Maternal paracetamol (acetaminophen) use during pregnancy and risk of autism spectrum disorder and attention deficit/hyperactivity disorder in offspring: umbrella review of systematic reviews.

Methods

Umbrella review of systematic reviews.

系统评价的综合评价。

data_sources

Medline, Embase, PsycINFO, and the Cochrane Database of Systematic Reviews, along with grey literature, Epistemonikos, and the reference lists of included studies (inception to 30 September 2025).

检索Medline、Embase、PsycINFO以及Cochrane系统评价数据库，包括灰色文献、Epistemonikos以及纳入研究的参考文献列表（从研究开始至2025年9月30日）。

inclusion_criteria

Systematic reviews of randomised trials and cohort, case-control, or cross sectional studies that reported maternal paracetamol use during pregnancy and the diagnosis of autism or ADHD in offspring.

系统评价了随机试验以及队列研究、病例对照研究或横断面研究，这些研究报道了孕期使用对乙酰氨基酚与后代诊断为自闭症或注意力缺陷多动障碍（ADHD）之间的关系。

Details of the primary studies included in the reviews are reported, including adjustments for key confounders (maternal characteristics, indication for paracetamol use, and familial factors) and unmeasured confounders and ascertainment of outcomes.

审查中包含的原始研究的详细信息被报告，包括对关键混杂因素（母亲特征、对对乙酰氨基酚使用的指示以及家族因素）的调整以及未测量的混杂因素和结果的确定。

Results

Nine reviews (40 studies) reporting on autism (six studies) and ADHD (17 studies) in offspring were included.

包括了九个审查（40项研究），报告了后代自闭症（六项研究）和注意力缺陷多动障碍（ADHD）（17项研究）的情况。

Four reviews undertook meta-analysis.

四篇综述进行了荟萃分析。

The overlap of primary studies included in the reviews was very high (corrected covered area 23%).

纳入综述中的原始研究重叠度非常高（校正覆盖面积为23%）。

The reviews reported a possible to strong association between maternal paracetamol intake and autism or ADHD or both in offspring.

综述报告了母亲使用对乙酰氨基酚与后代出现自闭症或注意力缺陷多动障碍（ADHD）或两者之间的可能至强关联。

Seven of the nine reviews advised caution when interpreting the findings owing to the potential risk of bias and confounding in the included studies.

九篇综述中有七篇建议在解释研究结果时要谨慎，因为纳入研究中存在潜在的偏倚风险和混杂因素。

Confidence in the findings of the reviews was low (two reviews) to critically low (seven reviews) based on the AMSTAR 2 (A MeaSurement Tool to Assess Systematic Reviews) criteria.

基于AMSTAR 2（系统评价评估工具）标准，评审结果的信心水平为低（两项评审）到极低（七项评审）。

Only one review included studies (n=2) reporting autism and ADHD in offspring that appropriately adjusted for familial factors and unmeasured confounding through sibling controlled analyses.

只有一项评审包括了适当调整家族因素和未测量混杂因素的兄弟姐妹对照分析的研究（n=2），这些研究报道了后代的自闭症和ADHD。

In both studies, the increased risk of autism in offspring (one study, hazard ratio1.05, 95% confidence interval1.02 to 1.08) and ADHD (two studies, 1.07, 1.05 to 1.10 and 2.02, 1.17 to 3.25 ) observed in the whole cohort analyses did not persist in sibling controlled analyses for autism (0.98, 0.93 to 1.04) and ADHD (0.98, 0.94 to 1.02 and 1.06, 0.51 to 2.05).

在这两项研究中，整个队列分析中观察到的后代自闭症风险增加（一项研究，风险比为1.05，95%置信区间为1.02至1.08）和注意力缺陷多动障碍（ADHD）（两项研究，分别为1.07，1.05至1.10和2.02，1.17至3.25）在同胞对照分析中并未持续，自闭症（0.98，0.93至1.04）和ADHD（0.98，0.94至1.02和1.06，0.51至2.05）。

Conclusions

Existing evidence does not clearly link maternal paracetamol use during pregnancy with autism or ADHD in offspring.

现有的证据并不清楚地将孕妇使用对乙酰氨基酚与后代的自闭症或ADHD联系起来。

systematic_review_registration

PROSPERO CRD420251154052.

PROSPERO CRD420251154052。