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Reuter I, Knaup S, Romanos M, Lesch KP, Drepper C, Lillesaar C. Developmental exposure to acetaminophen does not induce hyperactivity in zebrafish larvae. J Neural Transm (Vienna) 2016; 123:841-8. [PMID: 27116683 DOI: 10.1007/s00702-016-1556-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 04/12/2016] [Indexed: 12/11/2022]
Abstract
First line pain relief medication during pregnancy relies nearly entirely on the over-the-counter analgesic acetaminophen, which is generally considered safe to use during gestation. However, recent epidemiological studies suggest a risk of developing attention-deficit/hyperactivity disorder (ADHD)-like symptoms in children if mothers use acetaminophen during pregnancy. Currently, there are no experimental proofs that prenatal acetaminophen exposure causes developmental brain alterations of progeny. Exposure to high acetaminophen concentrations causes liver toxicity, which is well investigated in different model organisms. However, sub-liver-toxic concentrations have not been experimentally investigated with respect to ADHD endophenotypes such as hyperactivity. We used zebrafish to investigate the potential impact of acetaminophen exposure on locomotor activity levels, and compared it to the established zebrafish Latrophilin 3 (Lphn3) ADHD-model. We determined the sub-liver-toxic concentration of acetaminophen in zebrafish larvae and treated wild-type and lphn3.1 knockdown larvae with increasing concentrations of acetaminophen. We were able to confirm that lphn3.1 knockdown alone causes hyperactivity, strengthening the implication of Lphn3 dysfunction as an ADHD risk factor. Neither acute nor chronic exposure to acetaminophen at sub-liver-toxic concentrations in wild-type or lphn3.1 knock-downs increases locomotor activity levels. Together our findings show that embryonic to larval exposure to acetaminophen does not cause hyperactivity in zebrafish larvae. Furthermore, there are no additive and/or synergistic effects of acetaminophen exposure in a susceptible background induced by knock-down of lphn3.1. Our experimental study suggests that there is, at least in zebrafish larvae, no direct link between embryonic acetaminophen exposure and hyperactivity. Further work is necessary to clarify this issue in humans.
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Affiliation(s)
- Isabel Reuter
- Department of Physiological Chemistry, Biocenter, Am Hubland, University of Würzburg, 97074, Würzburg, Germany
- Division of Molecular Psychiatry, Department of Psychiatry, Psychosomatics and Psychotherapy, ADHD Clinical Research Network, Laboratory of Translational Neuroscience, University of Würzburg, 97080, Würzburg, Germany
| | - Sabine Knaup
- Department of Human Genetics, Biocenter, Am Hubland, University of Würzburg, 97074, Würzburg, Germany
| | - Marcel Romanos
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, 97080, Würzburg, Germany
| | - Klaus-Peter Lesch
- Division of Molecular Psychiatry, Department of Psychiatry, Psychosomatics and Psychotherapy, ADHD Clinical Research Network, Laboratory of Translational Neuroscience, University of Würzburg, 97080, Würzburg, Germany
| | - Carsten Drepper
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, 97080, Würzburg, Germany.
| | - Christina Lillesaar
- Department of Physiological Chemistry, Biocenter, Am Hubland, University of Würzburg, 97074, Würzburg, Germany.
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Abstract
Attention deficit hyperactivity disorder (ADHD) is a childhood-onset neurodevelopmental disorder with a prevalence of 1·4-3·0%. It is more common in boys than girls. Comorbidity with childhood-onset neurodevelopmental disorders and psychiatric disorders is substantial. ADHD is highly heritable and multifactorial; multiple genes and non-inherited factors contribute to the disorder. Prenatal and perinatal factors have been implicated as risks, but definite causes remain unknown. Most guidelines recommend a stepwise approach to treatment, beginning with non-drug interventions and then moving to pharmacological treatment in those most severely affected. Randomised controlled trials show short-term benefits of stimulant medication and atomoxetine. Meta-analyses of blinded trials of non-drug treatments have not yet proven the efficacy of such interventions. Longitudinal studies of ADHD show heightened risk of multiple mental health and social difficulties as well as premature mortality in adult life.
