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Prenatal and infant exposure to acetaminophen and ibuprofen and the risk for wheeze and asthma in children.
J Allergy Clin Immunol. 2015 Feb; 135(2):441-8.JA

Abstract

BACKGROUND

Several studies have reported an association between use of over-the-counter antipyretics during pregnancy or infancy and increased asthma risk. An important potential limitation of these observational studies is confounding by indication.

OBJECTIVES

We investigated the association of antipyretic intake during pregnancy and during the first year of life (infancy) with asthma-related outcomes before and after controlling for early-life respiratory tract infections.

METHODS

We included 1490 mother-child pairs in Project Viva, a longitudinal prebirth cohort study. We categorized prenatal acetaminophen exposure as the maximum intake (never, 1-9 times, or ≥10 times) in early pregnancy or midpregnancy and ibuprofen intake as presence or absence in early pregnancy. We expressed intake of antipyretics in infancy as never, 1 to 5 times, 6 to 10 times, or more than 10 times. We examined the associations of acetaminophen and ibuprofen (per unit increase in exposure category) during pregnancy and infancy with wheeze, asthma, and allergen sensitization in early childhood (3-5 years of age, n = 1419) and midchildhood (7-10 years of age, n = 1220).

RESULTS

Unadjusted models showed an increased asthma risk in early childhood for higher infant acetaminophen (odds ratio [OR], 1.21; 95% CI 1.04-1.41) and ibuprofen (OR, 1.35; 95% CI, 1.19-1.52) intake. Controlling for respiratory tract infections attenuated estimates for acetaminophen (OR, 1.03; 95% CI, 0.88-1.22) and ibuprofen (OR, 1.19; 95% CI, 1.05-1.36). Prenatal acetaminophen was associated with increased asthma (OR, 1.26; 95% CI, 1.02-1.58) in early childhood but not midchildhood.

CONCLUSIONS

Adjustment for respiratory tract infections in early life substantially diminished associations between infant antipyretic use and early childhood asthma. Respiratory tract infections should be accounted for in studies of antipyretics and asthma to mitigate bias caused by confounding by indication.

Authors+Show Affiliations

Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass.Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass.Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass.Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass.Child Health and Development Institute, Mount Sinai Hospital, New York, NY.Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass.Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass.Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass.Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass. Electronic address: augusto.litonjua@channing.harvard.edu.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

25441647

Citation

Sordillo, Joanne E., et al. "Prenatal and Infant Exposure to Acetaminophen and Ibuprofen and the Risk for Wheeze and Asthma in Children." The Journal of Allergy and Clinical Immunology, vol. 135, no. 2, 2015, pp. 441-8.
Sordillo JE, Scirica CV, Rifas-Shiman SL, et al. Prenatal and infant exposure to acetaminophen and ibuprofen and the risk for wheeze and asthma in children. J Allergy Clin Immunol. 2015;135(2):441-8.
Sordillo, J. E., Scirica, C. V., Rifas-Shiman, S. L., Gillman, M. W., Bunyavanich, S., Camargo, C. A., Weiss, S. T., Gold, D. R., & Litonjua, A. A. (2015). Prenatal and infant exposure to acetaminophen and ibuprofen and the risk for wheeze and asthma in children. The Journal of Allergy and Clinical Immunology, 135(2), 441-8. https://doi.org/10.1016/j.jaci.2014.07.065
Sordillo JE, et al. Prenatal and Infant Exposure to Acetaminophen and Ibuprofen and the Risk for Wheeze and Asthma in Children. J Allergy Clin Immunol. 2015;135(2):441-8. PubMed PMID: 25441647.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prenatal and infant exposure to acetaminophen and ibuprofen and the risk for wheeze and asthma in children. AU - Sordillo,Joanne E, AU - Scirica,Christina V, AU - Rifas-Shiman,Sheryl L, AU - Gillman,Matthew W, AU - Bunyavanich,Supinda, AU - Camargo,Carlos A,Jr AU - Weiss,Scott T, AU - Gold,Diane R, AU - Litonjua,Augusto A, Y1 - 2014/10/28/ PY - 2013/11/27/received PY - 2014/07/15/revised PY - 2014/07/22/accepted PY - 2014/12/3/entrez PY - 2014/12/3/pubmed PY - 2015/4/9/medline KW - Asthma KW - analgesic KW - antipyretic KW - respiratory infection SP - 441 EP - 8 JF - The Journal of allergy and clinical immunology JO - J Allergy Clin Immunol VL - 135 IS - 2 N2 - BACKGROUND: Several studies have reported an association between use of over-the-counter antipyretics during pregnancy or infancy and increased asthma risk. An important potential limitation of these observational studies is confounding by indication. OBJECTIVES: We investigated the association of antipyretic intake during pregnancy and during the first year of life (infancy) with asthma-related outcomes before and after controlling for early-life respiratory tract infections. METHODS: We included 1490 mother-child pairs in Project Viva, a longitudinal prebirth cohort study. We categorized prenatal acetaminophen exposure as the maximum intake (never, 1-9 times, or ≥10 times) in early pregnancy or midpregnancy and ibuprofen intake as presence or absence in early pregnancy. We expressed intake of antipyretics in infancy as never, 1 to 5 times, 6 to 10 times, or more than 10 times. We examined the associations of acetaminophen and ibuprofen (per unit increase in exposure category) during pregnancy and infancy with wheeze, asthma, and allergen sensitization in early childhood (3-5 years of age, n = 1419) and midchildhood (7-10 years of age, n = 1220). RESULTS: Unadjusted models showed an increased asthma risk in early childhood for higher infant acetaminophen (odds ratio [OR], 1.21; 95% CI 1.04-1.41) and ibuprofen (OR, 1.35; 95% CI, 1.19-1.52) intake. Controlling for respiratory tract infections attenuated estimates for acetaminophen (OR, 1.03; 95% CI, 0.88-1.22) and ibuprofen (OR, 1.19; 95% CI, 1.05-1.36). Prenatal acetaminophen was associated with increased asthma (OR, 1.26; 95% CI, 1.02-1.58) in early childhood but not midchildhood. CONCLUSIONS: Adjustment for respiratory tract infections in early life substantially diminished associations between infant antipyretic use and early childhood asthma. Respiratory tract infections should be accounted for in studies of antipyretics and asthma to mitigate bias caused by confounding by indication. SN - 1097-6825 UR - https://www.unboundmedicine.com/medline/citation/25441647/Prenatal_and_infant_exposure_to_acetaminophen_and_ibuprofen_and_the_risk_for_wheeze_and_asthma_in_children_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0091-6749(14)01277-9 DB - PRIME DP - Unbound Medicine ER -