooxygenase (COX) enzymes and prostaglandin synthesis, the endocannabinoid system, or the serotonergic pathways in the brain, for exerting its pain-relieving and fever-reducing effects.1 Recently, adverse effects of APAP exposure on fetal development have been raised. Studies have reported that APAP and its metabolites can cross the human placental barrier exposing the fetus during critical period of development. The APAP-induced oxidative stress is amplified during fetal life because of the main pathways for APAP metabolism is not active in the fetus until mid-gestation, and that sex-specific endocrine-disruptive effects of APAP are reported in animal studies.1
A growing body of epidemiological research have investigated the associations between prenatal exposure to APAP and adverse reproductive or neurological outcomes in childhood.1 However, previous epidemiological studies have predominantly relied on using self-reported data or single-biomarker measurements to characterize APAP exposure, raising concerns over exposure misclassification.3 On one hand, self-reported maternal intakes are susceptible to under-reporting or recall bias. On the other hand, APAP metabolites have a short half-life (ie, <4 hours), thus a single biological measurement may only reflect recent or frequent intake. To address this methodological concern and advance our understanding of the assessment of prenatal APAP exposure, we conducted a study to compare three APAP metabolite levels in paired maternal urine and cord blood samples, and maternal self-reported frequent APAP intake data.
Publication
Clinical Epidemiology
Type
Journal Articles
