Date of Award

12-15-2023

Document Type

Dissertation

Degree Name

Doctor of Medical Science (DMSc)

Department

Department of Physician Assistant Medicine

First Advisor

Erika McCarthy, MSM, PA-C

Second Advisor

Justin M. Gambini, DMSc, PA-C, DFAAPA

Abstract

Background: The purpose of this article is to produce a review of the literature on a recently growing topic of interest. We believe the widespread use of acetaminophen in pregnancy makes the rising concern for acetaminophen use in pregnancy and the development of childhood attention deficit hyperactivity disorder (ADHD) a national public health matter. The mechanism of action of acetaminophen, the pathophysiology of drug transfer through the placental barrier, and the most up-to-date research studies were analyzed with the goal of bringing clarity and promoting healthy pregnancies for all.

Methods: PubMed, PLOS One, and Google Scholar served as the cornerstone for our research. The database was narrowed using the search terms: “acetaminophen”, “paracetamol”, “ADHD”, “neurodevelopment”, and “pregnancy”. In order to properly lay the foundation for the topic and discuss the most up-to-date sources in detail, we adhered to a 10-year inclusion criteria.

Findings: The research to date has numerous retrospective studies but only two prospective cohort studies that could provide definitive quantitative data. After adjusting for confounding factors, all research studies continued to support an increased risk of the development of ADHD as the use of acetaminophen in pregnancy increased. The risk did not exist in individuals who were exposed to a single dose.

Interpretation: The literature available supports an association between the use of acetaminophen during pregnancy and the development of ADHD in offspring. However, there is not sufficient evidence to distinguish whether the association is correlation or causation. Based on what we understand, healthcare professionals should continue to encourage pregnant women to use acetaminophen only when medically indicated and at the lowest therapeutic dose possible.

Funding: none.

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