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Paracetamol use during pregnancy – a call for precautionary action
- qixv 5y agoWow! I have two young children, and we’ve been cautious about using paracetamol. But this really changes the perspective for me.
- TeMPOraL 5y agoSame here, two children (2.5yo and 3wo), both exposed to Paracetamol in what I now hope were low enough concentrations. I'm very concerned, to say the least.
- oynqr 5y agoWhy do you use the word "exposed"? You seem to be overreacting.
- ekianjo 5y agoAspirin is a much safer drug to give to kids, despite the bad press it has received. You only need to look at the actual data to be convinced that it should be prescribed over Paracetamol any day.
- phreeza 5y agoI think paracetamol is also used to lower fevers which are more common in little kids. Does aspirin also serve that function? I think it doesn't.
- _moof 5y agoOk... I looked at the data and when people stopped giving aspirin to children, prevalence of Reye syndrome dropped by 90%. I'm gonna go ahead and continue not giving aspirin to kids.
- ekianjo 5y agoYou know the saying that correlation is not causation ? https://pubmed.ncbi.nlm.nih.gov/11994026/ https://pubmed.ncbi.nlm.nih.gov/11994026/ > The presence of salicylates in the blood or urine of Reye's syndrome patients has not been demonstrated, and no animal model of Reye's syndrome has been developed where aspirin causes the disease. It is clear from epidemiological data that the incidence of Reye's syndrome was decreasing well before warning labels were placed on aspirin products. Reye's syndrome disappeared from countries where aspirin was not used in children as well as from countries which continued to use aspirin in children. This link with Reyes syndrom is about as valid as good old snake oil to treat ailments. Bad science was not invented just last year.
- zepin 5y agoWhile uncommon, Aspirin can cause Reye syndrome in children, which can lead to death or cause permanent disability. Paracetamol does not cause such harmful effects if used as directed. It definitely should be used as a first-line treatment (if needed) in case of fever or pain. Edit: typo
- bpodgursky 5y ago> Furthermore, in Western regions the prevalence of male reproductive and urogenital disorders has increased. These disorders include cryptorchidism, hypospadias and testicular germ cell cancer, together with early puberty, decreased sperm counts, levels of sex hormones and decreased fertility12,13. Data support the contribution of environmental exposure during fetal life, including exposure to pharmaceuticals, to these increases in rates of neurological, urogenital and reproductive disorders13,14. How much of the current sexual identity revolution is long-suppressed true identity, and how much is that we have poisoned an entire generation with untested pharmaceuticals, endocrine disruptors, and environmental toxins starting in-vitro and continuing through their entire childhood?
- isoprophlex 5y agoAside from prickly, politicized discussions about gender and identity... it might not be a bad thing altogether to reduce our fertility. We're exhausting the resources of the planet enough as it is.
- bpodgursky 5y agoI don't know if you're really out of date, but the current crisis is that populations in the developed world are about to collapse, and nothing good is going to come of it. But there are 5 billion people in the developing world about to become middle class... you having fewer kids is going to accomplish nothing. We're already going to have to engineer our way through this.
- rablackburn 5y agoWe’re projected to stabilise off at about 10 billion I believe. Which while a huge number, is not unsustained exponential growth. As countries get richer and women gain better access to education and improved rights, the countries seem to go through an inflection point where suddenly no one wants to have children and the birth rate falls below replacement (2.0, two children to replace two parents) For us as a species to survive we need to try and stabilise that at 2.0 + some small safety margin (to make up for infertility, people who really don’t want children, or physically can’t). While we’re bound to one planet (which it looks like is going to be for awhile, “sending people to Mars” is very different from “sizeable % of the total human population living on Mars”) it’s preferable for that stable population point to be as small as possible. 10 billion is a lot, but it looks stable at least. If we bring our replacement rate down more to peak the total population earlier, we have this weird problem where the replacement rate is well below 2.0, so no one is having children, and we suddenly have to convince people to start having more. It feels like everything else in life; the birthrate would keep yo-yo-ing above and below replacement rate, and we really don’t want it above while it’s so cramped here and we’re messing up fundamental environmental systems that we rely on. Like everything else these days it seems like it kind of comes back to “well, if you want to do something, first we’ve got to deal with climate instability”. /shrug
- ctur 5y agoaka acetaminophen (popularly aka Tylenol in the United States).
- charles_f 5y agoWhen I moved to Canada it took me 6 months to realize that paracetamol was available nowhere because acetaminophen was how it was called here.
