JAMA Clinical Reviews From the JAMA Network: Acetaminophen Use in Pregnancy and Risk of Autism
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Sep 30, 2025 Epidemiologist Brian Lee from Drexel University discusses his groundbreaking study on acetaminophen use in pregnancy and its potential link to autism and neurodevelopmental issues. He delves into the study's findings that suggest initial associations may vanish when sibling analyses are considered, challenging the notion of causality. Lee also addresses the rigorous design of the study, the importance of dose-response analysis, and how clinicians can effectively counsel expectant mothers amidst conflicting advice. This engaging conversation demystifies critical concerns for parents.
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Sibling Analysis Reverses The Association
- The initial population-level association between prenatal acetaminophen and autism/ADHD disappeared in sibling-controlled analyses.
- This suggests shared familial factors, not acetaminophen itself, likely explain the apparent link.
Ice Cream And Drowning Analogy
- Dr. Lee used the ice cream-and-drowning analogy to explain confounding.
- He showed that a third factor (hot weather) explains the apparent link, similar to confounders in acetaminophen studies.
Prospective Exposure Strengthens Evidence
- Prospective exposure data reduced recall bias because acetaminophen use was collected during pregnancy.
- This strengthens confidence in exposure measurement compared with retrospective studies.