Prenatal Exposure to Acetaminophen and Childhood Asthmatic Symptoms in a Population-Based Cohort in Los Angeles, California.

Zeyan Liew,Ondine S Von Ehrenstein,Marie E S Flores,Yuying Yuan,Beate Ritz,Qi Meng,Xin Cui

doi:10.3390/ijerph181910107

Abstract

Acetaminophen is the most common over-the-counter pain and fever medication used by pregnant women. While European studies suggest acetaminophen exposure in pregnancy could affect childhood asthma development, findings are less consistent in other populations. We evaluated whether maternal prenatal acetaminophen use is associated with childhood asthmatic symptoms (asthma diagnosis, wheeze, dry cough) in a Los Angeles cohort of 1201 singleton births. We estimated risk ratio (RR) and 95% confidence interval (CI) for childhood asthmatic outcomes according to prenatal acetaminophen exposure. Effect modification by maternal race/ethnicity and psychosocial stress during pregnancy was evaluated. The risks for asthma diagnosis (RR = 1.39, 95% CI 0.96, 2.00), wheezing (RR = 1.25, 95% CI 1.01, 1.54) and dry cough (RR =1.35, 95% CI 1.06, 1.73) were higher in children born to mothers who ever used acetaminophen during pregnancy compared with non-users. Black/African American and Asian/Pacific Islander children showed a greater than two-fold risk for asthma diagnosis and wheezing associated with the exposure. High maternal psychosocial stress also modified the exposure-outcome relationships. Acetaminophen exposure during pregnancy was associated with childhood asthmatic symptoms among vulnerable subgroups in this cohort. A larger study that assessed prenatal acetaminophen exposure with other social/environmental stressors and clinically confirmed outcomes is needed.

Highlights

IntroductionAcetaminophen, known as paracetamol, is the most common over-the-counter pain and fever medication used by pregnant women [1]
We evaluated the associations between maternal use of acetaminophen during pregnancy and the offspring’s asthmatic symptoms in early childhood in a Los Angeles (LA)
Our study suggested a potential modifying role of maternal psychosocial stress in pregnancy on the association between prenatal acetaminophen exposure and asthmatic outcomes in young children, which warrants further investigations

Summary

Introduction

Acetaminophen, known as paracetamol, is the most common over-the-counter pain and fever medication used by pregnant women [1]. Several prospective cohort studies have reported positive associations between prenatal exposure to acetaminophen and asthma development in offspring during childhood [2,3,4]. Acetaminophen can cross the placenta, exposing the fetus during critical periods of development [5,6]. Acetaminophen was suggested to deplete glutathione (GSH) [7], a key antioxidant in the airways, and enhance immune responses that can predispose prenatally acetaminophen-exposed children to asthmatic phenotypes

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