Pregnant women should not be denied appropriate care because of unsubstantiated claims, say three South African associations of medical specialists.
Suggestions of a possible link between the use of paracetamol (acetaminophen) during pregnancy and autism spectrum disorder (ASD) have been circulating internationally on and off for some time but were accented on Monday when US president Donald Trump weighed in, referencing the popular pain medication Tylenol.
Families need not worry, say the South African Society of Obstetricians and Gynaecologists, the Society of Obstetric Medicine SA and the SA Society for Ultrasound in Obstetrics and Gynaecology.
The associations said they understand the concerns of pregnant women, their families, and health-care providers, and have been reviewing the available evidence, drawing on large cohort studies, systematic reviews, sibling-controlled analyses and authoritative international assessments.
In agreement with position statements from several international bodies, they said: "We confirm that there is no evidence that taking paracetamol in pregnancy at recommended therapeutic doses causes autism in children.
"Paracetamol remains an essential, safe and effective treatment for fever and pain in pregnancy. No alternative agent has a superior safety profile."
Cautioning against leaving maternal symptoms untreated, they said: "Fever in pregnancy is not benign; it has been associated with miscarriage, congenital malformations including neural tube defects and cardiac defects, preterm delivery and intrauterine foetal demise. Similarly, severe or persistent pain, if not treated, can have a significant impact on maternal mental health, with clear consequences for both mother and foetus."
Elaborating on earlier studies that suggested a small association between prenatal paracetamol exposure and ASD, the health-care experts said: "These analyses were particularly vulnerable to confounding by genetic, familial, and environmental factors, and in many cases relied on self-reported exposure data of limited reliability.
"By contrast, more robust study designs, especially sibling-control analyses, show no increased risk of ASD. A large Swedish population-based study, for example, demonstrated that when shared familial factors were accounted for, the association between paracetamol use and ASD disappeared.
"Comprehensive systematic reviews and meta-analyses confirm this conclusion: once unmeasured confounding is considered, there is no meaningful increase in ASD risk. Together, the evidence strongly suggests that earlier reported associations were explained by confounding rather than a causal effect of paracetamol.
"We firmly state that there is no reliable evidence that paracetamol use in pregnancy causes ASD. Apparent associations are explained by confounding, not causation. Clinical practice should not change. Paracetamol remains an essential, safe and effective treatment for fever and pain in pregnancy, and pregnant women should not be denied appropriate care because of unsubstantiated claims."
The joint position statement was signed by doctors Jarrod Zamparini, Samantha Budhram and Prof Ismail Bhorat, the presidents of the three associations.
TimesLIVE
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