HEALTH

UCLA study questions acetaminophen safety in pregnant women

BY Michael Johnsen

LOS ANGELES — A long-term study by UCLA, in collaboration with the University of Aarhus in Denmark, has raised concerns about the use of acetaminophen during pregnancy, UCLA announced earlier this week.  

In a report in the current online edition of JAMA Pediatrics, researchers from the UCLA Fielding School of Public Health show that taking acetaminophen during pregnancy is associated with a higher risk in children of attention-deficity/hyperactivity disorder and hyperkinetic disorder.  

"The causes of ADHD and hyperkinetic disorder are not well understood, but both environmental and genetic factors clearly contribute," stated Beate Ritz, professor and chair of the department of epidemiology at the Fielding School and one of the senior authors of the paper. "We know there has been a rapid increase in childhood neurodevelopmental disorders, including ADHD, over the past decades, and it’s likely that the rise is not solely attributable to better diagnoses or parental awareness. It’s likely there are environmental components as well." 

"That gave us the motivation to search for environmental causes that are avoidable," added the University of Aarhus’ Jørn Olsen, another senior author and former chair of the UCLA. "Part of the neuropathology may already be present at birth, making exposures during pregnancy and/or infancy of particular interest. Because acetaminophen is the most commonly used medication for pain and fever during pregnancy, it was something we thought we should look at." 

The UCLA researchers used the Danish National Birth Cohort, a nationwide study of pregnancies and children, to examine pregnancy complications and diseases in offspring as a function of factors operating in early life. The cohort focuses especially on the side effects of medications and infections.

The researchers studied 64,322 children and mothers who were enrolled in the Danish cohort from 1996 to 2002. Acetaminophen use during pregnancy was determined using computer-assisted telephone interviews that were conducted up to three times during pregnancy and again six months after childbirth. 

The researchers next followed up with parents when their children reached the age of 7. They first asked parents about any behavioral problems in their children using the Strength and Difficulties Questionnaire, a standard behavioral screening questionnaire used by scientists. It assesses five domains, including emotional symptoms, conduct problems, hyperactivity, peer relationship and social behavior in children and adolescents between the ages of 4 years and 16 years.

In addition, they obtained diagnoses of hyperkinetic disorder among the cohort’s children (at an average age of 11) from the Danish National Hospital Registry or the Danish Psychiatric Central Registry. Last, they identified if ADHD medications, mainly Ritalin, were redeemed for the children using the Danish pharmaceutical prescription database.

More than half of all the mothers reported using acetaminophen while pregnant. The researchers found that children whose mothers used acetaminophen during pregnancy were at a 13% to 37% higher risk of later receiving a hospital diagnosis of hyperkinetic disorder, being treated with ADHD medications or having ADHD-like behaviors at age 7. The longer acetaminophen was taken — that is, into the second and third trimesters — the stronger the associations. The risks for hyperkinetic disorder/ADHD in children were elevated 50% or more when the mothers had used the common painkiller for more than 20 weeks in pregnancy.

"It’s known from animal data that acetaminophen is a hormone disruptor, and abnormal hormonal exposures in pregnancy may influence fetal brain development," Ritz said.

Acetaminophen can cross the placental barrier, Ritz noted, and it is plausible that acetaminophen may interrupt fetal brain development by interfering with maternal hormones or through neurotoxicity, such as the induction of oxidative stress, which can cause the death of neurons.

"We need further research to verify these findings, but if these results reflect causal associations, then acetaminophen should no longer be considered a ‘safe’ drug for use in pregnancy," Olsen said.

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Nutrisystem gearing for national retail launch

BY Michael Johnsen

FORT WASHINGTON, Pa. — Nutrisystem will make a national retail launch in 2014, noted Dawn Zier, Nutrisystem president and CEO, during a conference call Wednesday. The company already has distribution through 2,500 Walmart locations and will be introducing its weight loss kits into Target in the second quarter. 

"We successfully launched and tapped into 2,500 Wal-Mart stores for diet season 2014 and both the diet and diabetic kit as well as the shakes and snack pack continues to perform well," Zier said. "Channel expansion will be focused on mass and club with a test line approach before expanding nationally. Our first test is with Target in Q2," she said. "We are adding additional resources to our retail team to support our growth strategy."

Retail contributed $5.9 million in the quarter, representing 8.4% of total revenues. The company expects a $25 million from the retail channel in the next fiscal year. 

 

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New study suggests blood pressure should be measured in both arms

BY Michael Johnsen

PHILADELPHIA — New research published in the March issue of the American Journal of Medicine suggests that there is an association between a difference in interarm systolic blood pressure and a significant increased risk for future cardiovascular events, leading researchers to recommend expanded clinical use of interarm blood-pressure measurement.

While blood pressure is a widely used medical metric, most measurements are taken only using one arm. Measuring interarm blood pressure involves taking two readings, one for each arm. Increased interarm systolic blood pressure differences are defined as 10 mmHg or more, and while a link between interarm blood pressure and cardiovascular risk was suspected, little data existed to support the hypothesis until now. 

This new study examined 3,390 participants ages 40 years and older from the Framingham Heart Study. All subjects were free of cardiovascular disease at baseline, but investigators found that participants with higher interarm systolic blood-pressure differences were at a much higher risk for future cardiovascular events than those with less than a 10 mmHg difference between arms.

"In this large prospective, in a community-based cohort of middle-age men and women free of cardiovascular disease, an increased interarm systolic blood pressure difference was found to be present in nearly 10% of individuals and is associated with increased levels of traditional cardiovascular risk factors," explained lead investigator Ido Weinberg of the Institute for Heart Vascular and Stroke Care at Massachusetts General Hospital in Boston. "Furthermore, an increased interarm systolic blood pressure difference is associated with an increased risk for incident cardiovascular events, independent of traditional cardiovascular risk factors."

Researchers also found that participants with elevated interarm blood pressure difference were older, had a greater prevalence of diabetes mellitus, higher systolic blood pressure and a higher total cholesterol level.

According to these findings, investigators suggest practitioners should consider including blood-pressure readings in both arms in order to get the most accurate readings possible and detect any differences in interarm blood pressure. "Even modest differences in clinically measured systolic blood pressures in the upper extremities reflect an increase in cardiovascular risk," Weinberg said. "This study supports the potential value of identifying the interarm systolic blood pressure difference as a simple clinical indicator of increased cardiovascular risk."

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