Knowledge
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From the best-available current evidence (Ahlqvist 2024): NO
The American Academy of Obstetrics and Gynecology's journal ACOG, summarises it best in Damkier et al.'s 2025 review article:
"According to the current scientific evidence, in utero exposure to acetaminophen is unlikely to confer a clinically important increased risk of childhood ADHD or ASD." - Damkier (2025)
Ahlqvist et al's 2024 Swedish cohort study of 2.48 million children showed that when controlling for family confounders by using sibiling controls, there was no association between paracetamol/acetaminophen use and various neurodevelopmental problems:
"Acetaminophen use during pregnancy was not associated with children's risk of autism, ADHD, or intellectual disability in sibling control analysis." - Ahlqvist (2024)
The problem with many of the earlier (and often contradictory) studies that showed a possible association, was that by necessity these were observational studies that struggled to control for confounders. The classic "association is not causation" trap. Ahlqvist et al's very large study, while still observational, uses matched sibling controls to neutralise "unobserved confounding" – and reassuringly, the association dissapears.
Nonetheless, it’s worthwhile being aware of the body of evidence and how it has evolved over the last decade. Professional obstetric organisation advice remains unchanged: paracetamol is appropriate to use in pregnancy when managing fever and pain, which untreated have their own detrimental fetal effects.
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The remifentanil PCA for labour analgesia controversy continues...
Those advocating its first-line use point to reassuring evidence of maternal satisfaction and acceptability, reduced epidural rates, and some suggestion of reduced instrumental delivery rates.
For the negative, the ongoing safety concerns created by routine use of remifentanil PCAs are foremost, particularly given how uneven hospitals can be at implementing best safety practices. Observed rates of significant desaturation range from 25-70%, in addition to potential neonatal effects.
The greatest challenge facing the remiPCA advocates, is that the labour epidural is still the most effective form of labour analgesia, and has only improved over the decades as safety has been both maintained and increased.
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