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posted by Dopefish on Wednesday February 26 2014, @12:00AM   Printer-friendly
from the will-somebody-think-of-the-children? dept.

GungnirSniper writes:

"The Journal of the American Medical Association, Pediatrics, has found that use of acetaminophen (paracetamol) during pregnancy is associated with a higher risk for HKDs [hyperkinetic disorders] and ADHD-like behaviors in children. More than half of all mothers in the study reported acetaminophen use while pregnant.

The LA Times has a longer and lighter story about the study which reminds us 'that unchecked fevers have been associated with a number of poor health outcomes in babies, including lowered IQs.'

Led by neuropsychologist Miriam Cooper of the University of Cardiff in Wales, the group wrote that without more details on how acetaminophen might lay the foundations for later ADHD, and when and in whom it is most likely to boost risk, the current findings should be interpreted cautiously and should not change practice.

For pregnant women, the study underscores that, even when a medication is billed as safe, the safest route is to take it as rarely as possible and at the lowest effective dose, said UCLA obstetrician Dr. Daniel Kahn, a maternal-fetal health specialist who was not involved in the study.

Damned if you do, damned if you don't?"

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  • (Score: 2, Funny) by hatta on Wednesday February 26 2014, @12:23AM

    by hatta (879) on Wednesday February 26 2014, @12:23AM (#7127)

    Fetal Tylenol Syndrome.

    • (Score: 1, Funny) by Anonymous Coward on Wednesday February 26 2014, @01:39AM

      by Anonymous Coward on Wednesday February 26 2014, @01:39AM (#7154)

      Tylenol is just as safe as vaccinating your child for rabies. It couldn't possibly turn them into ass burgers.

    • (Score: 5, Insightful) by TWiTfan on Wednesday February 26 2014, @08:57AM

      by TWiTfan (2428) on Wednesday February 26 2014, @08:57AM (#7274)

      In most of the cases of ADHD I've seen lately, I would rename it "Postnatal Parental Hypochondria."

      --
      If real life were like D&D, my Charisma score would be a negative number
      • (Score: 1) by ragequit on Wednesday February 26 2014, @04:47PM

        by ragequit (44) on Wednesday February 26 2014, @04:47PM (#7578) Journal

        If'n I had mod points, you sir, would be karma richer.

        --
        The above views are fabricated for your reading pleasure.
  • (Score: 2) by c0lo on Wednesday February 26 2014, @12:28AM

    by c0lo (156) on Wednesday February 26 2014, @12:28AM (#7128)

    Damned if you do, damned if you don't?

    The way I know, paracetamol is not the only anti-fever drug, is it?

    • (Score: 5, Informative) by WildWombat on Wednesday February 26 2014, @01:13AM

      by WildWombat (1428) on Wednesday February 26 2014, @01:13AM (#7144)

      --"The way I know, paracetamol is not the only anti-fever drug, is it?"

      No, its not the only one. However all the other commonly available anti-inflammatory drugs are also contraindicated during pregnancy. Acetaminophen was, and probably still is even taking this news into account, one of the safer pain killers to take during pregnancy. There are a number of articles recommending it as the one to take during pregnancy, although they still usually contain a disclaimer to take it as little as possible.

      For instance in the US Acetaminophen is rated pregnancy category B while ibuprofen [wikipedia.org] and aspirin [wikipedia.org] are both in category D.

      Wikipedia has a decent bit on how different countries categorize [wikipedia.org] drugs for use during pregnancy.

      Also, from the abstract over 64,000 children were in the study. Its large scale studies like this that really help push medical knowledge forward. Major Kudos to the people who helped put that together.

      Not usually a disclaimer kind of guy but since its medical stuff...I'm not a doctor and the above isn't medical advice. And if you're ever tempted to take medical advice from a Wombat then you probably really need medical advice more advanced than a Wombat can administer.

      Cheers,
      -WW

      P.S. Yes, Wombat is a proper noun you insensitive clod.

      • (Score: 3, Funny) by weilawei on Wednesday February 26 2014, @01:41AM

        by weilawei (109) on Wednesday February 26 2014, @01:41AM (#7155)

        If Wombat is a proper noun, does that mean you (they?) have dissociative identity disorder, since you used the indefinite article? ;-)

        • (Score: 2, Funny) by similar_name on Wednesday February 26 2014, @02:31AM

          by similar_name (71) on Wednesday February 26 2014, @02:31AM (#7175)
          Wombat is his family name.
          --
          Where can I vote for ACs to be Anonymous Cows? It should always be plural :)
      • (Score: 3, Funny) by c0lo on Wednesday February 26 2014, @03:35AM

        by c0lo (156) on Wednesday February 26 2014, @03:35AM (#7200)

        No, its not the only one. However all the other commonly available anti-inflammatory drugs are also contraindicated during pregnancy.

