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Acetaminophen may be less safe during pregnancy than previously thought


    Acetaminophen tablets.  In most parts of the world, the drug is called paracetamol.

Acetaminophen tablets. In most parts of the world, the drug is called paracetamol.
Photography: Scott Barbour (Getty Images))

An international group of scientists warns pregnant women about over-the-counter pain medications, acetaminophen. In a consensus statement released this week, they claim that enough evidence has emerged to suggest that acetaminophen could be more harmful to take during pregnancy than currently thought. They now recommend that pregnant women take it as little as medically necessary until health regulators review its safety.

Acetaminophen is one of the oldest and most commonly used drugs in the medicine cabinet, it was discovered in the late 1800s and officially launched on the market in the 1950s. Although it has long since become a generic drug, it is best known as Tylenol. Outside the United States, acetaminophen is commonly referred to as paracetamol.

It is primarily used to treat mild to moderate pain, although it may offer some relief in fever as well. While other drugs, such as nonsteroidal anti-inflammatory drugs (e.g. ibuprofen) or aspirin, have advantages over acetaminophen, the drug still has many benefits. One use was intended only for pregnant women, as it was considered safer than any other painkiller throughout pregnancy. There are only small doses of aspirin recommended during pregnancy, although it can help prevent complications of blood pressure so called preeclampsia for high-risk individuals, while only nonsteroidal anti-inflammatory drugs assumed taken before the 20th week of pregnancy as it may increase the risk of kidney problems for the fetus.

Some research over the years has suggested that acetaminophen may have its own unique risks during pregnancy. And in the article published On Thursday, in the journal Nature Reviews Endocrinology, some scientists now say that enough evidence has been collected that these potential risks need to be taken more seriously.

Summarizing and citing various animal and population studies, they argue that the use of acetaminophen during pregnancy could alter fetal development, mainly through a drug or its by-products that act as a hormone-disrupting chemical. This disorder could then increase the risk of some neurodevelopmental and reproductive disorders, as well as genital defects.

“Based on this experimental and epidemiological literature, we believe that the potential harm of continued inactivity outweighs the damage that could result from precautionary action,” the authors wrote.

The scientists, a total of 13, are from many countries, including the United States, Canada, the United Kingdom, Brazil, and Denmark. And they all have relevant expertise in public health or gynecology. They also claim that 91 scientists, clinicians and public health researchers have signed their consensus statement.

The group does not say that acetaminophen should be banned for pregnant women, and rightly notes that it is the only option available to treat pain and fever towards the end of pregnancy, which are important conditions that should not be ignored. For now, they only recommend that doctors and patients be more aware of these possible risks and try to reduce the use and duration of the drug whenever they can – advice that the authors acknowledge that many pregnant women could still receive.

But they are also asking scientists to conduct new research on acetaminophen, preferably research that tries to explain things like genetics and other confusing factors. They want regulators like the Food and Drug Administration and the European Medicines Agency relevant gynecological organizations to review the latest evidence and update their current guidelines. And they call for all acetaminophen products to be labeled with pregnancy warnings and for countries to even investigate sales only in pharmacies, as some places do now.

Some outside scientists have already done so expressed disagreement with the statement, arguing that the evidence of any possible harm from acetaminophen is not as strong as the group claims it is. Time will tell if the FDA and others take this advice seriously. But the group says they felt obligated to speak up now, given how many people use these painkillers and the potential risks of taking nothing at all.

“Here we recognize our professional and social responsibility to take this action, even in the face of uncertainty, in light of the serious consequences of inaction,” they wrote.



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Naveen Kumar

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