2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:T4b3,Of the 2 092 926 singleton births between 2004 and 2015, 48.3% (n = 1 012 159) were born to mothers with at least 2 acetaminophen prescriptions during pregnancy. In the full cohort ASD dataset (N = 2 092 926), 23 557 children (1.1%) had ASD, and in the full ADHD dataset (N = 2 079 935), 116 387 children (5.6%) had ADHD. In the full cohort, offspring ADHD and ASDs were associated with prenatal prescriptions to acetaminophen, with associations noted for higher frequencies of acetaminophen use or higher mean daily dispensed doses of acetaminophen. In sibling-matched analyses, the associations between prenatal exposures to acetaminophen and ADHD and ASDs among offspring were null. However, a positive association was observed when only the older sibling was exposed (HR, 1.33 [95% CI, 1.17-1.52] for ADHD; HR, 1.75 [95% CI, 1.29-2.36] for ASDs), and a negative association was observed when only the younger sibling was exposed (HR, 0.75 [95% CI, 0.67-0.84] for ADHD; HR, 0.74 [95% CI, 0.57-0.96] for ASDs). The divergence of associations persisted in the bidirectional analyses of higher frequencies of acetaminophen use or higher mean daily doses of acetaminophen.31:Ta36,Whether maternal use of acetaminophen during pregnancy is associated with offspring's neurodevelopment remains debated. To evaluate the associations of maternal prenatal prescriptions of acetaminophen with attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorders (ASDs) among offspring. This cohort study analyzed 2 092 926 singleton births between 2004 and 2015 in Taiwan, with 1 231 819 having at least 1 sibling. Estimated hazard ratios (HRs) and 95% CIs were examined for offspring ADHD or ASDs according to prenatal acetaminophen prescriptions, adjusting for confounding factors. Prescriptions of acetaminophen were extracted from the National Health Insurance Research Database (NHIRD). Acetaminophen use was defined as having at least 2 dispense records during pregnancy, and the total number of prescriptions and the estimated mean daily dispensed dose were examined. The primary outcome was ascertaining diagnoses of ADHD and ASDs from the NHIRD. Of the 2 092 926 singleton births between 2004 and 2015, 48.3% (n = 1 012 159) were born to mothers with at least 2 acetaminophen prescriptions during pregnancy. In the full cohort ASD dataset (N = 2 092 926), 23 557 children (1.1%) had ASD, and in the full ADHD dataset (N = 2 079 935), 116 387 children (5.6%) had ADHD. In the full cohort, offspring ADHD and ASDs were associated with prenatal prescriptions to acetaminophen, with associations noted for higher frequencies of acetaminophen use or higher mean daily dispensed doses of acetaminophen. In sibling-matched analyses, the associations between prenatal exposures to acetaminophen and ADHD and ASDs among offspring were null. However, a positive association was observed when only the older sibling was exposed (HR, 1.33 [95% CI, 1.17-1.52] for ADHD; HR, 1.75 [95% CI, 1.29-2.36] for ASDs), and a negative association was observed when only the younger sibling was exposed (HR, 0.75 [95% CI, 0.67-0.84] for ADHD; HR, 0.74 [95% CI, 0.57-0.96] for ASDs). The divergence of associations persisted in the bidirectional analyses of higher frequencies of acetaminophen use or higher mean daily doses of acetaminophen. The findings of this cohort study in Taiwan suggest that positive associations were observed between maternal prenatal acetaminophen prescriptions and offspring's ADHD or ASDs in the full cohort but not in the sibling-matched analyses. A substantial divergence in associations in the sibling bidirectional analyses indicates unaddressed sources of bias and prevents firm conclusions from being drawn using the sibling design.32:Tf09, Importance Whether maternal use of acetaminophen during pregnancy is associated with offspring’s neurodevelopment remains debated. Objective To evaluate the associations of maternal prenatal prescriptions of acetaminophen with attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorders (ASDs) among offspring. Design, Setting, Participants This cohort study analyzed 2 092 926 singleton births between 2004 and 2015 in Taiwan, with 1 231 819 having at least 1 sibling. Estimated hazard ratios (HRs) and 95% CIs were examined for offspring ADHD or ASDs according to prenatal acetaminophen prescriptions, adjusting for confounding factors. Exposure Prescriptions of acetaminophen were extracted from the National Health Insurance Research Database (NHIRD). Acetaminophen use was defined as having at least 2 dispense records during pregnancy, and the total number of prescriptions and the estimated mean daily dispensed dose were examined. Main Outcomes and Measures The primary outcome was ascertaining diagnoses of ADHD and ASDs from the NHIRD. Results Of the 2 092 926 singleton births between 2004 and 2015, 48.3% (n = 1 012 159) were born to mothers with at least 2 acetaminophen prescriptions during pregnancy. In the full cohort ASD dataset (N = 2 092 926), 23 557 children (1.1%) had ASD, and in the full ADHD dataset (N = 2 079 935), 116 387 children (5.6%) had ADHD. In the full cohort, offspring ADHD and ASDs were associated with prenatal prescriptions to acetaminophen, with associations noted for higher frequencies of acetaminophen use or higher mean daily dispensed doses of acetaminophen. In sibling-matched analyses, the associations between prenatal exposures to acetaminophen and ADHD and ASDs among offspring were null. However, a positive association was observed when only the older sibling was exposed (HR, 1.33 [95% CI, 1.17-1.52] for ADHD; HR, 1.75 [95% CI, 1.29-2.36] for ASDs), and a negative association was observed when only the younger sibling was exposed (HR, 0.75 [95% CI, 0.67-0.84] for ADHD; HR, 0.74 [95% CI, 0.57-0.96] for ASDs). The divergence of associations persisted in the bidirectional analyses of higher frequencies of acetaminophen use or higher mean daily doses of acetaminophen. Conclusions and Relevance The findings of this cohort study in Taiwan suggest that positive associations were observed between maternal prenatal acetaminophen prescriptions and offspring’s ADHD or ASDs in the full cohort but not in the sibling-matched analyses. A substantial divergence in associations in the sibling bidirectional analyses indicates unaddressed sources of bias and prevents firm conclusions from being drawn using the sibling design. 25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"Analgesic: modality Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on Analgesic (modality). Clinician-written summaries and actionable practice insights. 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Over 80% required inpatient hospitalization. APAP-alone was the leading xenobiotic (males: 33%, females: 45%), with APAP-alone exposures surging 349% (males) and 380% (females), even as APAP-combination products fell 60–85% after early-2010s regulatory actions.","limitations":"Retrospective surveillance data rely on voluntary poison center reporting, which may undercount cases not routed through poison centers. Biochemical thresholds (AST/ALT >100 U/L) used to define liver injury may not capture full clinical severity spectrum. Intent and substance attribution are self- or reporter-classified, introducing possible misclassification.","practice_takeaway":"Clinicians should recognize APAP-alone as the dominant and rising driver of drug-induced liver injury, even as combination APAP products have declined — reinforce counseling on total daily APAP dose across all products. Poison center surveillance is a practical, real-time resource for tracking hepatotoxic trends and guiding prevention."}},{"doi":"10.1001/jamainternmed.2026.2215","pmid":"42371637","title":"Prenatal Acetaminophen (Paracetamol) Use and the Risk of Autism and/or Attention-Deficit/Hyperactivity Disorder Among Sibling-Matched Cohorts","journal_title":"JAMA Internal Medicine","journal_issn":"2168-6106","published_at":"2026-06-29T00:00:00.000Z","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13316715/","source_score":197,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-04T13:26:19.070Z","updated_at":"2026-07-04T13:26:19.070Z","tags":[{"paper_doi":"10.1001/jamainternmed.2026.2215","tag_type":"age_group","value":"pediatric","value_numeric":null},{"paper_doi":"10.1001/jamainternmed.2026.2215","tag_type":"category","value":"Medicine, General & Internal","value_numeric":null},{"paper_doi":"10.1001/jamainternmed.2026.2215","tag_type":"condition","value":"Attention-Deficit/Hyperactivity