To the Editor The study by Liew et al1 in JAMA Pediatrics on the association between gestational acetaminophen use with attention-deficit/hyperactivity disorder in childhood may bear practical implications for antipyretic use in pregnancy. Because gestational hyperpyrexia has potential adverse effects, including congenital malformations, the role of antipyretic medication in pregnancy is crucial. Numerous studies have shown associations between maternal hyperthermia and increased risk for neural-tube defects in offspring.2 Others have found associations between maternal fever and congenital heart defects.3,4 Significant associations were found between fever and influenza and congenital heart defects including atrioventricular septal defects in infants with Down syndrome. Maternal antipyretic use for fever or influenza tended to reduce these associations.5
Amitai Y. Characteristics of Acetaminophen Users Compared With Nonusers During Pregnancy, Behavioral Problems, and Hyperkinetic Disorders. JAMA Pediatr. 2014;168(9):865. doi:10.1001/jamapediatrics.2014.980
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