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Role of combined prenatal and postnatal paracetamol exposure on asthma development: the Czech ELSPAC study
  1. Pavel Piler1,
  2. Jan Švancara1,2,
  3. Lubomír Kukla1,
  4. Hynek Pikhart1,3
  1. 1 Research Centre for Toxic Compounds in the Environment (RECETOX), Faculty of Science, Masaryk University, Brno, Czech Republic
  2. 2 Institute of Biostatistics and Analyses, Faculty of Medicine and Faculty of Science, Masaryk University, Brno, Czech Republic
  3. 3 Department of Epidemiology and Public Health, University College London, London, UK
  1. Correspondence to Dr Hynek Pikhart, Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK; h.pikhart{at}


Background Prenatal and postnatal paracetamol exposure has been previously associated with asthma development in childhood in Western populations. We explore the association between prenatal and postnatal paracetamol exposure and asthma development in a Central European sample of Czech children, suggesting possible additive effect of the both exposures. Furthermore, since aspirin had been used more widely during study data collection in Central Europe, we also compared asthma development for those exposed to paracetamol and aspirin.

Methods We used data from 3329 children born in the 1990s as members of the prospective Czech European Longitudinal Study of Pregnancy and Childhood. Data about prenatal and postnatal paracetamol and aspirin exposure, and potential covariates were obtained from questionnaires completed by mothers. Data about incident asthma were obtained from paediatrician health records.

Results 60.9% of children received paracetamol only postnatally, 1.5% only prenatally and 4.9% of children were exposed both during pregnancy and infancy. Prevalence of asthma in following population was 5% at 11 years. Being exposed to paracetamol both in prenatal and postnatal period was associated with asthma development (unadjusted OR 1.98, 95% CI 1.02 to 3.87). Being exposed only in the postnatal period was also significantly associated with increased risk of asthma. No association between prenatal exposure only and outcome was found. A higher but non-significant risk of asthma was observed for those whose mothers used paracetamol during pregnancy compared with those who used aspirin.

Conclusions The main findings of this prospective birth cohort study add to previous observations linking prenatal and early postnatal paracetamol exposure to asthma development. However, the magnitude of effect is relatively modest, and therefore, we recommend paracetamol to remain the analgesic and antipyretic of choice throughout pregnancy and early childhood.

  • asthma
  • drug safety
  • cohort studies
  • epidemiology

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  • Contributors All authors contributed to preparation and writing of the manuscript, reviewed and approved the final version of this manuscript, and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. LK contributed to the design of the study and lead the data collection. PP and JŠ prepared data for the analyses. PP analysed data. HP advised on the analyses.

  • Funding This study was funded by the Ministry of Education, Youth and Sports of the Czech Republic and European Structural and Investment Funds (CETOCOEN PLUS project: CZ.02.1.01/0.0/0.0/15_003/0000469 and the RECETOX research infrastructure: LM2015051 and CZ.02.1.01/0.0/0.0/16_013/0001761).

  • Competing interests None declared.

  • Patient consent Parental/guardian consent obtained.

  • Ethics approval Ethics approval for all aspects of data collection was obtained from local ethics committees.

  • Provenance and peer review Not commissioned; externally peer reviewed.