Disorder","value_numeric":null},{"paper_doi":"10.1001/jamainternmed.2026.2215","tag_type":"condition","value":"Autism Spectrum Disorder","value_numeric":null},{"paper_doi":"10.1001/jamainternmed.2026.2215","tag_type":"generic","value":"acetaminophen","value_numeric":null},{"paper_doi":"10.1001/jamainternmed.2026.2215","tag_type":"generic","value":"atomoxetine","value_numeric":null},{"paper_doi":"10.1001/jamainternmed.2026.2215","tag_type":"generic","value":"lisdexamfetamine","value_numeric":null},{"paper_doi":"10.1001/jamainternmed.2026.2215","tag_type":"generic","value":"methylphenidate","value_numeric":null},{"paper_doi":"10.1001/jamainternmed.2026.2215","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1001/jamainternmed.2026.2215","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1001/jamainternmed.2026.2215","tag_type":"modality","value":"Analgesic","value_numeric":null},{"paper_doi":"10.1001/jamainternmed.2026.2215","tag_type":"modality","value":"Antipyretic","value_numeric":null},{"paper_doi":"10.1001/jamainternmed.2026.2215","tag_type":"sample_size","value":"n=708020","value_numeric":708020},{"paper_doi":"10.1001/jamainternmed.2026.2215","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1001/jamainternmed.2026.2215","tag_type":"study_design","value":"Sibling-Matched Cohort Study","value_numeric":null},{"paper_doi":"10.1001/jamainternmed.2026.2215","tag_type":"warning","value":"Full text was not accessible (publisher redirect); summary is based solely on the abstract and results excerpt provided.","value_numeric":null},{"paper_doi":"10.1001/jamainternmed.2026.2215","tag_type":"warning","value":"Level of evidence assigned as 3 (cohort study with active confounding control via sibling matching); some reviewers may rate this higher given the triangulation framework and large sample.","value_numeric":null},{"paper_doi":"10.1001/jamainternmed.2026.2215","tag_type":"warning","value":"The sample_size tag reflects the initial mother-child cohort (708,020); the analytic cohorts differ by outcome (124,333 for ASD; 97,285 for ADHD)—both are noted in the summary.","value_numeric":null}],"summaries":{"what_studied":"This population-based sibling-matched cohort study (Hong Kong, 2001–2023) assessed whether prenatal acetaminophen (paracetamol) exposure—identified from electronic dispensing records—was associated with incident ASD or ADHD diagnoses in offspring, using within-family comparison to control for unmeasured familial confounding.","key_result":"In sibling-matched analyses (n=124,333 for ASD; n=97,285 for ADHD), prenatal paracetamol exposure was not associated with ASD (aHR 1.00; 95% CI, 0.91–1.11) or ADHD (aHR 1.01; 95% CI, 0.93–1.08); null findings held across all exposure timings, cumulative doses, and usage patterns. Positive associations seen in conventional (unmatched) cohort analyses were replicated by negative control analyses using *prepregnancy* exposure (ASD HR 1.12; ADHD HR 1.24), strongly implicating familial confounding as the driver of prior positive signals.","limitations":"- Study is observational; sibling-matching controls familial confounding but cannot rule out all residual confounding.\n- Exposure ascertained from dispensing records only—actual consumption and over-the-counter use are not captured.\n- Findings are from a single health system in Hong Kong and may not generalize to other populations.","practice_takeaway":"Clinicians can reassure pregnant patients that indicated paracetamol use does not appear to raise the risk of ASD or ADHD in their children—prior observational signals were likely driven by shared family factors, not the drug itself. The guidance to use paracetamol at the lowest effective dose for the shortest necessary duration during pregnancy remains prudent but need not be motivated by neurodevelopmental concerns."