Prenatal over-the-counter acetaminophen use and birth outcomes in the ECHO Cohort
Year: 2026
Type: article
Study design: Observational Study
Abstract: Acetaminophen is among the most common over-the-counter medications used during pregnancy. Given inconsistent findings from both experimental and epidemiological studies on associations between use and adverse health outcomes, further research is warranted. To address this, our objective was to assess the relationship between prenatal acetaminophen use and birth outcomes. We studied 8957 mother-infant pairs from 36 pediatric study sites participating in the Environmental influences on Child Health Outcomes (ECHO) program. After imputation and inverse probability weighting, we used regression models to examine the relationship between acetaminophen during pregnancy and the following outcomes: (1) preterm birth, (2) birthweight, (3) small-for-gestational age (SGA), and (4) large-for-gestational-age (LGA). Approximately 59% of mothers reported using acetaminophen at any point during their pregnancy (n = 5257). After adjustment for relevant covariates, prenatal acetaminophen use was associated with lower odds of LGA (adjusted odds ratio [aOR]: 0.87; 95% CI: 0.79, 0.96). Prenatal acetaminophen use was not associated with preterm birth (aOR: 0.99; 95% CI: 0.86, 1.14), birthweight (aβ: -7.52 g; 95% CI: -27.80, 12.77) or SGA (aOR: 1.02; 95% CI: 0.88, 1.18). Based on these findings, future research should test for dose-response, trimester-specific exposures, and factors affecting individual responses.
Source: American Journal of Epidemiology
DOI: 10.1093/aje/kwag110
Authors: Katelyn K Huff, Noya Galai, Garrett Fuselier, Guojing Wu, Hadley J Hartwell, Catherine M Bulka, Margaret A Adgent, Akram N Alshawabkeh, Brennan H Baker, Maria M Talavera-Barber, Traci A Bekelman, Whitney Cowell, Zoe T Duberstein, Amy J Elliott, Daniel A Enquobahrie, Akhgar Ghassabian, Margaret R Karagas, Amber Kautz, Barry M Lester, Tengfei Ma, Cindy T McEvoy, Kimberly S McKee, John D Meeker, Ruby H N Nguyen, Thomas G O'Connor, Nigel Paneth, Wei Perng, Christina A Porucznik, Sheela Sathyanarayana, Hyagriv N Simhan, Shanna H Swan, Megan L Woodbury, Stephan Ehrhardt, T Michael O’Shea, Rebecca C Fry
Institutions: University of North Carolina at Chapel Hill, Johns Hopkins University, University of Haifa, University of South Florida, Vanderbilt University Medical Center, Northeastern University, University of Washington, Seattle Children's Research Institute, University of South Dakota, Avera McKennan Hospital & University Health Center, Colorado School of Public Health, New York University, University of Rochester, Dartmouth College, University of Rochester Medicine, Brown University, Women & Infants Hospital of Rhode Island, Michigan State University, Oregon Health & Science University, University of Michigan, University of Minnesota, University of Utah, University of Pittsburgh, Icahn School of Medicine at Mount Sinai
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,856
Awards: Childhood Allergy and the NeOnatal Environment (CANOE) ECHO Pediatric Follow-Up and New Enrollment, Mediators and Modifiers of Prenatal Environmental Exposures and Child Neurodevelopment: DNA methylation, Prenatal Diet, and Cognitive Stimulation (MEND), ECHO Renewal for the CANOE Study Cohort, Multi-omic approaches to mechanisms of vitamin D, environmental influences, and the microbiome on asthma, A South Carolina ECHO Pregnancy Cohort, Childhood Allergy and the NeOnatal Environment in St Louis (CANOE-STL) and the Impact of Wheezing Illnesses on Neurocognitive Development of Preschool Children, Developmental Impact of NICU Exposures (DINE) phase II, Prenatal and Early Childhood Pathways To Health: An Integrated Model of Chemical and Social Exposures, Biological Mechanisms, and Sex-Specific Effects on Neurodevelopment and Respiratory