Use of acetaminophen during pregnancy and risk of preeclampsia, hypertensive and vascular disorders: A birth cohort study

Abstract

Objective. To examine whether pregnant women who used acetaminophen, a prostaglandinG2 synthase inhibitor, had an increased risk of preeclampsia, gestational hypertension, thromboembolic complications, or abruptio placentae.

Methods. We selected 63,833 women participating in the Danish National Birth Cohort who gave birth to a live born singleton and had information on acetaminophen use during pregnancy reported by three interviews. Through linkage to the National Hospital Discharge Registry we obtained data from hospital diagnose of the outcomes we study.

Results. Women who used acetaminophen during the third trimester of pregnancy had an increased risk of preeclampsia (adjusted relative risk RR = 1.40, 95% CI: 1.24–1.58). The risk was higher among women who had early preeclampsia (before the 32nd gestational week) (RR = 1.47, 95% CI: 1.12–1.93), severe preeclampsia (RR = 1.51, 95% CI: 1.15–2.00), or chronic hypertension (RR = 1.44, 95% CI: 1.13–1.83). Second and third trimester use was associated with an increased risk of pulmonary embolisms (RR = 3.02, 1.28–7.15) and deep vein thrombosis (RR = 2.15, 1.06–4.37), respectively.

Conclusions. Acetaminophen use during pregnancy is associated with an increased risk of diseases in which a reduction of prostacyclin during pregnancy has been postulated to play a role, including preeclampsia and thromboembolic diseases.

Keywords:

• Pregnancy complications
• cardiovascular
• pregnancy
• high-risk
• vascular diseases
• prostacyclin
• prostaglandin H synthase

Acknowledgements

We thank Ms Inge Eisensee (Danish Epidemiology Science Centre, University of Aarhus) for dataset preparation and Ms Estel Plana (Centre for Research in Environmental Epidemiology) for her support in data management and analysis. We are especially grateful to the physicians, nurses, interviewers and mothers without whose participation the study would not have been possible. Financial support; the Danish National Research Foundation has established the Danish Epidemiology Science Centre that initiated and created the Danish National Birth Cohort. The cohort is furthermore a result of a major grant from this Foundation. Additional support for the Danish National Birth Cohort is obtained from the Pharmacy Foundation, the Egmont Foundation, the March of Dimes Birth Defects Foundation, the Augustinus Foundation and the Health Foundation. C Rebordosa was partly supported by the Fondo de Investigación Sanitaria (ISCIII-CM06/00118) and by the European Union Sixth Framework Program (FP6-2003-Food-3-A).