        So I learnt, thank you.

        Yes, Wombat is a proper noun you insensitive clod.

        Yeah... nah, mate, am not insensitive. For other clods (be them insensitive or not) who may not know: see here [wikipedia.org].

      • (Score: 2) by frojack on Wednesday February 26 2014, @05:50PM

        by frojack (1554) on Wednesday February 26 2014, @05:50PM (#7605)

        The pregnancy risk is probably overstated, the principal risk factor to the fetus of aspirin use during pregnancy is Reye's syndrome, however this is merely speculative at this point, because aspirin association with Reye's syndrome, has ONLY been associated with aspirin consumption by children with viral illness, but Reye's also occurs in the absence of aspirin use and has also associated with Tylenol.

        Aspirin readily crosses the placental barrier. This is the principal origin of the categorization, not any actual studies showing real risk to the fetus.

        The interesting thing about aspirin is not JUST that it is good for so many different things, but if it were discovered today, you probably wouldn't be able to get it approved simply for the gastrointestinal risks alone.

        --
        Discussion should abhor vacuity, as space does a vacuum.
  • (Score: 5, Interesting) by zim on Wednesday February 26 2014, @01:04AM

    by zim (1251) on Wednesday February 26 2014, @01:04AM (#7140)
    Tylenol kills about 500 people a year. And sends 80,000 to the emergency room.

    And that's just the ones we KNOW were caused by Acetaminophen.
    Not a real common thing to look for since it's OTC and most people don't even think it's a 'drug' or dangerous.

    It's some bad shit. And the margin for error is very very small on its dose. Even smaller for anyone who drinks.
    • (Score: 0) by Anonymous Coward on Saturday June 21 2014, @10:56AM

      by Anonymous Coward on Saturday June 21 2014, @10:56AM (#25836)

      azR7VO ueupizdwjshh [ueupizdwjshh.com], [url=http://qxsjomrwsyqa.com/]qxsjomrwsyqa[/url], [link=http://mlxlmphjjfuw.com/]mlxlmphjjfuw[/link], http://dphnefoiciez.com/ [dphnefoiciez.com]

  • (Score: 5, Informative) by JimmyCrackCorn on Wednesday February 26 2014, @01:12AM

    by JimmyCrackCorn (1495) on Wednesday February 26 2014, @01:12AM (#7142)

    I have stopped using, especially with alcohol.

    maybe some gubment stuff to add scientific things:
    http://www.fda.gov/Safety/MedWatch/SafetyInformati on/SafetyAlertsforHumanMedicalProducts/ucm381650.h tm [fda.gov]

    http://livertox.nih.gov/Acetaminophen.htm [nih.gov]

    • (Score: 0) by Anonymous Coward on Monday September 22 2014, @05:26AM

      by Anonymous Coward on Monday September 22 2014, @05:26AM (#28091)

      jCRIsH kpeuxdkgfwxp [kpeuxdkgfwxp.com], [url=http://spnqkkgnecny.com/]spnqkkgnecny[/url], [link=http://mlvtmgwiijkb.com/]mlvtmgwiijkb[/link], http://kxqkwxuwqtje.com/ [kxqkwxuwqtje.com]

  • (Score: 5, Insightful) by useless on Wednesday February 26 2014, @01:16AM

    by useless (426) on Wednesday February 26 2014, @01:16AM (#7147)

    "Because the exposure and outcome are frequent, these results are of public health relevance but further investigations are needed"

    Translation: it could be Tylenol, or it could be any number of other factors, because this study was too broadly defined.

    • (Score: 3, Insightful) by cloying on Wednesday February 26 2014, @01:57AM

      by cloying (91) on Wednesday February 26 2014, @01:57AM (#7163)

      Well indeed. "More than half of all mothers in the study reported acetaminophen use while pregnant"

      I'm sure more than half the mothers also drank milk, or applied makeup, or watched tv.

      • (Score: 4, Insightful) by maxwell demon on Wednesday February 26 2014, @02:46AM

        by maxwell demon (1608) on Wednesday February 26 2014, @02:46AM (#7182)

        And 100% of then consumed Dihydrogen monoxide in one form or another.