}},{"doi":"10.1016/j.annemergmed.2026.03.029","pmid":"42138680","title":"Intravenous Magnesium Sulfate for Acute Nontraumatic Headache in the Emergency Department","journal_title":"Annals of Emergency Medicine","journal_issn":"0196-0644","published_at":"2026-05-15T00:00:00.000Z","url":"https://doi.org/10.1016/j.annemergmed.2026.03.029","source_score":1,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-22T13:22:20.280Z","updated_at":"2026-05-22T13:22:20.280Z","tags":[{"paper_doi":"10.1016/j.annemergmed.2026.03.029","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.03.029","tag_type":"category","value":"Emergency Medicine","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.03.029","tag_type":"condition","value":"Acute Nontraumatic Headache","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.03.029","tag_type":"generic","value":"acetaminophen","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.03.029","tag_type":"generic","value":"magnesium sulfate","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.03.029","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.03.029","tag_type":"level_of_evidence","value":"1","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.03.029","tag_type":"modality","value":"Analgesic","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.03.029","tag_type":"modality","value":"Magnesium Supplementation","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.03.029","tag_type":"sample_size","value":"n=1028","value_numeric":1028},{"paper_doi":"10.1016/j.annemergmed.2026.03.029","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.03.029","tag_type":"study_design","value":"Randomized Controlled Trial","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.03.029","tag_type":"warning","value":"Full text was unavailable; all data are drawn from the abstract only — adverse event types, baseline NRS scores, and headache subtype breakdowns cannot be verified.","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.03.029","tag_type":"warning","value":"Statistical significance was achieved for several outcomes, but the authors explicitly note NRS differences did not meet the accepted 1.3-point clinical importance threshold — clinicians should weigh statistical vs. clinical significance carefully.","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.03.029","tag_type":"warning","value":"The study does not distinguish between headache subtypes (e.g., migraine vs. tension-type), so results may not apply uniformly across headache diagnoses.","value_numeric":null}],"summaries":{"what_studied":"This double-blind RCT evaluated whether adding IV magnesium sulfate (MgSO4 2 g over 30 min) to 1 g oral paracetamol improves pain relief vs. paracetamol + placebo saline in adult ED patients with acute nontraumatic headache; primary outcome was ≥30% NRS reduction at 30 minutes.","key_result":"Treatment success was higher with MgSO4 (78.9% vs. 65.1%; difference 13.8%, 95% CI 8–19%), and rescue analgesia was needed less often (7.1% vs. 15.3%; difference −8.2%, 95% CI −12 to −4.3%); however, all NRS score differences fell below the accepted 1.3-point threshold for clinical importance, and adverse events were modestly more frequent with MgSO4 (15.4% vs. 11.1%).","limitations":"- All NRS differences were below the 1.3-point threshold for clinical importance, raising questions about real-world benefit.\n- Headache subtypes (migraine, tension-type, etc.) were not separately analyzed, limiting subgroup-specific guidance.\n- Full-text was unavailable; details on blinding fidelity, baseline NRS scores, and adverse event characterization are not verifiable from the abstract alone.","practice_takeaway":"IV MgSO4 added to paracetamol reduces rescue analgesia needs and modestly improves patient satisfaction, but pain score improvements fall below clinically important thresholds — consider it as an adjunct when rescue analgesia is a concern, weighing its mild but significantly increased side effect rate."}},{"doi":"10.1001/jamapediatrics.2026.0646","pmid":"41973453","title":"Acetaminophen Exposure During Pregnancy and the Risk of Autism in Offspring","journal_title":"JAMA Pediatrics","journal_issn":"2168-6203","published_at":"2026-04-13T00:00:00.000Z","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13077571/","source_score":595,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-07T22:49:18.764Z","updated_at":"2026-05-07T22:49:18.764Z","tags":[{"paper_doi":"10.1001/jamapediatrics.2026.0646","tag_type":"age_group","value":"pediatric","value_numeric":null},{"paper_doi":"10.1001/jamapediatrics.2026.0646","tag_type":"category","value":"Pediatrics","value_numeric":null},{"paper_doi":"10.1001/jamapediatrics.2026.0646","tag_type":"condition","value":"Autism