Reacción a "Reactions to study associating paracetamol use in pregnancy with attention and sleep problems in children"

The study is of high quality, but like most of these studies it is limited, being based on a database that, although of high quality, was not designed to accurately assess the objective of the study. For this reason, the conclusions, although valid and relevant, must be contextualized, especially in the sense that it is not possible to rule out confounding factors that may explain the observed association. A very clear example is that when the authors adjust for maternal stress some associations are lost, and this demonstrates the complexity of assessing associations between consumption in pregnancy and a subsequent outcome, which can only be established with some certainty in studies that are randomized clinical trials specifically designed to answer the research question. 

The study fits with previous evidence and, therefore, it is plausible that there is a (weak) association between the use of paracetamol and (mild) neurodevelopmental alterations. It does not provide any further news beyond the fact that it is a somewhat larger study, but it is consistent with previous studies along the same lines. 

The important implication is that any medication during pregnancy should be taken with a doctor's prescription. The relevance of the study being with paracetamol is that it is a drug generally considered by the general population, and by many health professionals, to be "almost" harmless. And as this study shows, this may not be the case. But it should be remembered that when indicated, paracetamol is the best analgesic and antipyretic option we have in pregnancy and, therefore, if a mother must use it under medical prescription she should be reassured that the benefits outweigh the risks. Always remembering that any medication in pregnancy should be used for the minimum essential time and never without medical indication. 

But, in general, this is not alarming information, the associations are weak and the study itself shows that maternal stress is much more important than paracetamol. In short, everything that happens in pregnancy can affect fetal development and therefore the best lifestyle and emotional balance of mothers should be promoted, but without generating alarms. The effects of pregnancy can also be compensated during the first years of life and an adequate family environment, welcoming and with adequate love and attention for the child, will compensate for many effects that may have occurred during pregnancy.