        --
        The Tao of math: The numbers you can count are not the real numbers.
      • (Score: 3, Funny) by useless on Wednesday February 26 2014, @09:47AM

        by useless (426) on Wednesday February 26 2014, @09:47AM (#7303)

        Yep, but that won't stop the junk science "journalists "from their sensational scare headlines, then the mommy bloggers screaming "ZOMG! Teh tylonolz gave my snowflake teh stoopids!"
        It's going to be a rough week…

      • (Score: 2) by Open4D on Thursday February 27 2014, @12:12PM

        by Open4D (371) on Thursday February 27 2014, @12:12PM (#8050) Journal

        The sentence you quoted serves to show how important it is that their finding be investigated further.

        To be clear, their finding is that there is an association between "maternal acetaminophen use during pregnancy" and "HKDs and ADHD-like behaviors in children" - with a stated level of statistical confidence.

        What is the point you are making about milk, make-up, and TV?

        • (Score: 1) by cloying on Thursday February 27 2014, @04:49PM

          by cloying (91) on Thursday February 27 2014, @04:49PM (#8128)

          Erm. The same point. And the opposite. just because more than half of the mothers took acetominophen does not actually mean there is any association.
          Similarly, If more than half the mothers with "HKDs and ADHD-like behaviors in children" drank milk, would there be an association? and if not why not?

          Statistical statements like "more than half of those that did bla suffered bla" do not necessarily indicate any link whatsoever, especially when it is such a common item.

          However I never read the article, as the summary showed such statistical illogicality it didn't seem worth it.

          • (Score: 2) by Open4D on Thursday February 27 2014, @07:10PM

            by Open4D (371) on Thursday February 27 2014, @07:10PM (#8170) Journal

            Statistical statements like "more than half of those that did bla suffered bla" do not necessarily indicate any link whatsoever, especially when it is such a common item.

            If you read your original post where you quoted the sentence, you will see that it is merely: "More than half of all mothers in the study reported acetaminophen use while pregnant."

            This sentence serves to show how important it is that their findings be investigated further. It is not intended to indicate any link. The study's findings indicate the link.

            If very few pregnant women took acetaminophen, then this issue wouldn't be so important. But actually large numbers of pregnant women take acetaminophen - more than half of all mothers in the study reported doing so, for example.

             

            The summary showed such statistical illogicality it didn't seem worth it.

            I think the most you could argue is that the summary gave a bit too much prominence to that particular sentence.

            • (Score: 1) by cloying on Friday February 28 2014, @07:58AM

              by cloying (91) on Friday February 28 2014, @07:58AM (#8454)

              If it doesn't indicate a link, which it doesn't, why waste money investigating it? The sentence indicates no actual findings..

              I understood your point the first time. I don't think you've grasped mine:
              Just because more than 50% of people in a study do something, doesn't mean it has any bearing whatsoever on another happening. It's one of the most common mistakes applied to statistics. It means nothing. Hence why I refer to what if more than half the mothers drank milk in the study? would that make it worth investigating further? of course not. or maybe. its a completely useless statement!

              • (Score: 2) by Open4D on Friday February 28 2014, @11:14AM

                by Open4D (371) on Friday February 28 2014, @11:14AM (#8566) Journal

                Firstly, if anyone else reading this could step in and settle the matter, cloying and I would both be grateful!

                                            `
                But I'll try again myself too ...

                Studies of the Danish National Birth Cohort [sagepub.com] have produced much useful information.

                One such piece of information is that acetaminophen is used quite a lot by pregnant women. "More than half of all mothers in the study reported acetaminophen use while pregnant." This is of no surprise to anyone.

                A far more interesting piece of information is that "use of acetaminophen (paracetamol) during pregnancy is associated with a higher risk for HKDs [hyperkinetic disorders] and ADHD-like behaviors in children."

                Your argument against the 2nd piece of information consists of criticizing the use of the 1st piece of information to deduce the 2nd. But no-one has used the 1st piece of information to deduce the 2nd.

                • (Score: 1) by cloying on Saturday March 01 2014, @12:39AM

                  by cloying (91) on Saturday March 01 2014, @12:39AM (#8979)

                  No Need. I can step in myself, my apologies, I now see the confusion.

                  Thanks for sticking with it and reiterating and reexplaining. I thought you were trolling for a second, but then re read your stuff, and can see now how the sentence is intended to be interpreted to raise awareness of the issue due to the fact so many people are using it during pregnancy. The summary was weak in getting that across, but I was slow getting your point, and thinking I already had!