Spectrum Disorder","value_numeric":null},{"paper_doi":"10.1001/jamapediatrics.2026.0646","tag_type":"condition","value":"Prenatal Acetaminophen Exposure","value_numeric":null},{"paper_doi":"10.1001/jamapediatrics.2026.0646","tag_type":"generic","value":"acetaminophen","value_numeric":null},{"paper_doi":"10.1001/jamapediatrics.2026.0646","tag_type":"impact_flag","value":"safety_signal","value_numeric":null},{"paper_doi":"10.1001/jamapediatrics.2026.0646","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1001/jamapediatrics.2026.0646","tag_type":"modality","value":"Analgesic","value_numeric":null},{"paper_doi":"10.1001/jamapediatrics.2026.0646","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1001/jamapediatrics.2026.0646","tag_type":"study_design","value":"Cohort Study","value_numeric":null},{"paper_doi":"10.1001/jamapediatrics.2026.0646","tag_type":"warning","value":"Level of evidence assigned as 3 (cohort study) based on study design; this may vary depending on specific methodological quality not detailed in the abstract.","value_numeric":null},{"paper_doi":"10.1001/jamapediatrics.2026.0646","tag_type":"warning","value":"Sample size tag omitted as no participant count was reported in the source text.","value_numeric":null},{"paper_doi":"10.1001/jamapediatrics.2026.0646","tag_type":"warning","value":"The abstract provides only minimal detail; specific effect sizes, sample size, confidence intervals, and covariate adjustments are not available from the provided text — key result summary reflects this limitation.","value_numeric":null}],"summaries":{"what_studied":"This cohort study examined whether prenatal acetaminophen (paracetamol) exposure is associated with increased risk of autism spectrum disorder (ASD) in offspring, using Danish national register data.","key_result":"The study evaluated the association between acetaminophen use during pregnancy and ASD diagnosis in children; specific effect estimates are not detailed in the abstract alone.","limitations":"Findings are based on register data, which may introduce exposure misclassification (e.g., self-reported or dispensed medication vs. actual use); residual confounding from underlying maternal conditions (e.g., fever, pain) cannot be excluded; generalizability beyond the Danish population is uncertain.","practice_takeaway":"Clinicians counseling pregnant patients on acetaminophen use should be aware of ongoing research on neurodevelopmental risks, while weighing untreated pain or fever against potential fetal exposure. Current evidence does not yet support a definitive change in prescribing guidance, but shared decision-making is warranted."}},{"doi":"10.1001/jamapediatrics.2026.0071","pmid":"41801232","title":"Maternal Acetaminophen Use and Child Neurodevelopment","journal_title":"JAMA Pediatrics","journal_issn":"2168-6203","published_at":"2026-03-09T00:00:00.000Z","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC12973218/","source_score":79,"is_retracted":false,"is_open_access":true,"raw_metadata":{"ooir":{"day":"2026-05-06","doi":"10.1001/jamapediatrics.2026.0071","days":"14","issn":"2168-6203","rank":"8","field":"Clinical Medicine","score":"79","category":"Pediatrics","categories":["Pediatrics"],"_categories":["Pediatrics"]},"pubmed":{"doi":"10.1001/jamapediatrics.2026.0071","title":"Maternal Acetaminophen Use and Child Neurodevelopment.","journal":"JAMA pediatrics","methods":"","results":"$30","abstract":"$31","keywords":[],"pubmed_id":"41801232","conclusions":"","publication_date":"2026-03-09T00:00:00"},"crossref":{"DOI":"10.1001/jamapediatrics.2026.0071","URL":"https://doi.org/10.1001/jamapediatrics.2026.0071","ISSN":["2168-6203"],"link":[{"URL":"https://jamanetwork.com/journals/jamapediatrics/articlepdf/2845519/jamapediatrics_lee_2026_oi_260002_1777584358.33555.