Pre-natal exposure to paracetamol and risk of wheezing and asthma in children: A birth cohort study

Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.
International Journal of Epidemiology (Impact Factor: 9.18). 07/2008; 37(3):583-90. DOI: 10.1093/ije/dyn070
Source: PubMed


Paracetamol use has been associated with increased prevalence of asthma in children and adults, and one study reported an association between pre-natal exposure to paracetamol and asthma in early childhood.
To examine if pre-natal exposure to paracetamol is associated with the risk of asthma or wheezing in early childhood, we selected 66 445 women from the Danish National Birth Cohort for whom we had information on paracetamol use during pregnancy and who participated in an interview when their children were 18-months-old and 12 733 women whose children had reached the age of 7 and estimated the prevalence of physician-diagnosed asthma and wheezing at the ages of 18 months and 7 years. We also linked our population to the Danish National Hospital Registry to record all hospitalizations due to asthma up to age of 18 months.
Paracetamol use during any time of pregnancy was associated with a small but statistically significant increased risk of physician-diagnosed asthma or bronchitis among children at 18 months [relative risk (RR) = 1.17, 1.13-1.23)], hospitalizations due to asthma up to 18 months (hazard ratio = 1.24, 1.11-1.38) and physician-diagnosed asthma at 7 years (RR = 1.15, 1.02-1.29). The highest risks were observed for paracetamol use during the first trimester of pregnancy and persistent wheezing (wheezing at both 18 months and 7 years) (RR = 1.45, 1.13-1.85).
Paracetamol use during pregnancy was associated with an increased risk of asthma and wheezing in childhood. If this association is causal, we may need to revisit the clinical practice on use of paracetamol during pregnancy.

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Available from: Henrik Toft Sorensen, Nov 12, 2015
    • "[12] In addition, various studies have observed an association between drug intake or other chemical exposures and the development of diseases. [13] [14] [15] In order to evaluate the impact of prenatal environmental exposure on the allergy risk of newborns, a prospective mother-child cohort study, 'Lifestyle and environmental factors and their influence on Newborn Allergy risk' (LiNA), was initiated at the Helmholtz Center for Environmental Research (Leipzig, Germany), in cooperation with the St Georg Hospital in Leipzig, Germany. [16] [17] Within that study it was shown that the development of chronic diseases such as atopic eczema and lung diseases are strongly associated with prenatal and early lifetime exposures by environmental tobacco smoke and volatile organic compounds (VOC). "
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    ABSTRACT: Various studies pointed towards a relationship between chronic diseases such as asthma and allergy and environmental risk factors, which are one aspect of the so-called Exposome. These environmental risk factors include also the intake of drugs. One critical step in human development is the prenatal period, in which exposures might have critical impact on the child's health outcome. Thereby, the health effects of drugs taken during gestation are discussed controversially with regard to newborns' disease risk. Due to this, the drug intake of pregnant women in the third trimester was monitored by questionnaire, in addition to biomonitoring using a local birth cohort study, allowing correlations of drug exposure with disease risk. Therefore, 622 urine samples were analyzed by an untargeted liquid chromatography-tandem mass spectrometry (LC-MS/MS) urine screening and the results were compared to self-administered questionnaires. In total, 48% (n = 296) reported an intake of pharmaceuticals, with analgesics as the most frequent reported drug class in addition to dietary supplements. 182 times compounds were detected by urine screening, with analgesics (42%; n = 66) as the predominantly drug class. A comparison of reported and detected drug intake was performed for three different time spans between completion of the questionnaires and urine sampling. Even if the level of accordance was low in general, similar percentages (~25%, ~19%, and ~ 20%) were found for all groups. This study illustrates that a comprehensive evaluation of drug intake is neither achieved by questionnaires nor by biomonitoring alone. Instead, a combination of both monitoring methods, providing complementary information, should be considered. Copyright © 2014 John Wiley & Sons, Ltd.
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    • "Several studies have shown an association between offspring asthma and low socio-economic status50,51, high maternal BMI52,53, maternal smoking during pregnancy14,54, maternal asthma55,56, maternal intake of paracetamol57,58, exposure to antibiotics 59, maternal stress during pregnancy 60, maternal intake of vitamin D 61, vitamin E22,62, folic acid63,64, and omega-3 polyunsaturated fatty acids65,66 during pregnancy and mode of delivery 67–69. Twin studies, however, indicate that some of these exposures are rather confounders, since twins share maternal factors but can still differ in size and incidence of asthma/atopic disease 35 (Fig. 1A). "
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