Prenatal exposure to paracetamol and the risk of autism and attention‐deficit/hyperactivity disorder: An umbrella review and meta‐meta‐analysis

Paracetamol (also called acetaminophen) is the most commonly recommended pain reliever and fever medicine during pregnancy. In recent years, some studies have suggested that taking paracetamol while pregnant might increase the chance of children developing autism or attention-deficit/hyperactivity disorder (ADHD). However, the findings have been inconsistent, leading to uncertainty among pregnant women and healthcare professionals. We conducted an umbrella review, which is a study that combines and evaluates evidence from previously published systematic reviews and meta-analyses. We included seven meta-analyses covering more than 3 million mother–child pairs and carefully assessed the quality of the available evidence. When all studies were considered together, we found small statistical associations between prenatal paracetamol use and both autism and ADHD. However, when we focused only on the highest-quality reviews and the primary studies at the lowest risk of bias, these associations became much weaker and often disappeared. Many of the included studies had important limitations, such as difficulty accurately measuring paracetamol use during pregnancy and separating the effects of the medicine from the underlying illnesses (such as pain, fever, or infection) for which it was taken. Overall, our findings suggest that the currently available evidence does not support a strong causal link between taking paracetamol during pregnancy and autism or ADHD in children. The small associations reported in some studies are likely explained, at least in part, by methodological limitations rather than by a true harmful effect of the medication.