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Affiliation(s)
- Anita Thapar
- Child & Adolescent Psychiatry Section, Institute of Psychological Medicine and Clinical Neurosciences, and MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Cardiff, UK.
| | - Miriam Cooper
- Child & Adolescent Psychiatry Section, Institute of Psychological Medicine and Clinical Neurosciences, and MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Cardiff, UK
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103
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Amundsen S, Nordeng H, Nezvalová-Henriksen K, Stovner LJ, Spigset O. Pharmacological treatment of migraine during pregnancy and breastfeeding. Nat Rev Neurol 2016; 11:209-19. [PMID: 25776823 DOI: 10.1038/nrneurol.2015.29] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Migraine affects up to 25% of women of reproductive age. In the majority of these women, migraine improves progressively during pregnancy, but symptoms generally recur shortly after delivery. As suboptimally treated migraine in pregnancy could have negative consequences for both mother and fetus, the primary aim of clinicians should be to provide optimal treatment according to stage of pregnancy, while minimising possible risks related to drug therapy. Nonpharmacological approaches are always first-line treatment, and should also be used to complement any required drug treatment. Paracetamol is the preferred drug for acute treatment throughout pregnancy. If paracetamol is not sufficiently effective, sporadic use of sumatriptan can be considered. NSAIDs such as ibuprofen can also be used under certain circumstances, though their intake in the first and third trimesters is associated with specific risks and contraindications. Preventive treatment should only be considered in the most severe cases. In women contemplating pregnancy, counselling is essential to promote a safe and healthy pregnancy and postpartum period for the mother and child, and should involve a dialogue addressing maternal concerns and expectations about drug treatment. This Review summarizes current evidence of the safety of the most common antimigraine medications during pregnancy and breastfeeding, and provides treatment recommendations for use in clinical practice.
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van den Anker JN, Allegaert K. Treating Pain in Preterm Infants: Moving from Opioids to Acetaminophen. J Pediatr 2016; 168:13-15. [PMID: 26490127 DOI: 10.1016/j.jpeds.2015.09.061] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 09/23/2015] [Indexed: 10/22/2022]
Affiliation(s)
- John N van den Anker
- Division of Pediatric Clinical Pharmacology, Department of Pediatrics, Children's National Medical Center, Washington, DC; Department of Paediatric Pharmacology, University of Basel Children's Hospital, Basel, Switzerland; Intensive Care and Department of Pediatric Surgery, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands.
| | - Karel Allegaert
- Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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105
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Abstract
Over-the-counter (OTC) medications are among the most commonly used products in pregnancy. Similar to prescription medications, for many products there is a lack of adequate data on safety of use in pregnancy. Assumptions of safety for these products based on long experience and OTC status, in the absence of data, may be ill founded. Examples of four OTC products used to treat common conditions in pregnancy are described. Potential links to adverse short- and long-term infant outcomes for these products are reviewed, and the strengths and limitations of data to support these. Research to detect or rule out these risks is essential.
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Affiliation(s)
- Christina Chambers
- Division of Dysmorphology and Teratology, Department of Pediatrics, University of California San Diego, 9500 Gilman Dr. Mail Code 0828, La Jolla, CA 92093.
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106
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Hoover RM, Hayes VAG, Erramouspe J. Association Between Prenatal Acetaminophen Exposure and Future Risk of Attention Deficit/Hyperactivity Disorder in Children. Ann Pharmacother 2015; 49:1357-61. [DOI: 10.1177/1060028015606469] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objective: To evaluate the effect of prenatal acetaminophen exposure on the future development of attention deficit/hyperactivity disorder (ADHD) in children. Data Sources: Literature searches of MEDLINE (1975 to June 2015), International Pharmaceutical Abstracts (1975 to June 2015), and Cochrane Database (publications through June 2015) for prospective clinical trials assessing the relationship of prenatal acetaminophen exposure and the development of attention deficit disorders or hyperactivity. Study Selection and Data Extraction: Studies comparing self-reported maternal acetaminophen use during pregnancy to development of ADHD or ADHD-like behaviors in offspring between the ages of 3 and 12 years. Data Synthesis: Four studies examining the effects of prenatal acetaminophen exposure on subsequent ADHD behaviors were identified. Of these, one early study found no link to ADHD behaviors while the other studies found statistically significant correlations with the most prominent being a study finding a higher risk for using ADHD medications (hazard ratio = 1.29; 95% CI, 1.15-1.44) or having ADHD-like behaviors at age 7 years as determined by the Strengths and Difficulties Questionnaire (risk ratio = 1.13; 95% CI, 1.01-1.27) in children whose mothers used acetaminophen during pregnancy. Conclusion: While there does appear to be a mild correlation between prenatal acetaminophen use and the development of ADHD symptoms in children, current data do not provide sufficient evidence that prenatal acetaminophen exposure leads to development of ADHD symptoms late in life. Acetaminophen is a preferred option for pain management during pregnancy when compared with other medications such as nonsteroidal anti-inflammatory drugs or opioids for pyretic or pain relief.