    • (Score: 5, Insightful) by Open4D on Wednesday February 26 2014, @09:50AM

      by Open4D (371) on Wednesday February 26 2014, @09:50AM (#7309) Journal

      ... it could be Tylenol, or it could be any number of other factors, because this study was too broadly defined

      What do you mean by too broadly defined?

      They claim to have established an association between "maternal acetaminophen use during pregnancy" and "HKDs and ADHD-like behaviors in children" - with a stated level of statistical confidence. Are you disputing that? If yes, please elaborate. If not, please read on ...

                  .

      We all know that correlation != causation. But if it's not the case that acetaminophen causes ADHD then it would have to be either:

      • #1 - some other systematic link between the two, or
      • #2 - the researchers have been unlucky, and reality is outside of the confidence interval defined by their data

                                          .

      An example of #1 might be that certain problems during pregnancy cause mothers to be more likely to take acetaminophen and cause the child to be more likely to have ADHD. This possibility could perhaps be investigated by seeing whether any acetaminophen alternatives were also correlated with ADHD. I don't know whether they did anything like that. But the abstract does say, "results did not appear to be confounded by maternal inflammation, infection during pregnancy, the mother's mental health problems, or other potential confounders we evaluated."

      I would guess that the possibility of a non-causal systematic link between acetaminophen and ADHD is the reason the researchers said that without more details "the current findings should be interpreted cautiously and should not change practice."

                              .
      One "insightful" reply to your post talks about milk, make-up, and TV. I hope you don't agree with that poster's implied argument. Unless you geniunely think they may be part of the mechanism of a systematic link between acetaminophen and ADHD that the experts hadn't considered.

                        .
      Disclaimer: I am just a programmer. The above just derives from what I learnt during secondary education (15 years ago). Corrections are welcomed.

      • (Score: 1) by useless on Wednesday February 26 2014, @10:52AM

        by useless (426) on Wednesday February 26 2014, @10:52AM (#7349)

        No, I don't think milk causes ADHD, and I'm pretty sure the poster of that comment doesn't either. ;)
        My main problem isn't in the study so much (the DNBC* was a great program), but the uneducated/sensationalized reaction to it.
        This finding was from pouring through massive amounts of generalized data, finding a *potential* correlation, and saying "Hey, this might mean something, we should study this". This is a preliminary finding, and in the conclusion they say as much. But that hasn't stopped people from running with the headline as fact.

        In programming terms, this is just the idea that leads to the business plan. Then comes the spec, prototyping, programming/debugging, then release. People are going from the idea to release, without all the lengthy work in between.

        Thanks for the reply, and hope this helps you get where I'm coming from.

        * Overview on the DNBC here if you're interested. It's lead to some great research:
          http://sjp.sagepub.com/content/29/4/300.abstract [sagepub.com]

        • (Score: 2) by Open4D on Wednesday February 26 2014, @11:15AM

          by Open4D (371) on Wednesday February 26 2014, @11:15AM (#7374) Journal

          No, I don't think milk causes ADHD, and I'm pretty sure the poster of that comment doesn't either. ;)

          Agreed, but the poster seems to be implying that there is some kind of flaw in the study, so that any old random factor such as milk or make-up could be relevant.

          Whereas I think the results are far more definitive than that. Either acetaminophen causes ADHD, or there is some other systematic link between the two that the researchers haven't been able to account for.

                                                                        .
          The poster picked up [dev.soylentnews.org] on this sentence from the abstract, "More than half of all mothers in the study reported acetaminophen use while pregnant". Possibly he or she got confused and assumed that this fact itself was the evidence that the researchers were presenting.

          • (Score: 2, Insightful) by useless on Wednesday February 26 2014, @11:47AM

            by useless (426) on Wednesday February 26 2014, @11:47AM (#7401)

            Ah, ok, I think I see where you may be getting my point confused. Correct me if I'm wrong:
            This study was not an actual clinical trial to test the effects of acetaminophen during pregnancy, or a trial to find the potential causes of ADHD. It was more of a research project on general pregnancy data, and they found an interesting, potential link. Check out the overview of the DNBC to see where their research data came from, and the wide array of follow-up studies it has lead to.

            So there is not really a "flaw" in the report per se, it's that this report did not come from a focused study. Meaning there are no definitive results to base an factual conclusion on.

            Cheers

            • (Score: 2, Interesting) by sbgen on Wednesday February 26 2014, @01:08PM

              by sbgen (1302) on Wednesday February 26 2014, @01:08PM (#7437)

              You are right this was not a clinical study, it was epidemiological inquiry. However, the results are definitive and the factual conclusion is that there is enough data in here to formulate a hypothesis to start detailed basic science research. Not everything in medical science need to be clinical study to be of valid concern to public health. I agree that sensationalizing to the general public is not good but then again I read only the actual paper, not the general press.

