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Acetaminophen use in pregnancy linked to child's behavioral problems
- glibgil 10y agoOr, people with headaches produce offspring with headaches, but kids don't know they have headaches and just get angry and act out
- eric_h 10y agoCertainly plausible, and the article itself makes some attempt to discount the certainty of a causative link (though not 'til the end, so not everyone who reads it will necessarily get that far).
- redofrac 10y agoFrom the article: "They looked for a link between a child’s behavioral problems at age 7 and his or her mother’s post-natal acetaminophen use, and found none. They looked for a link between a child’s behavioral problems at age 7 and acetaminophen use by the mother’s partner during pregnancy. Again, they found no association."
- hinkley 10y agoYou guys are downvoting a guy that didn't ask what you're answering. Who isn't reading for content?
- greenshackle 10y ago> They looked for a link between a child’s behavioral problems at age 7 and acetaminophen use by the mother’s partner during pregnancy They thought about that. Doesn't look like it.
- hinkley 10y agoBut they didn't look at a link between acetaminophen use by the child and behavioral problems.
- dopamean 10y agoDidn't read the article?
- whiddershins 10y agoRemoved my downvote, because i get why you wrote that, but possibly the parent didn't read it carefully, or possibly didn't understand, or possibly simply disagrees with the methodology used to eliminate confounders, or any number of other possibilities. From the guidelines: Please don't insinuate that someone hasn't read an article. "Did you even read the article? It mentions that" can be shortened to "The article mentions that." https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html
- hinkley 10y agoIf you read between the lines: > They failed to discern a pattern of increased medication-taking by women who were carriers of genetic variations linked to behavioral problems. The mothers carrying known behavioral genetic markers were not more likely to take acetaminophen. If the headaches were correlated to a known marker then you would expect it to also be passed on to an offspring in a statistically significant way. But if there's an unknown marker that correlates with pain complaints? I know of at least one psychologist who is going back to some of Jung's commentary on behavioral issues and trying to carve out a set of people who are diagnosed as 'shy' or 'ADD' but who just have heightened senses. The gist of it is that some people have a less aggressive filter on their senses, and eventually they can't cope with the information overload and they begin to act out, not unlike an exhausted child. Depending on environment and luck, they might develop shyness, ADD like symptoms, become scarily perceptive (extreme case: Sherlock Holmes, Psych), or some combination of all three. These people also complain about physical discomforts and pain with a higher frequency than normal people. The question of how exactly they eliminated pre-natal painkiller use of the mother as a predictor for behavioral problems wasn't addressed in either summary but might be buried in the data.
- samatman 10y agoThis is why it makes me sad that we're still doing things like pharmacology without a full genetic workup of every subject in the study. What if there's a marker that not only correlates the aspirin use and the child's behavioral problems, but subjects with the marker more strongly correlate the relationship than subjects who don't? That kind of statistical analysis is how we find out a random stretch of DNA is a marker in the first place. All forms of human study will advance dramatically once this becomes standard practice, as indeed it must. Of course, you're completely throwing out the fig leaf of 'anonymous' health data. But it turns out that for the vast majority of health studies, deanonymizing the data is quite practicable in most cases already. And the gain to medicine would be enormous.
- atemerev 10y agoThat would somewhat explain the rise of prevalence of ADHD. (My mother didn't take acetaminophen during her pregnancy. Still have adult ADD. Unlucky me.)
- contingencies 10y agoOK well I'm not pregnant but I've been downing tonnes of these things for a sprained ankle recently. I don't like doing it as they are hepatoxic to some extent, and would prefer codeine, but the authorities make it too hard to get your hands on in most countries. Grr.
- stephentmcm 10y agoFor a sprained ankle you likely want a NSAID like ibuprofen...
- ars 10y agoAgreed. Acetaminophen is really not safe in high quantities. Ibuprofen has a much better safety profile. PS. Don't walk on the ankle just because you don't feel the pain! You can turn a 3 month recovery into a 2 year recovery if you do that.
