Scientists call for limiting paracetamol during pregnancy

Ibuprofen, aspirin … Many drugs are not allowed during pregnancy. What is left for pregnant women to soothe their pain? Paracetamol? Not really, according to international researchers for whom this analgesic could impact the healthy development of the fetus. Through works described and published in Nature review endocrinology Thursday, September 23, thirteen researchers specializing in gynecology, neurology, pediatrics or endocrinology, carried out a meta-study, that is to say the collection and analysis of all the studies conducted between 1995 and 2020 on the risks that may be caused by taking paracetamol on fetal development. Result: After reading all this data, scientists call for greater caution.

“We ask that women and health professionals be better informed, that there is more communication around the risks associated with this product, and the need for its use to be really as limited as possible.“, says David Kristensen, neurologist and co-author of the publication. In France, the use of paracetamol in pregnant women is authorized “if necessary”, but must “be used at the lowest effective dose, for the shortest possible time and at the lowest possible frequency”, indicates the Medicines Agency (ANSM).

Reproductive, neurological, endocrinological …

“More and more experimental and epidemiological research suggests that prenatal exposure to N-acetyl-p-aminophenol (APAP which is more commonly called paracetamol, editor’s note) could alter the development of the fetus, which could increase the risks of certain neurodevelopmental, reproductive and urogenital disorders “, write the authors.

According to their observations, the drug could act as an endocrine disruptor : it could influence the production of certain hormones in the child and the mother. “APAP is known to easily cross the placenta and the blood-brain barrier. During pregnancy, changes occur in the metabolism of APAP, which could make pregnant women and their fetuses more vulnerable to toxic effects.”, detail the scientists.

Also, he could be responsible forreproductive system effects. “The results of five of these studies suggest that prenatal exposure to APAP is associated with urogenital and male reproductive system abnormalities, showing an increased risk of undescended male testes (cryptorchidism) and reduced anogenital distance. “, we read in the meta-study.

That’s not all. Other studies suggest that paracetamol could cause effects on the neurological development of the fetus, with a possible link to, among others, attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD) or language delays.

Should we avoid paracetamol during pregnancy?

The researchers ask the health authorities to reassess the risk of taking paracetamol in pregnant women. And that this information can be made available to caregivers and those most affected. As the authors of the study point out, it should also be taken into account that it is not obvious for healthcare professionals to suggest another medication to patients. “We recognize that there are limited medical alternatives to treat pain and fever” that are safe during pregnancy. They also warn that this meta-study has its limitations. Scientists do not know “precisely the exhibition” paracetamol of the partipantes, indicates Shanna Shawn, recognized specialist in endocrinology, during a press conference. “We unfortunately have very little data on how much women take it, we know how many women take it, we know that it is half the women in the world, which is huge, but we do not know how many took what and when. ”

The authors therefore recommend “that APAP be used by pregnant women with caution at the lowest effective dose for the shortest possible time. Long-term or high-dose use should be limited to the indications recommended by a healthcare practitioner “. At last, “the packaging must include warning labels including these recommendations”.