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Comment & Response
February 13, 2017

Acetaminophen in Pregnancy and Adverse Childhood Neurodevelopment

Author Affiliations
  • 1Home Delivery, OptumRx, Irvine, California
JAMA Pediatr. Published online February 13, 2017. doi:10.1001/jamapediatrics.2016.5034

To the EditorJAMA Pediatrics published an observational retrospective longitudinal cohort study by Stergiakouli et al1 that examined the associations between acetaminophen use during pregnancy and childhood behavioral problems.1 In the article, the authors concluded that the results show prenatal exposure to acetaminophen increases the risk of behavioral problems in children. They postulated an intrauterine mechanism because no associations were found from postnatal or partner’s use. However, the authors’ conclusions dismiss significant increases in the risk of behavioral problems in children associated with partner acetaminophen use. As shown in Table 3 in the article, the partner’s acetaminophen use was associated with conduct problems (risk ratio, 1.38; 95% CI, 1.02-1.88). The effect size and number of associated problems increased after adjusting for confounders in eTable 3 in the Supplement, where the partner’s acetaminophen use was associated with conduct problems and hyperactivity symptoms in children (adjusted risk ratio, 1.63; 95% CI, 1.11-2.40 and adjusted risk ratio, 1.41; 95% CI, 1.02-1.97, respectively). This association held constant after adjusting for the mother’s prenatal use at 18 and 32 weeks, as observed in eTable 5 in the Supplement. Furthermore, partner’s use positively affected the association of 3 Strength and Difficulties Questionnaire domains with maternal prenatal acetaminophen use at 32 weeks in eTable 9 in the Supplement (total difficulties, conduct problems, and peer problems) when compared with eTable 6; prenatal use at 32 weeks positively affected the association of emotional symptoms with partner’s use when comparing eTable 9 with eTable 7 in the Supplement. All 3 of the Strength and Difficulties Questionnaire domains in eTable 2 that were associated with prenatal acetaminophen use at 32 weeks with confidence intervals greater than 1 (total difficulties, conduct problems, and hyperactivity symptoms) were positively affected after adjusting for maternal postnatal use in eTable 4 of the Supplement.

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