Clinics in Mother and Child Health

Raising Awareness of Acetaminophen Risk in Pregnancy and Developmental Concerns

Tatsuro Nobutoki^* Department of Pediatrics, Tokatsu Medical Welfare Center Koyoen, Kashiwa, Japan
^*Correspondence: Tatsuro Nobutoki, Department of Pediatrics, Tokatsu Medical Welfare Center Koyoen, Kashiwa, Japan, Email:

Received: 23-Feb-2024, Manuscript No. CMCH-24-24999; Editor assigned: 26-Feb-2024, Pre QC No. CMCH-24-24999 (PQ); Reviewed: 11-Mar-2024, QC No. CMCH-24-24999; Revised: 18-Mar-2024, Manuscript No. CMCH-24-24999 (R); Published: 25-Mar-2024, DOI: 10.35248/2090-7214.24.21.480

About the Study

Pregnant women receiving the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) vaccines are recommended to opt for Acetaminophen (APAP) over nonsteroidal antiinflammatory drugs as a safe medication for managing adverse effects, including local pain and fever. Despite the prevalent use of Over-The-Counter (OTC) APAP in Japan for vaccineassociated side effects, including pain and fever, awareness regarding its safety during pregnancy is limited.

In recent years, the number of children with developmental disabilities has increased owing to, in part, an increased awareness of these conditions, allowing those who were previously undiagnosed to be diagnosed [1]. Its causes are multifactorial and include genetic, infectious, and environmental factors. A recent study showed that higher APAP metabolites levels in the cord blood are associated with the subsequent development of Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) in a dose dependent manner [2]. According to one study, APAP exposure during pregnancy increases the risk of ADHD diagnosis in children at 7 years of age [3]. Currently, the U.S. Food and Drug Administration discourage the usage of APAP at all stages of pregnancy [4].

Potential mechanisms linking prenatal APAP exposure to ADHD/ASD include the following:

• The role of APAP as an endocrine disruptor in the developing brain has been extensively studied [5]. During pregnancy, APAP decreases estrogen synthesis in the uterus [6]. Estrogen is essential for regulating apoptosis, synaptogenesis, and morphometry of neurons in the developing brain [7].

• Prenatal APAP exposure during prenatal development adversely affects the hippocampus of the fetal brain. This is manifested as a reduction in the expression of genes related to sex-determining region Y-box 2/notch signaling, leading to a diminished proliferation of neural progenitor stem cells [8]. Moreover, APAP directly causes neurotoxicity in cortical neurons by inducing apoptosis [9].

• Cord blood analysis suggests that unmetabolized APAP disrupts the homeostatic balance of glutathione synthesis, thereby increasing oxidative stress in the central nervous system. Elevated glycine levels lead to the activation of Nmethyl- d-aspartate receptors, contributing to the pathogenesis of ADHD [10].

• A molecular database and literature mining study suggested that APAP, along with maternal exposure to pesticides, increases the risk of ASD by affecting apoptosis and the metabolism of reactive oxygen species and carbohydrates [11].

Conclusion

When addressing pain and fever, (a concern not exclusive to the SARS-CoV-2 vaccine), pregnant women should exercise caution with medications and dietary supplements. Whenever possible, opting for cryotherapy modalities, like ice packs, is advisable. Emphasizing the risk associated with analgesic-antipyretic drugs during pregnancy is essential unless a causal relationship between APAP and developmental problems can be ruled out. Physicians should consider providing detailed explanations of the risks of APAP using easy-to-understand pamphlets with illustrations. Delayed safety education on the use of any medication during pregnancy may negatively impact maternal and infant health. Moreover, the rise in OTC medication overdoses is a recent concern, as many common cold remedies contain APAP, and many women are unaware of its content and associated side effects. Therefore, providing information during prenatal examinations is important. Epidemiological studies on the association between APAP use during pregnancy and developmental outcomes that consider variations based on race, dose, and duration of use are needed globally.

Conflict of Interest

This article is a personal opinion, and the responsibility lies with the author.

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