- dEnigma 5y agoSame in Japan apparently http://www.survivingnjapan.com/2011/01/how-to-find-tylenol-in-japan.html http://www.survivingnjapan.com/2011/01/how-to-find-tylenol-i...
- arcticbull 5y agoTylenol (paracetamol) is also the leading cause of acute liver failure in the United States and Canada [1]. The toxic dose is very close to the active dose, far more so than pretty much any other OTC drug you run into. It's also even more toxic when combined with alcohol. [edit] > "It is the most common cause of liver injury. Period. Full stop," said Dr. Michael Rieder, a pediatric clinical pharmacologist at Western University in London, Ont. [1] https://www.cbc.ca/news/health/acetaminophen-toxicity-health-canada-1.3764672 https://www.cbc.ca/news/health/acetaminophen-toxicity-health...
- throwaway2048 5y agoif tylenol was a newly created drug, there is no chance it would have so few restrictions on its usage.
- lostlogin 5y agoImaging trying to get alcohol past regulators.
- ekianjo 5y agoI would not be so sure. Regulatory agencies have recently approved AD treatment without any sort of evidence. In 2021.
- np_tedious 5y agoTrue, but not quite relevant. That is a prescription drug which does/will therefore have quite a few more restrictions than over the counter Tylenol
- ekianjo 5y agoIt's relevant in the sense that you can't trust the FDA for anything scientific anymore. It's been hacked.
- deleted 5y ago[deleted]
- KingMachiavelli 5y agoThis is extremely concerning since the two obvious alternatives, aspirin and ibuprofen, are already considered unsafe during pregnancy. Without a decent alternative, the best we can probably do is to limit the dose and duration of use. This policy is probably the best for any medication during pregnancy and childhood.
- baybal2 5y agoThere is nimesulide, which seems to be all nice, but comes with 1 in a 100000 chance to destroy your liver with 1-2 doses if you are born without some (yet unknown) enzymes.
- gremloni 5y agoNo, the best we can do is not take any pain relievers and suffer through the pain.
- 88840-8855 5y agoProbably just not take anything that can alter body functions in a significant manner.
- Angostura 5y ago9 months without any medication
- gremloni 5y agoYes, it’s quite reasonable considering the end result.
- KingMachiavelli 5y agoReally? At what size of an effect of increased risk of ADHD, obesity, etc. do we say that a non-tangible amount of pain should be endured? IMO the biggest benefit of studies like this is to discourage pointless use of OTC painkillers. These painkillers are pretty weak anyway so if you old have mild discomfort or find that your pain isn't responding to the drug this is yet another reason to not just 'pop an asprin' (or ibuprofen, Tylenol, etc.) at the slightest bit of discomfort or even taking it regularly without good reason. I have seen even young people just get in the habit of taking ibuprofen, Benadryl, etc. multiple times a week or even daily which just seems excessive. On the other hand, we are reaching the point where everything is a compromise. If you are pregnant AND working I am going to take a gamble and guess that OTC pain meds are pretty much par for the course.
- forgingahead 5y agoI don't know whether this is a truly serious paper or can be filed under "Spurious Correlations"[0] - paracetamol is widely enough used that links to the mentioned "issues" could be tenuous at best. [0]: https://www.tylervigen.com/spurious-correlations https://www.tylervigen.com/spurious-correlations
- Zpalmtree 5y agoParacetamol is widely used so any attempts to investigate its safety aren't 'truly serious'? This is really strange, closed minded thinking.
- flarg 5y agoIt is possible that lifestyle and other factors lead to both the negative outcomes in the article, and by general pain and fever that require paracetamol. The animal studies, if verified, may be more concerning.
- rewma 5y ago> I don't know whether this is a truly serious paper or can be filed under "Spurious Correlations"[0] I don't understand what leads you to believe that a paper that can be filed under "spurious correlation" could be automatically discarded as not being serious. One of the purposes of scientific articles is to report interesting findings to peers, which serve as food for thought. By definition, the state of the art of any field is perpetually in a "work in progress" stage, and researchers feed off each other's work to progress. This paper reports an observation. Like all similar papers, now the community is free to look into it and bring some clarity to the topic. This is how progress is achieved.
- amanaplanacanal 5y agoI think the issue comes when results are reported and consumers try to use those results to determine which behaviors are risky. We all try to stay on top of "the latest science" but are results like this really actionable by consumers?
- andy_ppp 5y agoI found it very frustrating you cannot buy paracetamol in Japan. I wonder if the know something we don’t…
- bdowling 5y agoIt's sold under the name アセトアミノフェン (acetaminophen) in Japan. http://www.survivingnjapan.com/2011/01/how-to-find-tylenol-in-japan.html http://www.survivingnjapan.com/2011/01/how-to-find-tylenol-i...
