The risk of developing ADHD was 3 times higher among children whose mothers used the pain-relief drug acetaminophen (paracetamol) during pregnancy. The association was stronger among daughters, with the daughters of acetaminophen-exposed mothers showing a 6.16 times higher likelihood of ADHD.

[u/mvea]

https://newsroom.uw.edu/news-releases/child-adhd-risk-linked-to-mothers-use-of-acetaminophen

[u/wildbergamont]

This summary doesn't seem to really match the paper. The summary from the paper reads:

Prenatal APAP exposure and ADHD were associated with placental upregulation of immune system pathways in females and downregulation of oxidative phosphorylation in both sexes. In females only, prenatal APAP was associated with 5.22% higher odds (0.0456–13.1%) of ADHD statistically, mediated through increased immunoglobulin heavy constant gamma 1 (IGHG1) expression. These results highlight placental molecular mechanisms that may underlie developmental toxicity of prenatal APAP exposure.

[u/tert_butoxide → u/wildbergamont]

This is much more interesting than the press writeup. But that phrasing is still messing up correlation and causation, isn't it? I can't find any prior work showing that IGHG1 expression is elevated by acetaminophen use, though it is related to immune response and inflammation. Immune activation and inflammation are a documented risk factor for essentially every psychiatric condition, and also a risk factor for taking anti-inflammatory meds....

Maybe the OP paper discusses this more clearly in the main text. However, I can't actually access it even with my university log-in, so it's a particularly hard paywall.

Which made me curious, since to my understanding all federally funded research must be open access now. This one does list some federal grants, but the primary funder of the underlying data collection is the Urban Child Institute. Which is, weirdly, a project of the RAND Corporation? probably not relevant except as the reason it's not open access...

[u/Mejai91 → u/tert_butoxide]

So really the data could potentially be confounded by the fact that people taking acetaminophen probably have inflammation from another cause

[u/Asyran → u/Mejai91]

Not just inflammation, but anything and everything that would cause someone to take acetaminophen to begin with. I'm not sure how the authors controlled for that.

[u/yukon-flower → u/Asyran]

Yep. You can’t take ibuprofen when pregnant, not even during the course of labor! The only thing you can take is acetaminophen. And pregnancy isn’t exactly a soothing experience.

[u/baoo → u/yukon-flower]

Fentanyl it is!

[u/Nutarama → u/baoo]

You joke, but fentanyl is actually one of the approved drugs for use in epidurals. Tiny exact doses straight into the CSF.

The actual solution mostly is structural fixes.

[u/ivorybiscuit → u/Nutarama]

That blew my mind when I was getting ready to give birth and I heard that in a class. And then again when I caved after hours of excruciating back labor with minimal progress and asked for the epidural.

Edit: my preference was to try unmedicated first then switch to pain relief if the situation called for it. My word choice of caved was perhaps poor for what I intended- I caved in the sense that I couldn't physically handle labor at that point so I chose, with no judgement on myself from myself or any part of my care team, to get an epidural. I just moved to one of the options I had already thought out. Apologies if my language was inferring any judgement on people getting epidurals.

I firmly believe everyone should have the choice to follow their own birth preferences and keep them and their child safe, be that medicated, unmedicated, etc. Epidurals are an incredible medical feat and people should be able to freely choose if they want them or not based on what is important to them.

[u/bewilderedfroggy → u/ivorybiscuit]

I would reframe that as "after hours of excruciating back labor with minimal progress(etc)....I got the pain relief I needed".

[u/ivorybiscuit → u/bewilderedfroggy]

I hear what youre saying, but It wasn't like they denied me the epidural though. I was trying to go unmedicated and hit a point where I couldn't, but I had wonderful responsive care that I felt in control of the whole time. I got it as soon as possible after I asked for it, and they respected my decision to not have it until I asked.

[u/horyo → u/baoo]

I know you're joking but even women aren't spared from that. Opioid withdrawal happening in newborns is a sad sight.

[u/BirdieZazu → u/yukon-flower]

I don‘t know how it‘s in the US but you can take ibuprofen during pregnancy - just not in the last trimester. Oftentimes it‘s safer to say „you can never!“ so that they don‘t buy a packsge in the first weeks and use it later. But you could.

[u/smeIIyworm → u/BirdieZazu]

Please don't share such harmful information. Ibuprofen should NOT be taken during any stage of pregnancy.

