Background: We recently reported links between frequent paracetamol (acetaminophen) use and wheezing and asthma in adults and children, but data are lacking on possible effects of prenatal exposure on wheezing in early childhood.
Methods: In the population based Avon Longitudinal Study of Parents and Children (ALSPAC) women were asked twice during pregnancy (at 18–20 weeks and 32 weeks) about their usage of paracetamol and aspirin. Six months after birth, and at yearly intervals thereafter, mothers were asked about wheezing and eczema symptoms in their child. The effects of paracetamol and aspirin use in pregnancy on the risk in the offspring of wheezing at 30–42 months (n=9400) and eczema at 18–30 months (n=10 216) and on their risk of different wheezing patterns (defined by presence or absence of wheezing at <6 months and at 30–42 months) were examined.
Results: Paracetamol was taken frequently (most days/daily) by only 1% of women. After controlling for potential confounders, frequent paracetamol use in late pregnancy (20–32 weeks), but not in early pregnancy (<18–20 weeks), was associated with an increased risk of wheezing in the offspring at 30–42 months (adjusted odds ratio (OR) compared with no use 2.10 (95% CI 1.30 to 3.41); p=0.003), particularly if wheezing started before 6 months (OR 2.34 (95% CI 1.24 to 4.40); p=0.008). Assuming a causal relation, only about 1% of wheezing at 30–42 months was attributable to this exposure. Frequent paracetamol use in pregnancy was not associated with an increased risk of eczema. Frequent aspirin use in pregnancy was associated with an increased risk of wheezing only at <6 months.
Conclusions: Frequent use of paracetamol in late pregnancy may increase the risk of wheezing in the offspring, although such an effect could explain only about 1% of the population prevalence of wheezing in early childhood.
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This study, SOS and RBN were funded by the UK Department of Health. Core funding for the long term follow up of the cohort came from the Medical Research Council, the Wellcome Trust, the UK Department of Health, the Department of the Environment, DfEE, the National Institutes of Health, a variety of medical research charities and commercial sponsors, including Stirling-Winthrop who enabled the original collection of data on paracetamol use. The Department of Health were shown (and commented on) an early version of the manuscript. Otherwise, the study sponsors had no role in the study design, data analysis, data interpretation, writing the report, or in the decision to submit the paper for publication. Some sponsors contributed to the funding of data collection, including information on paracetamol use, but this was carried out before conception of our hypothesis.
S Shaheen had the original idea for the study and wrote the draft paper. The study was designed by S Shaheen, J Henderson, J Golding and P Burney. A Sherriff carried out analyses of wheezing patterns before the study. J Heron carried out preliminary analyses related to paracetamol use in pregnancy. R Newson and S Shaheen carried out the main analyses. All authors contributed to interpretation of the data, revision of the paper, and approved the final version.
Conflicts of interest: none.
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