- andy_ppp 5y agoOkay, but as it says in the article most normal pharmacies don’t sell it, they said look for larger ones near train stations. I did look for it many times. And Japanese people are certainly not in the business of regularly taking Tylenol etc.
- ekianjo 5y agowrong on all counts. https://www.bufferin.net/ https://www.bufferin.net/ It's heavily advertised and available in every drug store in Japan (you don't even need to go to pharmacies!).
- el_don_almighty 5y agoBefore I started visiting, I was told that TABASCO was the key to surviving Japan because it goes with everything; fish eyes, ink sacks, sea urchin guts, etc... 20-years later I realize how delicious nearly everything is on its own. (I still don't recommend any of the aforementioned, especially while wearing a white shirt)
- spoonjim 5y agoThankful that the authors have found a way to thread the needle and have just said “we use women and men to mean cisgender women and cisgender men” so they can just deal with it once. I’m sure someone will complain though.
- bencollier49 5y agoRather fitting considering the subject of the article.
- dEnigma 5y agoI see only one complaint in this thread, and that is your comment.
- spoonjim 5y agoIt’s not a complaint. Much better than the alternatives: https://twitter.com/iaindale/status/1441504448266833920?s=21 https://twitter.com/iaindale/status/1441504448266833920?s=21
- nnx 5y agoConsidering the ongoing experiment with novel mRNA technology, it's interesting, if confirmed, that we're learning after decades on the market that this drug so well-known and massively used could have some unforeseen side effects during pregnancy.
- ekianjo 5y agoYou are not supposed to say this kind of things nowadays, because we must blindly accept whatever the authorities tell us in 2021.
- bencollier49 5y agoWell, fortunately Hacker News doesn't employ the same "fact checking" service as Facebook or YouTube. There was a very important article on what to do if pulled over by an unmarked police car in the UK. FB's fact checker marked it as "false" because it didn't apply to the US.
- VBprogrammer 5y agoThat sounds reasonable to me. Except perhaps in the most unusual extreme circumstances, treating a British police officer with everything up to shear and utter contempt is likely to lead to nothing more than a stern talking to. While I'm sure we only hear the worst of the American police force, I'm still not confident that anything but absolute and total cooperation is a safe approach.
- bencollier49 5y agoIt came about as a result of people with fake police lights committing assaults. The advice in the UK is to carry on driving and pull up in the nearest possible public place, like a petrol station.
- Pyramus 5y agoDo I understand you correctly that the occurrence of false positives is more damaging than the distribution of misinformation? It's easy to say it's all black or all white, as a matter of fact we live in a world that's different shades of grey. It turns out that social media is the perfect vector to spread misinformation and it's costing lives today. Where do you draw the line?
- deleted 5y ago[deleted]
- ekianjo 5y agoIt's so funny that people think that Aspirin is a super dangerous drug that we should avoid giving kids based on some obscure bullshit reason, while Paracetamol has this "safe" image coming out of nowhere, despite all evidence and the trail of deaths it keeps leaving behind.
- bluejekyll 5y ago> "safe" image coming out of nowhere. If nowhere is the marketing department for Tylenol. It was created in 1877, before the FDA was in place with such rigorous testing requirements for drugs. It’s safe image has been marketed since then and now represents enough money for the Johnson & Johnson company that they lobby against restrictions on its use.
- refurb 5y ago98% of all acetaminophen sales are not Tylenol but rather generic acetaminophen. J&J would be wasting their time considering they have drugs that provide 100x the revenue.
- feanaro 5y agoHow is Reye's syndrome a bullshit obscure reason?
- robocat 5y agoEvery drug has risks - what matters is the relative risks, and the potential gains. Reye's syndrome affects fewer than one in a million children a year — Wikipedia. However I do presume that number would go up significantly if more children were given aspirin? Accidental overdoses of Paracetamol affect about 20 per million people. Calculation: (a) The current population of Canada is 38 million, (b) 700 accidental overdoses per year in Canada: https://news.ycombinator.com/item?id=28735280 https://news.ycombinator.com/item?id=28735280
- wonnage 5y ago
- phreeza 5y agoInteresting comment from gwern on a discussion over on reddit: https://www.reddit.com/r/slatestarcodex/comments/q01gwl/comment/hf5armc/ https://www.reddit.com/r/slatestarcodex/comments/q01gwl/comm...