- contingencies 10y agoThanks. Have ibuprofen too but it apparently has nasty side effects if you take it too long. Right now I am looking at weeks, so trying to limit consumption. Was given one SAID and one NSAID but also too many side effects for my liking.
- jrowley 10y agoI'm a big fan of naproxen with a large glass of water.
- kafkaesq 10y agoA.k.a. paracetamol, Tylenol. If validated, the implications of this finding are potentially quite troubling.
- sangd 10y ago"Finding a link between acetaminophen use during pregnancy and an outcome affecting the child is no proof that acetaminophen is the cause of the outcome. But the authors contend that the study results do heighten concerns that fetal exposure to acetaminophen can give rise to neurodevelopmental problems." This study and its results are misleading. The scope & method aren't good for the conclusion. It doesn't answer whether people should use tylernol while pregnant or how much can they consume.
- ASpring 10y agoGood of the authors to explicitly acknowledge that there is no causal link indicated here. Fun Hypothesis: There exists an underlying latent variable that determines both of these. It takes the form of a negative affect activation function; ie. at some level of pain/annoyance we start to consider the source a problem and look for solutions. Adding this latent variable to the analyses would mediate the relationship between acetaminophen use and the child's behavioral 'issues'. The authors do address this a bit with: "They looked for a link between a child’s behavioral problems at age 7 and his or her mother’s post-natal acetaminophen use, and found none." I would not suppose that this activation function is linear which may confound the authors attempt to control for this.
- pessimizer 10y agoWhat an unnecessary, garbage drug; one that's responsible for half the liver failures in the United States. Maybe a restriction on pregnant women taking it could move it behind the counter, or better, into the dimly-remembered past.
- dragonwriter 10y agoGiven the issues with NSAIDs in general (and even moreso with NSAIDs with particular populations), acetaminophen being available remains important. It definitely has dangers particularly if used improperly (and a much narrower gap between normal and dangerous doses than many other drugs), but its not an unnecessary or garbage drug.
- caf 10y agoRight - for example pain management in Crohns.
- caidh 10y agoIt's definitely necessary for some people. I'm allergic to NSAIDs, though to differing degrees. Really bad hives (to the point of needing epinephrine) from aspirin, less severe reaction to naproxen. I can tolerate a single pill of ibuprofen, maybe 2 in 24 hours but that's it. I don't take acetaminophen frequently, but it is one of the only things I can tolerate for pain (sinus/tension headaches mostly).
- k-mcgrady 10y agoRegarding your comment on liver failure: wouldn't you need to take more than the allowed dose for this to happen?
- kirrent 10y agoYou do. The interesting thing about paracetamol is that toxicity arises at only about 3 times the maximum daily recommended dose. For a drug which is perceived as so safe it's common for someone to continue downing them when they're in pain and become quite sick. Certainly a problem of education, not the drug itself.
- ars 10y agoBTW Pregnant women should not take ibuprofen either due to the potential for premature closure or patent ductus arteriosus. So if this is true I don't think there are any safe painkillers during pregnancy.
- jaboutboul 10y agoUmmm maybe it's the actual ailment that caused the mother to take the acetaminophen that is the root cause?
- koolba 10y agoI'd wager dollars to donuts that women with lower pain tolerances and more willing to treat pain with drugs, would also be less capable of raising children. They'd also be more likely to report their children as suffering from ADHD, simply because they can't deal with the child.
- selllikesybok 10y agoI'll take that action.
