Prenatal Use of Aspirin and Acetaminophen [22N

Abstract

INTRODUCTION: Acetaminophen is widely used in pregnancy for pain management. Recently published data indicates that in-utero acetaminophen exposure may be associated with greater odds that the resulting child will develop ADHD. Aspirin may be a suitable alternative to pain management in the first and second trimesters. METHODS: A systematic review of English language publications using the search terms, “salicylates, pregnancy,” “congenital defects, aspirin,” acetaminophen and ADHD” was conducted to describe perinatal outcome of in utero acetaminophen and aspirin exposure studies showing only third trimester adverse effects were excluded. RESULTS: The search found the following publications. 1 case report, 1 meta-analysis, 2 systematic reviews, 1 case control, 1 randomized controlled trial, 4 retrospective cohort and 2 prospective cohort studies. Aspirin use during the first trimester was associated with increased risk of miscarriage and gastroschisis. There appears to be a comparable risk of cryptorchidism with both aspirin and acetaminophen use in the second trimester. The increased risk of miscarriage was significant only when the analgesic agent was taken at the time of conception. However, the increased risk of gastroschisis was heterogeneous, in the absence of controls for numerous confounders, may not be clinically significant. CONCLUSION: Prior to use of pain relievers during pregnancy, a thorough discussion of the known and potential risks versus the benefits of available analgesic agents should be followed by shared decision making when considering analgesic options. This has ethical and public health implications, given the reports that have associated in-utero acetaminophen exposure with an increased risk of ADHD.