Outcomes, Minnesota HHEAR Targeted Analysis Laboratory, Early Life Stress and the Environmental Origins of Disease: a Population-based Prospective Longitudinal Study of Children in Rural Poverty (ECHO), Common and distinct early environmental influences on cardiometabolic and respiratory health: Mechanisms and methods, Environmental Influences on Child Health Outcomes (ECHO) and Pregnancy in Ohio, Wadsworth Center's Human Health and Exposure Analysis Resource (WC-HHEAR), Lifecourse Approach to Developmental Repercussions of Environmental Agents on Metabolic and Respiratory health (LA DREAMERs), Enriching ECHO Cohorts with High-risk Pregnancies and Children with Disabilities (Enriching ECHO), ECHO in Agricultural Washington and Rural Environments (ECHO AWARE), Developmental Impact of NICU Exposures (DINE), ECHO Renewal for the INSPIRE Study Cohort, Breaking the cycle of intergenerational disadvantage: neurodevelopment among Puerto Rican children., Prenatal Environment And Child Health (PEACH) in ECHO, Early Life Determinants of Child Health: A New Denver-Based Cohort, The Environmental Factors in FEtal to Childhood Trajectories Cohort, ENVIRONMENTAL INFLUENCES ON NEURODEVELOPMENTAL OUTCOME IN INFANTS BORN VERY PRETERM, The ECHO Minnesota Asian American and Pacific Islander Pre-Conception and Pregnancy Cohort, Penn-CHOP ECHO, New Jersey ECHO, Epidemiology of multimorbid pediatric atopic and airway diseases and the impact of prenatal maternal environmental exposures and placental epigenetics, Miami-ECHO: A Cohort of Mothers, Children and Fathers in Miami-Dade County, Retaining the diverse CANDLE cohort to advance ECHO Cohort solution-oriented research and identify early-life modifiable risk factors for obesity and mental health problems in children, Preconception and Prenatal Health Impacting Factors and Child Health, Utah Children's Project, Common Mechanisms linking Pre- and Post-Natal Exposures for Child Health Outcomes, Early Life Exposure to Endocrine Disrupting Chemicals and Child Growth, Adiposity, and Neurodevelopment, The NYU Children’s Health & Environment Study: an ECHO Cohort, Prenatal Exposures and Child Health Outcomes 2: A Statewide Study of Michigan Families, The Early Growth and Development Study Cohort of the ECHO Program, Atlanta ECHO Pediatric Cohort, Host genetics, early-life microbiome, and childhood asthma: MARC-43 Boston, Continued follow-up of the Vitamin C and Smoking in Pregnancy (VCSIP) cohorts through the ECHO consortium, focus on Echo-wide protocols, respiratory outcomes, airway function, and epigenetic changes, A prospective study of critical environmental exposures in formative early life that impact lifelong health in rural US children: the New Hampshire Birth Cohort Study, Environmental influences on Child Health Outcomes (ECHO) Coordinating Center, ASSESSING THE EVOLVING IMPACT OF EARLY LIFE EXPOSURES ON CHILD PHYSICAL HEALTH AND NEURODEVELOPMENT, Mount Sinai HHEAR Network Untargeted Lab Hub, The Illinois Kids Development Study ECHO Pregnancy and Pediatric Cohort, Resilience to prenatal stress: Implications for offspring health and neurodevelopment, Human Health Exposure Analysis Resource Core: Untargeted Analysis, Environmental influences on Child Health Outcomes in the Northern Plains PASS-ECHO Cohort, Revisiting ReCHARGE: ECHO Follow up on Middle Childhood and Adolescence, ECHO DAC (Environmental Influences on Child Health Outcomes Data Analysis Center), Wisconsin Infant Study Cohort (WISC) ECHO Pediatric Follow-Up, Human Health Exposure Analysis Resource (HHEAR): Coordinating Center, Mount Sinai HHEAR Network Targeted Lab Hub, Environment, Epigenetics, Neurodevelopment & Health of Extremely Preterm Children, ECHO-PROTECT Cohort Study Site in Puerto Rico, Environmental influences on Child Health Outcomes - 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OpenAlex ID: W7162031936