To investigate whether maternal paracetamol use in early pregnancy is associated with cerebral palsy (CP) in offspring. We conducted a registry and biobank-based case-control study with mother-child pairs. We identified CP cases (n=322) born between 1995 and 2014 from a nationwide CP-registry. Randomly selected controls (n=343) and extra preterm controls (n=258) were obtained from a birth registry. For each mother, a single serum sample from early pregnancy (gestation weeks 10-14) was retrieved from a biobank and analyzed for serum concentrations of paracetamol, categorized into unexposed (<1ng/ml), mildly exposed (1-100ng/ml), and highly exposed (>100ng/ml), and in quartiles. Analyses were performed using logistic regression and adjusted for potential confounders. Separate analyses were conducted including only those children born preterm and only those born term. Of the 923 participants, 36.8% were unexposed, 53.2% mildly exposed, and 10% highly exposed to paracetamol. Overall, prenatal exposure to paracetamol was not associated with CP. Sensitivity and subgroup analyses showed no clear associations between paracetamol and CP across strata of term/preterm birth as well as subtypes of CP. The present study does not support an association between intrauterine exposure to paracetamol in early pregnancy and the risk of CP. However, it is important to stress that the exposure estimate is based on a single serum sample.

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