Having said, done: after the announcements of the past few days, the US administration has officially married the thesis that sees in the use of paracetamol in pregnancy one of the main causes of autism. The Food and Drugs Advalmination has confirmed that soon the possible link with the development of autism spectrum disorders will be clearly reported on the bugardini of medicines. And Donald Trump went down even harder: “Do not use paracetamol – warned the US president during a press conference – fought as matte so as not to take it”.
According to the US health department, the decision would have been made in accordance with the results of the most recent research, which would lead to not recommend the use of this pain reliever in pregnancy, if not for the treatment of serious feverish states, and on the indication of the doctor. There is something true? Or is it just the last madness of the current American administration?
The causes of autism
Many research in recent years have investigated the possible environmental causes of autism. Looking for a factor external to genetics, which can explain the apparent increase in the diagnosis of autism spectrum disorders recorded in recent decades a bit in all developed countries. Exposure to drugs and chemicals during the crucial phases of embryonic development is one of the possibilities brought up more often. And among these, vaccines and over -the -counter drugs are those who are most likely to be used by mothers during gestation, or by infants in the first months of life.
Despite the efforts of the No Vax movement – and with all due respect to the current American health secretary Robert Kennedy – no research has ever confirmed the link between vaccines and autism. The discussion is different as regards the paracetamol: the drug, studied because it was considered the pain reliever and antipyretic adoption for pregnant women, has in fact actually connected to an increase in the incidence of autistic spectrum disorders by different research. And the possible link has recently been confirmed by a wide systematic revision of the scientific literature created by a group of researchers led by the Italian Andrea Baccarelli, principal and professor of environmental health of the Harvard That School of Public Health.
What the study says, really
Research is a systematic revision, that is, a examination of the scientific literature available on the relationship between paracetamol and autism, which evaluates the strength of each study to establish in which direction dot, and with what level of reliability, the data available today. In total, the research identified and analyzed was 46, relating to a total of over 100 thousand participants. And despite strong differences in the design of studies and in the results, according to the authors, the current scientific evidence would support a causal link between paracetamol and autism.
“Our results show that high quality studies are more likely to indicate a link between the prenatal exposure to the paracetamol and a uamented risk of autism and ADHD,” explained Diddier Prada, professor of environmental health of the ICAHN School of Mount Sinai Medicine in a press release released in August, on the occasion of the publication of the study in the magazine BMC Environmental Health. “And given the wide diffusion of this medicine, even a small increase in risk can have enormous implications in terms of public health.”
How to interpret the results?
The research led by Baccarelli and colleagues is a serious job, and aims at a possible link between paracetamol and autism. But it is important to understand what kind of research we are talking: epidemiological studies in such cases are necessarily observational studies, in which the statistical force of the link between a variable and a potential health result is analyzed. By their nature, they cannot demonstrate the association, but only to suggest it: in order to have a certainty, a randomized clinical study should be carried out, taking thousands of pregnant women, administering paracetaman in the middle of them, and then counting how many children with autistic spectrum disorders are born in one and the other group. Clearly it cannot be done, and therefore the available studies, as well as the systematic reviews that are based on them, can only suggest how probable the association between paracetamol and autism is likely.
In support of the biological plausibility of this association, Baccarelli and colleagues cite the fact – demonstrated – that paracetamol can overcome the placenta. And that several laboratory research reveal that it can induce oxidative stress, interfere with the action of hormones and with the neural development in the fetal phase, all circumstances that could explain the increase in cases of autism in children who are exposed to you in the embryonic phase. Not only that: paracetamol is currently the first choice pain reliever during pregnancy, and in the last decade there would have been an increase of 20 times of the new diagnoses of autism, temporal coincidence – according to Harvard researchers – not to be underestimated.
So what to do?
Before considering the question closed, it is good to keep in mind that all the systematic review has important limits. The main one, that all the research analyzed cannot certain in a certain way that the association that emerged between paracetamol and autism is linked not to the medicine, but rather to the underlying causes that push to take it: it could in fact be the infection or the painful state that pushes women to take the paracetamanla to represent a risk factor for the unborn child, a possibility not less plausible from a biological point of view.
Another not obvious aspect is that there is an epidemic of autism of which to seek the cause: if the increase in diagnoses in the last 10 years is in fact certain, that this actually represents an increase in the diffusion of neurosviluppo problems among the youngest is much less. Several experts and different research indicates that the most probable explanation is another: the change in the diagnostic criteria that took place just about ten years ago, which brings together a multiplicity of symptoms under the definition of spectrum disorders that once would not have been associated with autism, combined with the increase in awareness that they have parents, teachers and healthcare personnel compared to this kind of problems, and that probably helps to intercept many cases unnoticed and would never have had a diagnosis.
Because the cases of autism are increasing
That’s not all. There are several systematic research and revisions, even recent (the last is February of this year), which deny the link between paracetamol in pregnancy and autism. And also in the research in which the link emerges, the increase in risk is really minimal. Alternatives to paracetamol, moreover, at the moment there are not: the other great class of bench painkillers and antipyretic, non -steroidal anti -inflammatory (NSAIDs) such as ibuprofen, in fact, they place even more serious risks for fetal health if taken during pregnancy. For this reason, the indication of Harvard researchers is to reduce, if possible, the use of paracetamol when you are pregnant, reserving it for the treatment of high fever and on the advice of your doctor.
The new indications of the American Health Department go in this direction. Trump, with the usual arrogance, went further, exhorting women to hold on, because withstanding fever and pain without drugs would have no side effects, and warning to administer paracetamol to newborns even after childbirth. Both indications are incorrect, and dangerous: high fever in pregnancy can place concrete risks for the fetus, which only a doctor can evaluate in relation to those (hypothetical) placed by paracetamol that is used to lower it. The same goes for children and babies, with the addition that in this case there is no research that indicates the possibility that taking paracetamol at the end of fetal development affects the risk of developing a neurosviluppo disorder.
Meanwhile, the European Agency for Medicines (EMA) has denied that there are new tests that require changes to current recommendations on the use of paracetamol during pregnancy.
“The available tests have not found any connection between the use of paracetamol during pregnancy and autism”
European Agency for Medicines
Ema added that paracetamol can be used during pregnancy when necessary, carefully not to abuse it, using effective dose and with the lower frequency.
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