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Association between maternal acetaminophen use and adverse birth outcomes in a pregnancy and birth cohort



Acetaminophen is the only analgesic recommended for use during pregnancy. This use has recently been linked to childhood developmental disorders, a finding that requires further investigation. Adverse birth outcomes—preterm birth, low birthweight, and small for gestational age—are associated with increased risk of developmental disorders and can serve as intermediate outcomes when examining the impact of maternal acetaminophen use.


Clinical and lifestyle-factor data were gathered from 1200 women within the Ontario Birth Study who delivered between January 2013 and June 2017. Poisson regression with robust error variance was used to estimate the relationship between acetaminophen use before and during pregnancy and low birthweight, preterm birth, and small for gestational age.


Offspring of mothers who used acetaminophen before pregnancy had a higher risk of low birthweight and small for gestational age. Acetaminophen use <once/week was associated with small for gestational age, adjusted relative risk (aRR) = 1.46 (95% CI 1.02, 2.11). Acetaminophen use ≥once/week was associated with both small for gestational age, RR = 1.82 (95% CI 1.12, 2.94), and low birthweight, aRR = 2.16 (95% CI 1.02, 4.54). Acetaminophen use during pregnancy was not associated with the examined outcomes.


Prepregnancy acetaminophen use may be associated with higher risk of adverse birth outcomes.

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The authors would like to thank the participants of the Ontario Birth Study. This work was supported by funding from the Dalla Lana School of Public Health at the University of Toronto, the Lunenfeld−Tanenbaum Research Institute, Mount Sinai Hospital Women’s Auxiliary, through a grant to S.J.L., and the Department of Obstetrics and Gynecology at Mount Sinai Hospital. Additional funding was provided by the Canadian Institute of Health Research through a grant to S.J.L. (FDN‐143262).

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All authors (J.A., R.J.H., R.A.S., J.A.K., S.L.H., A.B., S.J.L., and J.D.B.) have met the Pediatric Research requirements for authorship. All authors (J.A., R.J.H., R.A.S., J.A.K., S.L.H., A.B., S.J.L., and J.D.B.) made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; drafted the article or revised it critically for important intellectual content; and provided final approval of the version to be published.

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Correspondence to Jennifer D. Brooks.

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Arneja, J., Hung, R.J., Seeto, R.A. et al. Association between maternal acetaminophen use and adverse birth outcomes in a pregnancy and birth cohort. Pediatr Res 87, 1263–1269 (2020).

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