How Safe is Acetaminophen and Pregnancy?
Abstract & Commentary
By John C. Hobbins, MD
Professor and Chief of Obstetrics, University of Colorado Health Sciences Center, Denver
Dr. Hobbins reports no financial relationship to this field of study.
Synopsis: A study evaluates whether acetaminophen, one of the most frequently used drugs among pregnant women, is associated with an increased prevalence of congenital abnormalities.
Source: Rebordosa C, et al. Acetaminophen use during pregnancy: effects on risk for congenital anomalies. Am J Obstet Gynecol. 2008;198:178.e1-178.e7.
Being pregnant puts patients in a special category where, seemingly, everything they put in their mouths, even some foods, has some risk to the fetus. Since some individuals are allergic to aspirin, and at one time there was a suspicion (although unconfirmed) that this medication may even have teratogenic effects, the most commonly used analgesic has been acetaminophen (Tylenol®).
Rebordosa et al have shown in a seven-year prospective study published in the American Journal of Obstetrics & Gynecology that in a group of 26,424 Danish patients exposed to acetaminophen during the first trimester the incidence of congenital anomalies was 4.28%, vs 4.30% in the 61,718 patients not exposed to this drug. In effect, in any anomaly category studied, there was no difference between groups.
Commentary
We know that smoking is not good for the fetus and placenta, that alcohol can have teratogenic effects if it is used excessively, and that some analgesics and anti-inflammatory drugs have been linked to premature closure of the ductus arteriosus and/or oligohydramnios. It is interesting that for years aspirin had been on the "avoid" list, but now we have been using low dose aspirin liberally because of its beneficial effect on the placental bed in patients at risk for preeclampsia, fetal growth restriction, and in those patients with thrombophilia. However, for those many patients who simply have, let's say, a headache, the staple medication has been acetaminophen. Although the drug has not been subject to intensive investigation, it is now heartening to know that, at a time when almost every drug is suspect, this seemingly innocuous medication is not a teratogen. However, for non-analgesic use it cannot be substituted for low-dose aspirin since only aspirin can retard small vessel clotting by its effect on the balance between prostacyclin and thromboxane.
Being pregnant puts patients in a special category where, seemingly, everything they put in their mouths, even some foods, has some risk to the fetus.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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