Editing Paracetamol (section)

===Use in pregnancy===
Paracetamol safety in pregnancy has been under increased scrutiny. There appears to be no link between paracetamol use in the first trimester and adverse pregnancy outcomes or [[birth defects]]. However, indications exist of a possible increase in the risk of asthma and developmental and reproductive disorders in the offspring of women with prolonged use of paracetamol during pregnancy.<ref name="pmid29863746"/>

Paracetamol use by the mother during pregnancy is associated with an increased risk of childhood [[asthma]],<ref>{{cite journal| vauthors=Eyers S, Weatherall M, Jefferies S, Beasley R |title=Paracetamol in pregnancy and the risk of wheezing in offspring: a systematic review and meta-analysis|journal=Clinical and Experimental Allergy |date= April 2011|volume=41|issue=4|pages=482–9|pmid=21338428|doi=10.1111/j.1365-2222.2010.03691.x |s2cid=205275267}}</ref><ref name="pmid28237129">{{cite journal |vauthors=Fan G, Wang B, Liu C, Li D |title=Prenatal paracetamol use and asthma in childhood: A systematic review and meta-analysis |journal=Allergol Immunopathol (Madr) |volume=45 |issue=6 |pages=528–533 |date=2017 |pmid=28237129 |doi=10.1016/j.aller.2016.10.014}}</ref> but so are the maternal infections for which paracetamol may be used, and separating these influences is difficult.<ref name="pmid29863746"/> Paracetamol, in a small-scale meta-analysis was also associated with a 20{{ndash}}30% increase in [[autism spectrum disorder]], [[attention deficit hyperactivity disorder]], and [[conduct disorder]], with the association being lower in a meta-analysis where a larger demographic was used, but it is unclear whether this is a causal relationship and whether there was potential bias in the findings.<ref name="pmid29863746"/><ref name="pmid29688261">{{cite journal |vauthors=Masarwa R, Levine H, Gorelik E, Reif S, Perlman A, Matok I |title= Prenatal Exposure to Acetaminophen and Risk for Attention Deficit Hyperactivity Disorder and Autistic Spectrum Disorder: A Systematic Review, Meta-Analysis, and Meta-Regression Analysis of Cohort Studies |journal=Am J Epidemiol |volume=187 |issue=8 |pages=1817–1827 |date=August 2018 |pmid=29688261 |doi=10.1093/aje/kwy086 |doi-access= free |title-link = doi }}</ref><ref name="pmid31664451">{{cite journal |vauthors=Ji Y, Azuine RE, Zhang Y, Hou W, Hong X, Wang G, Riley A, Pearson C, Zuckerman B, Wang X |title= Association of Cord Plasma Biomarkers of In Utero Acetaminophen Exposure With Risk of Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorder in Childhood |journal=JAMA Psychiatry |volume=77 |issue=2 |pages=180–189 |date=February 2020 |pmid=31664451 |pmc=6822099 |doi=10.1001/jamapsychiatry.2019.3259}}</ref> There is also an argument that the large number, consistency, and robust designs of the studies provide strong evidence in favor of paracetamol causing the increased risk of these neurodevelopmental disorders.<ref name="pmid29341895">{{cite journal |vauthors=Bauer AZ, Kriebel D, Herbert MR, Bornehag CG, Swan SH |title=Prenatal paracetamol exposure and child neurodevelopment: A review |journal=Horm Behav |volume=101 |issue= |pages=125–147 |date=May 2018 |pmid=29341895 |doi=10.1016/j.yhbeh.2018.01.003 |s2cid=4822468}}</ref><ref name="pmid30654621">{{cite journal |vauthors=Gou X, Wang Y, Tang Y, Qu Y, Tang J, Shi J, Xiao D, Mu D |title=Association of maternal prenatal acetaminophen use with the risk of attention deficit/hyperactivity disorder in offspring: A meta-analysis |journal=Aust N Z J Psychiatry |volume=53 |issue=3 |pages=195–206 |date=March 2019 |pmid= 30654621 |doi=10.1177/0004867418823276 |s2cid=58575048}}</ref> In animal experiments, paracetamol disrupts fetal [[testosterone]] production, and several epidemiological studies linked [[cryptorchidism]] with mother's paracetamol use for more than two weeks in the second trimester. On the other hand, several studies did not find any association.<ref name="pmid29863746"/>

The consensus recommendation appears to be to avoid prolonged use of paracetamol in pregnancy and use it only when necessary, at the lowest effective dosage, and for the shortest time.<ref name="pmid29863746"/><ref name="pmid28986045">{{cite journal |vauthors=Toda K |title=Is acetaminophen safe in pregnancy? |journal=Scand J Pain |volume=17 |issue= |pages=445–446 |date=October 2017 |pmid=28986045 |doi=10.1016/j.sjpain.2017.09.007 |s2cid=205183310}}</ref><ref name="pmid31242344">{{cite journal |vauthors=Black E, Khor KE, Kennedy D, Chutatape A, Sharma S, Vancaillie T, Demirkol A |title=Medication Use and Pain Management in Pregnancy: A Critical Review |journal=Pain Pract |volume=19 |issue=8 |pages=875–899 |date=November 2019 |pmid=31242344 |doi=10.1111/papr.12814 |s2cid=195694287}}</ref>

In pregnancy, paracetamol and [[metoclopramide]] are deemed safe as are NSAIDs until the [[third trimester]].<ref name="Gilmore2011">{{cite journal | vauthors = Gilmore B, Michael M | title = Treatment of acute migraine headache | journal = American Family Physician | volume = 83 | issue = 3 | pages = 271–280 | date = February 2011 | pmid = 21302868 }}</ref>