- WithinReason 5y agoThat's interesting. Basically it says that the causation is inverse for ADHD: e.g. parents with ADHD are more likely to take acetaminophen long term and then pass ADHD to the child genetically, which shows up as a correlation between acetaminophen use during pregnancy and ADHD in the child in an epidemiological study. If you control for it the correlation disappears. However, I don't see how liver damage could lead to paracetamol use.
- yarcob 5y agoAs a counterpoint, embryotox says that the studies linking paracetamol to genital defects show only weak correlations and are of questionable quality [1]. The links to ADHS etc are apparently even more tenuous -- one study apparently even found a correlation between ADHS and paracetamol use by the father during pregnancy (how would that work?). [1]: https://www.embryotox.de/arzneimittel/details/paracetamol/ https://www.embryotox.de/arzneimittel/details/paracetamol/
- bencollier49 5y agoI expect that there will be a lot of contending articles and sources, considering the amount of money made from paracetamol globally.
- Certhas 5y agoembryotox is the website of the top German research hospital and the ministry summarizing the state of knowledge on pregnancy/nursing risks of medication. It's as close to an objective source as I've come across on this topic.
- Certhas 5y agoHow would that work? If both the maternal drug use and the ADHD outcome are the result of a third familial confounding variable, then it's reasonable to expect that this third variable also leads to paternal drug use. This would be corroborated by the fact that siblings of kids whose mothers took Paracetamol during pregnancy also experienced higher ADHD. As always in these things, effect sizes are small, confounding variables are huge, and much much much larger socio economic factors that we as a society could actually do something about are routinely ignored.
- blub 5y agoEmbryotox is a collection of pregnancy safety info for many drugs maintained by the Charite hospital in Berlin, Germany. It’s very popular locally, I’ve seen it used also in pharmacies. Paracetamol is the therapy of choice for pain and fever during pregnancy. Doctors, pharmacists, etc all recommend it in Germany. Ibuprofen is more problematic.
- pillefitz 5y agoHow about not taking any medicine during pregnancy that's not strictly necessary, independent of study results? There's a myriad interactions going on, with just the tip of the iceberg being known. Studies might give you confidence you won't experience catastrophic outcomes (think: Contergan), but any subtle deficits in future behavior of your child and similar are probably unaccounted for. It's just 9 months of abstinence from modern comforts ffs.
- VBprogrammer 5y ago> It's just 9 months of abstinence from modern comforts ffs. While undergoing one of the most intense transformations the human body is capable of.
- touisteur 5y agoLowering fever is not only comfort. High fever for a long time can be damaging. Women are already told to avoid everything not strictly necessary during pregnancy. Oh, but they're also supposed to keep working, commuting, handling the modern world without 'modern comfort'. This is all without saying that pregnancies can be pretty painful and a shitty experience. How about we give them a break (if they want) or, barring that, a little empathy. And try to find something to help?
- robbedpeter 5y agoTylenol/paracetamol/acetaminophen doesn't work as an analgesic, and should be avoided, regardless of pregnancy. If your doctor prescribes it, request that they research the Cochrane reviews of Tylenol, and other studies that show efficacy no better than placebo. Tylenol is a marketing hack, not a painkiller.
- touisteur 5y agoI'm not sure I understand: hundred millions of people feeling (even slight) relief from their pain are victims of some placebo effect/marketing hack? It doesn't relieve pain at all and I've been dreaming it my whole life? I was also talking about lowering fever, I suppose it doesn't work for that either?
- hamstergene 5y agoI am highly concerned with all the comments in the thread, that say, "it has only affected a tiny minority". Life-threatening liver damage to a tiny minority likely means non-life threatening liver damage to everyone else. Just because everyone else didn't end up complaining to a doctor does not mean no harm was done. The vulnerable elements of society are often indicators of what will happen to the normal elements, if the pressure is increased—or if the damage gets accumulated over time.
- lotsofpulp 5y agoEverything in life involves trade offs. And every decision in life involves unknown unknowns. The only option is to keep collecting and evaluating data over and over and make decisions with the best available information.
- newintellectual 5y agoIsn't it ironic that there's a concern over this, while completely new drugs, the mRNA vaccines, already shown to have by far the highest reported serious adverse effects of any other vaccine, are blithely recommended to pregnant women by the CDC? For something encapsulated in lipid nanoparticles that almost certainly cross the placental barrier and into rapidly dividing fetal cells, causing the SARS-CoV-2 spike protein to be expressed on their surface? Such a recommendation is a gigantic crime.
- cpach 5y agoRelated discussion: https://news.ycombinator.com/item?id=28735314 https://news.ycombinator.com/item?id=28735314