              --
              Warning: Not a computer expert, but got to use it. Yes, my kind does exist.
              • (Score: 1) by useless on Wednesday February 26 2014, @01:32PM

                by useless (426) on Wednesday February 26 2014, @01:32PM (#7456)

                Exactly my point. It's a start, not the end.

            • (Score: 2) by Open4D on Wednesday February 26 2014, @01:19PM

              by Open4D (371) on Wednesday February 26 2014, @01:19PM (#7445) Journal

              So there is not really a "flaw" in the report per se, it's that this report did not come from a focused study. Meaning there are no definitive results to base an factual conclusion on.

              The abstract gives numerical results in the form of "hazard ratios" (presumably this [wikipedia.org]) and CIs (which I assume stands for Confidence Intervals). Aren't those definitive enough? If an actual clinical trial to test the effects of acetaminophen during pregnancy had been done instead, and had come up with the same results & confidence intervals, should that have been considered more definitive?

              Notwithstanding the criticisms of epidemiology [oxfordjournals.org], shouldn't all the relevant issues have been factored in to the confidence intervals? So the mere fact that this is yet another result from the Danish National Birth Cohort shouldn't be seen as lessening the validity of the result - should it?

      • (Score: 2, Informative) by sbgen on Wednesday February 26 2014, @11:32AM

        by sbgen (1302) on Wednesday February 26 2014, @11:32AM (#7388)

        You are right about the correlation/causation and I admire you for providing the two (properly numbered!) alternative possibilities. The study is based on the telephone interview of mothers about acetaminophen usage during pregnancy and the data available on their children (at 7 years age) about ADHD etc. The data they have used therefore can only provide correlation. While the statistical treatment of the analysis seems to be rigorous there is not functional analysis to definitively say acetaminophen usage resulted in the later life outcome for the children. The most important aspect is that now there is a definitive study correlating one to the other and the matter is really of public importance. I am sure actual functional analysis to show the biology (or to disprove causality) will follow (provided some one funds that research). The article also quotes previous studies showing that acetaminophen can cross placenta barrier, can be an endocrine disrupt or etc. ADHD/Autism/... seem to have some causes in very early part of life, perhaps prenatally. There is stuff to be worried about the effect of acetaminophen but solid data is necessary to proceed further.

        --
        Warning: Not a computer expert, but got to use it. Yes, my kind does exist.
    • (Score: 3, Interesting) by MozeeToby on Wednesday February 26 2014, @01:05PM

      by MozeeToby (1118) on Wednesday February 26 2014, @01:05PM (#7434)

      Maybe their full paper goes into more detail, but without knowing why the women were taking it I have to view it with a big grain of salt. We already know fevers, influenza, even common colds can affect brain development in ways big and small. Acetaminophen is the primary course of action to prevent damage to the fetus when a woman is pregnant and has a fever.

      And that's just the most obvious correlation I can come up with, stretching things a bit makes a number of places worth looking for. Many people take pain killers for head aches, pregnant women can experience head aches from fluctuations in blood pressure and heart rate. For all we know, abnormal blood pressure is causing the ADD and the taking of Tylenol.

      It's interesting research and certainly worth more investigation. I just hope people don't overreact to what is essentially a survey study looking at a single potential correlation.

      • (Score: 3, Interesting) by Open4D on Wednesday February 26 2014, @01:46PM

        by Open4D (371) on Wednesday February 26 2014, @01:46PM (#7466) Journal

        Maybe their full paper goes into more detail, but without knowing why the women were taking it I have to view it with a big grain of salt. We already know fevers, influenza, even common colds can affect brain development in ways big and small. Acetaminophen is the primary course of action to prevent damage to the fetus when a woman is pregnant and has a fever.

        I haven't seen the full paper, but the abstract says: "Results did not appear to be confounded by maternal inflammation, infection during pregnancy, the mother's mental health problems, or other potential confounders we evaluated."
        Does that alleviate the big grain of salt?

         

        It's interesting research and certainly worth more investigation. I just hope people don't overreact to what is essentially a survey study looking at a single potential correlation.

        I agree, and so do the study authors (if the abstract is anything to go by).

        I tend to feel that most medical science reporting can't really be categorized as 'responsible journalism'. In this case, the LA Times article is okay. Though I still can't help feeling they would have been better spending their resources instead on a story emphasizing the importance some existing piece of official/consensus medical advice.