- shanacarp 10y agoI'm starting to become a little shocked at the lack of black box warnings involved with Acetaminophen given how easy it is to poison yourself with it, and what appears to be a growing list of long-term side effects
- rabboRubble 10y agoAcetaminophen is one of the more dangerous over the counter drugs available. It is right up there with alcohol for causing liver failure. http://www.mayoclinic.org/diseases-conditions/liver-failure/basics/causes/con-20030966 http://www.mayoclinic.org/diseases-conditions/liver-failure/... The tricky thing with acetaminophen is that it is included in products without adequate warning. If I'm sick, I have a headache and take 2 tylenol, plus cold medicine, plus whatever, and BAM I've killed my liver because those 3 things all had acetaminophen in it. The tipping point between being 100% healthy, and 100% needing a liver transplant is really narrow. http://www.dailymail.co.uk/news/article-2064964/Warning-hidden-danger-taking-Paracetamol.html http://www.dailymail.co.uk/news/article-2064964/Warning-hidd... http://www.esquire.com/lifestyle/health/a235/esq1103-nov-body/ http://www.esquire.com/lifestyle/health/a235/esq1103-nov-bod... Nevermind what acetaminophen does to fetuses, this drug needs to be treated with a lot more caution. I have dialed my intake waaaaaaay back. I'm sure my liver is happier with me. If you take tylenol, make sure you take no more than the suggested dose. Make sure you aren't getting duplicate dosing bundled with other medications. Make sure you don't routinely take it longer than the bottle dose instructions indicate.
- tedunangst 10y agoEverything, around here at least, with acetaminophen in it says so right on the front of the box, with a fairly prominent warning not to double dose with other meds. I don't know what it would take to make an "adequate" warning.
- marpstar 10y agoI never take acetaminophen anymore and generally only take ibuprofen, and only a few times a year. Serious question: Why do people even take acetaminophen anymore?
- patmcc 10y agoIt's very safe at the recommended dosage, and has effectively zero side effects. Ibuprofen very commonly causes upset stomach / heartburn.
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- fifteenforty 10y agoAnaesthesia trainee here (doctor, similar to an anesthesiology resident in US vocabulary) I've read the actual referenced paper and not the LA times piece. This type of research is hypothesis generating. As they acknowledge, this shows a correlation, not causation. The big question here is why were these women taking paracetamol/acetaminophen? Was it the drug or the cause of their pain/fever/discomfort that is more relevant to the outcomes observed? As part of a cohort study, this was just one outcome measured. It is not clear to me whether this was a outcome measure they had intended to analyse from the outset or whether it was post-hoc. This makes a huge difference to the credibility of the finding With regards to the relative safety of paracetamol and ibuprofen, well, they are totally different drugs. For most healthy, young people, in short courses both will cause little harm, with paracetamol having the edge in safety. Ibuprofen causes significant, undetected kidney and gastrointestinal injury. Paracetamol can cause liver failure, but generally only in overdose, prolonged use or when associated with poor nutritional intake. A healthy person taking the odd dose will not develop liver toxicity. Prolonged administration of ibuprofen will invariably cause damage. For paracetamol it is less clear. Source: I prescribe and manage these drugs and their side effects daily. Pain management is a core part of my day job.
- bdamm 10y agoMy reading of the study was that the indication measured was if the mother had remembered taking Acetaminophen and not a direct measure of her actual Tylenol intake. So the study should read "mothers who remembered their drug intake have a slightly elevated risk of attention deficit children."
- fifteenforty 10y agoGood point. It adds yet another layer of uncertainty to the findings.
- rand_r 10y agoGiven how taxing these types of drugs are, why are opiates not an option for most people? They don't cause any long or short-term damage to organs.
- kchoudhu 10y agoSo: pregnant women can't do ibuprofen, and they can't do acetaminophen. What's left for them?
- fifteenforty 10y agoThey shouldn't take ibuprofen, but this research is extremely poor quality and shouldn't change practice regarding acetaminophen. That's not to say that someday the results may not be confirmed, but right now it's not worth getting worried about. Edit: I shouldn't say it's poor quality research. It's misleading reporting.
- jinpa_zangpo 10y agoThere are non-drug methods of dealing with pain.
- figgis 10y agoCan you expand on what non-drug methods you are speaking about? And whether you are speaking about immediate relief or long term relief? These drugs used are usually used for immediate pain.
- erdevs 10y agoA more rigorous write-up of this paper: http://www.npr.org/sections/health-shots/2016/08/15/490069664/how-big-a-risk-is-acetaminophen-during-pregnancy http://www.npr.org/sections/health-shots/2016/08/15/49006966...