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"page":"527","type":"journal-article","issue":"5","score":1,"title":["Maternal Acetaminophen Use and Child Neurodevelopment"],"author":[{"given":"Pei-Chen","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan"}]},{"given":"Yu-Hsuan","family":"Chuang","sequence":"additional","affiliation":[{"name":"Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan"}]},{"given":"Ya-Hui","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan"}]},{"given":"Chia-Ni","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan"}]},{"given":"Chung-Yi","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan"}]},{"given":"Ying-Yeh","family":"Chen","sequence":"additional","affiliation":[{"name":"Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan"},{"name":"Institute of Public Health, Department of Public Health, National Yang-Ming University, Taipei, Taiwan"}]},{"given":"Julia E.","family":"Heck","sequence":"additional","affiliation":[{"name":"College of Health and Public Service, College of Health Sciences, University of North Texas, Denton"},{"name":"Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles"}]},{"given":"Giselle","family":"Bellia","sequence":"additional","affiliation":[{"name":"Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut"},{"name":"Yale Center for Perinatal, Pediatric, and Environmental Epidemiology, Yale School of Public Health, New Haven, Connecticut"}]},{"given":"Haoran","family":"Zhuo","sequence":"additional","affiliation":[{"name":"Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut"},{"name":"Yale Center for Perinatal, Pediatric, and Environmental Epidemiology, Yale School of Public Health, New Haven, Connecticut"}]},{"given":"Onyebuchi A.","family":"Arah","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los 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which may be substantial — was not captured, potentially underestimating true exposure.","value_numeric":null},{"paper_doi":"10.1001/jamapediatrics.2026.0071","tag_type":"warning","value":"Level of evidence assigned as 3 (observational cohort); the sibling-matched component adds methodological rigor but does not resolve all confounding given the bidirectional divergence.","value_numeric":null},{"paper_doi":"10.1001/jamapediatrics.2026.0071","tag_type":"warning","value":"The sibling bidirectional analysis shows a paradoxical divergence in risk direction (older vs. younger exposed sibling), which the authors flag as indicating unresolved bias — conclusions from either the full-cohort or sibling design should be interpreted with caution.","value_numeric":null}],"summaries":{"what_studied":"This large Taiwanese cohort study (N = 2,092,926 singleton births, 2004–2015) examined whether maternal prenatal acetaminophen prescriptions (≥2 dispenses during pregnancy) were associated with offspring ADHD and autism spectrum disorder (ASD), using both full-cohort and sibling-matched designs.","key_result":"In the full cohort, prenatal acetaminophen was positively associated with offspring ADHD (5.6% prevalence) and ASD (1.1% prevalence), with stronger associations at higher doses/frequencies. However, sibling-matched analyses showed **null** associations. Sibling bidirectional analyses revealed a divergence: older exposed siblings had higher risk (HR 1.33 [95% CI 1.17–1.52] for ADHD; HR 1.75 [95% CI 1.29–2.36] for ASD), while younger exposed siblings had lower risk (HR 0.75 [95% CI 0.67–0.84] for ADHD; HR 0.74 [95% CI 0.57–0.96] for ASD), indicating residual bias rather than a causal effect.","limitations":"- Sibling bidirectional analysis revealed substantial unexplained divergence, meaning neither the full-cohort nor the sibling-matched estimates can be taken at face value.\n- Acetaminophen exposure was defined by prescription records, not actual consumption, and does not capture over-the-counter use.\n- Study is limited to a single national database (Taiwan NHIRD), which may limit generalizability.","practice_takeaway":"The sibling-controlled analyses do not support a causal link between prenatal acetaminophen use and offspring ADHD or ASD — the full-cohort association appears driven by unaddressed confounding. Clinicians should not use this study alone as grounds to restrict medically indicated acetaminophen use in pregnancy."}}],"initialOffset":5,"fetchConfig":{"kind":"tags","tags":[{"tag_type":"modality","value":"Analgesic"}]},"breadcrumbItems":[{"name":"Home","href":"/"},{"name":"Research Hub","href":"/hub"},{"name":"Modalities","href":"/hub/tag/modality"},{"name":"Analgesic"}],"hrefConfig":{"basePath":"/hub/papers","webViewQueryParams":{"hub_ctx":"tag","hub_tag_type":"modality","hub_tag_value":"Analgesic"}}}]]

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