Prenatal Exposure to Paracetamol and Asthma Development

Paracetamol is widely regarded as a safe and effective analgesic and antipyretic during pregnancy, yet a growing body of observational research has linked in utero exposure to an elevated risk of wheezing and asthma in childhood. The hypothesised biological mechanism centres on the metabolism of paracetamol via hepatic pathways that deplete glutathione and induce oxidative stress in developing foetal lung tissue. Epidemiological cohorts from diverse populations have consistently reported modest but significant increases in asthma incidence and recurrent wheeze among offspring of mothers who used paracetamol, though the strength of association varies by timing, dosage and adjustment for maternal infections or co-medications. Animal studies have yielded conflicting results: some neonatal models suggest augmented airway inflammation after prenatal dosing, while others demonstrate no effect on allergic airways disease. Overall, the relationship remains unresolved, with concerns that confounding factors—such as indications for paracetamol use and co-exposures—may explain much of the observed association. Given the global prevalence of both maternal analgesic use and paediatric asthma, rigorous assessment of benefit–risk balance and guidance on minimal effective dosing are of high public health importance.

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Prenatal Exposure to Paracetamol and Asthma Development publication trend

The graph below shows the total number of articles in prenatal exposure to paracetamol and asthma development across all publications each year (not limited to Nature Index journals).

Technical terms

Paracetamol: A commonly used analgesic and antipyretic agent metabolised in the liver.

Wheeze: A high-pitched whistling sound during breathing, often indicative of airway narrowing.

Oxidative stress: A state in which reactive oxygen species exceed antioxidant defences, potentially damaging cellular structures.

Confounding: Distortion of an observed association due to a third variable related to both exposure and outcome.

Airway hyper-responsiveness: An exaggerated bronchoconstrictive response to stimuli, characteristic of asthma.

References

1. Prenatal Paracetamol Exposure and Wheezing in Childhood: Causation or Confounding?. PLOS ONE (2015).
2. Perinatal paracetamol exposure in mice does not affect the development of allergic airways disease in early life. Thorax (2015).
3. Effects of Prenatal Paracetamol Exposure on the Development of Asthma and Wheezing in Childhood: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine (2023).