[u/ganzzahl → u/smeIIyworm]

No, that's not true. There are only tenuous links to any issues for ibuprofen taken in the first half of pregnancy: https://www.ncbi.nlm.nih.gov/books/NBK582759/

[u/Sayurisaki → u/Mejai91]

Ye my first thought reading this was that mothers of kids who have ADHD are probably more likely to use paracetamol than other mums because of genetics. ADHD is commonly co-morbid with many inflammatory conditions, as is ASD which commonly runs in the same families as ADHD.

That doesn’t mean maternal paracetamol use increases risk of an ADHD kid, it means that mums of ADHD kids are more likely to have the genes that lead to sensory issues and inflammatory/autoimmune conditions.

Anecdotally, I used a ton of paracetamol and my kid is probably ADHD. If I were in this study, I would’ve contributed to “paracetamol use increases risk of ADHD”. But autism and ADHD are very strong in my family, I am both, I have a chronic pain condition and am hypersensitive to pain due to ASD. My kid being ADHD is so obviously genetics and in order to determine if paracetamol is a causative factor, you’d have to control for the genetic component which is further complicated by the fact that many women of childbearing age aren’t diagnosed until their children are due to changes in how ADHD is viewed since the 90s.

[u/rainbow84uk → u/Sayurisaki]

This was exactly what I thought when I read the title (except you expressed it way better than I ever could!)

I'm also from a family full of ADHD and ASD folks, most of whom also have chronic pain due to hypermobility and/or autoimmune disorders.

[u/YoghurtTechnical5654 → u/rainbow84uk]

This! My mom, three sisters and I all have some combo of ADHD, ASD, auto immune problems, hyper mobility

[u/Digitlnoize → u/Sayurisaki]

I think you’re right.

[u/sadi89 → u/Mejai91]

There is more and more evidence showing a strong correlation between adhd and hypermobility. Hypermobility can be a cause of chronic muscular skeletal pain. Pregnancy also causes hypermobility, which for someone with baseline hypermobility throws everything out of whack.

This is all just armchair theory

[u/pvrhye → u/sadi89]

Anecdotally, I am pretty sure I have ADHD and I can lock my hands behind my back and spin them all the way around my head and knees like a jumprope. I was always exceptionally flexible.

[u/the_edgy_avocado → u/tert_butoxide]

It doesnt seem to be paywalled via the 'study' hyperlinked via the nature.com article? I can see all 19 pages?

[u/JLeeSaxon → u/wildbergamont]

This summary doesn't seem to really match the paper.

I swear I see those words in the comments of nearly every post on this sub.

[u/NV-6155 → u/wildbergamont]

Ah yes, the classic "Write a flashy headline first, worry about the actual academics later (if at all)".

[u/Mobius_One → u/[deleted]]

That interval is so close to zero. They should be embarrassed by using that rounding/sig digits to come to this conclusion.

I thought so too until I looked at the study. It's a matter of converting coefficients and the actual CI is NOT so close to 0. See the study where the odds-ratio is very non-zero.

"Overall, detection of APAP in second trimester plasma was associated with higher odds for child ADHD diagnosis (odds ratio of 3.15 (95% confidence interval 1.20 to 8.29))."

Logistic regression gets whacky when you convert out of the base statistical units because math.

And here's more context on their data. Only African-American women, and only 3/4 or so of them have data to look at because they had to look at the children 10 years later and idk but probably lost contact.

"We evaluated ADHD-related outcomes in a follow-up visit at age 8–10 years for 307 children among this subsample. Mothers were on average 24.8 years of age dur-ing pregnancy, and the majority were not exposed to tobacco (87.3%) or alcohol (93.5%) during pregnancy, self-identified as not Hispanic/Latino (98.0%) and delivered vaginally (61.6%) (Table 1). Children were on average 9.1 years of age at neurodevelopmental assessment, approxi-mately half were female (51.1%) and most did not have immediate family members with mental health disorders (82.4%)."

[u/PearShapedBaby14 → u/Mobius_One]

Ok but to be fair, an OR of 1 means equal odds of each outcome happening, so an OR CI ranging between 1.2 and 8.3 is pretty close to overlapping with 0 when the OR is standardized. It's also pretty wide suggesting there is some factor not identified in the analysis contributing to a lot of variance.

[u/manchesterthedog → u/wildbergamont]

You are seriously doing gods work

[u/bduxbellorum → u/wildbergamont]

Inflamation is always for a reason. Treating inflammation (pain/etc) as a symptom seems to always throw off the body’s processes, so i’m not surprised by this even when it’s unclear how they controlled for differences in underlying causes of pain, and the methodology leaves a lot to be desired.

[u/wildbergamont → u/bduxbellorum]

To be fair, there are a lot of pains involved with being pregnant. It's a painful process.