Could taking paracetamol in pregnancy make your child wheeze?
Concerns have been growing about an increase in the risk of asthma or allergy following exposure to paracetamol early in life. It has been noted that levels of allergic diseases in the Western world have risen concomitant to the increased use of paracetamol. 
A study has now looked at prenatal exposure to paracetamol in pre-school children with inhaled corticosteroid-treated wheeze.  Could it be the case that taking paracetamol during pregnancy would make your baby more likely to experience wheezy, asthma-like symptoms during infancy and childhood?
What do they mean by ‘wheeze’?
Well, the researchers were quite diligent in pinning down exactly which type of wheeze showed an association with medication taken during pregnancy. They started off by defining two types of wheeze: one experienced during a passing viral infection (e.g. a cold or chest infection); and the other experienced recurrently, not only with viral infections but also in between infections. They called this latter type ‘multiple-trigger wheeze’, and likened it to asthma.
To all intents and purposes, if your child is wheezing on a regular basis for no particular reason (they haven’t got something shoved up their nose and aren’t in a smoky environment, for example) then they are experiencing a symptom associated with asthma.
They further defined a recurrent wheeze that had been treated by a doctor with inhaled corticosteroids as being synonymous with doctor-diagnosed asthma, since those children have been evaluated by a doctor as being in need of the type of treatment given for asthma. This was also defined as a multiple-trigger wheeze, as it didn’t occur solely during an episode of viral infection.
Commonly prescribed inhaled corticosteroids include beclomethasone dipropionate and fluticasone propionate
So you’ve got your multiple-trigger wheeze, whether treated with inhaled corticosteroids or not, and your viral-induced wheeze, which is confined to those times when a bug has stricken your child snotty.
What were the results?
The researchers found that maternal use of paracetamol during pregnancy increased the risk of pre-school age children experiencing multiple-trigger wheeze that was treated by inhaled corticosteroids. In fact it more than doubled the risk. It didn’t make the children more likely to experience wheezing when affected by a virus (e.g. cold or chest infection), but did make them more likely to suffer generally from a wheeze. These children are more likely to develop allergic asthma as they grow up. 
So there’s a thought: is that paracetamol really necessary, or is your present headache bearable in comparison with the harassment of a wheezy child in years to come? Yet another maternal dilemma! At least now women can be certain that it is actually a possible factor in their child’s future health, and can make choices accordingly.
What are the alternatives?
Helpfully, there are options for women who want something to treat a minor discomfort such as a bruise, strain, muscle ache or pain, without having recourse to paracetamol. Topical herbal preparations can sometimes be used. For example, Arnica Gel is suitable for use during pregnancy and breast-feeding, so long as the mother has checked with her doctor or pharmacist. This is just to ensure that the pain is not something serious that has been mistaken for a mere passing ache: a sensible precaution, to check that mothers are taking care of themselves.
The study involved more than 8,000 families in Sweden. The mothers gave information as to their medication use during pregnancy, and then the children were assessed at 6 months, 12 months and 4.5 years old. They had to have had three or more episodes of wheezing or one episode of inhaled corticosteroid-treated wheezing during the preceding 12 months (or 6 months at the first assessment) in order to qualify as properly wheezy. The researchers adjusted the results to take into account maternal smoking during pregnancy and breast-feeding, and maternal antibiotic use during pregnancy (which would indicate maternal respiratory infection, to which the child might then be more prone) to avoid confusing the possible factors promoting wheezing.
 Farquhar H et al. Clin Exp Allergy 2010; 40: 32-41
 Goksor E et al Prenatal paracetamol exposure and risk of wheeze at preschool age. Acta Paediatrica, 2011; 100 (12): 1567 DOI: 10.1111/j.1651-2227.2011.02403.x
 Brand PL et al. Eur Respir J 2008; 32: 1096-1110
Author: Alison has worked in the health industry since 1987. Alison lectures & trains on health issues, and is often to be found quoted in health magazines.
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