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Affiliation(s)
| | | | - John Erramouspe
- College of Pharmacy, Idaho State University, Pocatello, ID, USA
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107
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Human metabolism and excretion kinetics of aniline after a single oral dose. Arch Toxicol 2015; 90:1325-33. [DOI: 10.1007/s00204-015-1566-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 07/06/2015] [Indexed: 12/24/2022]
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de Fays L, Van Malderen K, De Smet K, Sawchik J, Verlinden V, Hamdani J, Dogné JM, Dan B. Use of paracetamol during pregnancy and child neurological development. Dev Med Child Neurol 2015; 57:718-24. [PMID: 25851072 DOI: 10.1111/dmcn.12745] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/03/2015] [Indexed: 12/13/2022]
Abstract
Paracetamol (acetaminophen) remains the first line for the treatment of pain and fever in pregnancy. Recently published epidemiological studies suggested a possible association between paracetamol exposure in utero and attention-deficit-hyperactivity disorder/hyperkinetic disorder (ADHD/HKD) or adverse development issues in children. However, the effects observed are in the weak to moderate range, and limitations in the studies' design prevent inference on a causal association with ADHD/HKD or child neurological development. In parallel, recent animal data showed that cognition and behaviour may be altered following exposure to therapeutic doses of paracetamol during early development. These effects may be mediated by interference of paracetamol with brain-derived neurotrophic factor, neurotransmitter systems (including serotonergic, dopaminergic, adrenergic, as well as the endogenous endocannabinoid systems), or cyclooxygenase-2. However, no firm conclusion can be made on the relevance of these observations to humans. We conclude that additional well-designed cohort studies are necessary to confirm or disprove the association. In the context of current knowledge, paracetamol is still to be considered safe in pregnancy and should remain the first-line treatment for pain and fever.
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Affiliation(s)
- Laurence de Fays
- Federal Agency for Medicines and Health Products (FAMHP), Brussels, Belgium
| | - Karen Van Malderen
- Federal Agency for Medicines and Health Products (FAMHP), Brussels, Belgium
| | - Karen De Smet
- Federal Agency for Medicines and Health Products (FAMHP), Brussels, Belgium
| | - Javier Sawchik
- Federal Agency for Medicines and Health Products (FAMHP), Brussels, Belgium
| | - Veerle Verlinden
- Federal Agency for Medicines and Health Products (FAMHP), Brussels, Belgium
| | - Jamila Hamdani
- Federal Agency for Medicines and Health Products (FAMHP), Brussels, Belgium
| | | | - Bernard Dan
- Laboratory of Neurophysiology and Biomechanics of Movement, ULB Neuroscience Institut, Université Libre de Bruxelles, Brussels, Belgium
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109
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Abstract
BACKGROUND Depression during pregnancy affects 5%-8% of women. While the percentage of women in the US taking serotonin reuptake inhibitors during pregnancy has risen over the last decade, pregnant women continue to report that they prefer non-pharmacologic interventions. OBJECTIVE We review the literature regarding neuromodulation techniques for major depressive disorder during pregnancy. The rationale for their use in this population, new developments, and future directions are discussed. METHODS A literature search was conducted in PubMed Plus, Ovid Medline, and Embase to collect all articles on neuromodulation for the treatment of depression during pregnancy. Key search words included electroconvulsive therapy, transcranial magnetic stimulation, deep brain stimulation, transcranial direct current stimulation, neuromodulation, depression, and pregnancy. Given the sparse literature, all articles from 1960 to 2014 that addressed the use of neuromodulation in pregnancy were included. CONCLUSION The data support the use of electroconvulsive therapy in all trimesters of pregnancy for major depressive disorder. New data are emerging for the use of transcranial magnetic stimulation in pregnancy, which is likely safe, but more data are needed before it can be recommended as a primary treatment modality during pregnancy. Other neuromodulation techniques have not been well studied in this population.
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Affiliation(s)
- Deborah R Kim
- Department of Psychiatry, Penn Center for Women’s Behavioral Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jessica L Snell
- Department of Psychiatry, Penn Center for Women’s Behavioral Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Grace C Ewing
- Department of Psychiatry, Penn Center for Women’s Behavioral Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - John O’Reardon
- Department of Psychiatry, Rowan University, Rowan School of Medicine, Cherry Hill, NJ, USA
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