Prenatal Acetaminophen (Paracetamol) Use and the Risk of Autism and/or Attention-Deficit/Hyperactivity Disorder Among Sibling-Matched Cohorts

作者：Shan Luo, Qiaowa Gong, Yujie Ai, Jiayue Zhang, Linda Chan, William Chi Wai Wong, P C T Ip, E YT Chan, Peter Tanuseputro, Ian Chi Kei Wong, Eric Yuk Fai Wan · 发表于：JAMA Internal Medicine · 年份：2026 · DOI：10.1001/jamainternmed.2026.2215 · 被引用次数：1 · 研究领域：Pregnancy and Medication Impact、Prenatal Substance Exposure Effects、Drug-Induced Hepatotoxicity and Protection

Importance: Paracetamol (acetaminophen) is the first-line analgesic and antipyretic recommended globally during pregnancy. Observational studies have reported associations with increased risks of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) in offspring, raising public and clinical concern; however, these findings may be substantially confounded by unmeasured familial factors. Objectives: To assess the association between prenatal paracetamol exposure and risk of ASD and ADHD in offspring using a sibling-matched study design to control for familial confounding. Design, Setting, and Participants: This population-based cohort study, conducted from January 1, 2001, to December 31, 2023, in Hong Kong, used deidentified electronic health records within a triangulation framework. From an initial cohort of 708 020 mother-child pairs (approximately 43.3% with prenatally paracetamol exposure), sibling-matched cohorts were constructed of children from families with discordant prenatal paracetamol exposure and sufficient follow-up (≥2 years for ASD and ≥5 years for ADHD). Data analysis was conducted from October 2, 2025, to March 24, 2026. Exposure: Prenatal paracetamol exposure, identified from electronic dispensing records (British National Formulary [BNF], section 4.7.1) with data on drug name, strength, dosage, and prescription dates. Main Outcomes and Measures: Incident diagnoses per the International Classification of Diseases, Ninth Revision,...