{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T07:59:48Z","timestamp":1790150388085,"version":"4.0.1"},"reference-count":64,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Develop Med Child Neuro"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To evaluate whether prenatal exposure to paracetamol (acetaminophen) is associated with an increased risk of autism and attention\u2010deficit\/hyperactivity disorder (ADHD) in offspring, using a meta\u2010meta\u2010analytical (umbrella review) approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>We conducted a registered umbrella review (PROSPERO CRD420251243790) of systematic reviews with meta\u2010analyses assessing prenatal paracetamol exposure and autism or ADHD. Searches were performed in six major databases up to November 2025. Methodological quality was appraised using AMSTAR\u20102, and overlap of primary studies was quantified using the corrected covered area. Random\u2010effects meta\u2010meta\u2010analyses were performed for unrestricted, partially quality\u2010restricted, and fully quality\u2010restricted models. When overlap was high, additional meta\u2010analyses of low\u2010risk primary studies were conducted, with risk of bias assessed using ROBINS\u2010E.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Seven meta\u2010analyses were included, encompassing more than 3\u2009million participants. Unrestricted meta\u2010meta\u2010analyses showed small positive associations between prenatal paracetamol exposure and both autism (risk ratio 1.17) and ADHD (risk ratio 1.29). However, after restricting analyses to higher\u2010quality meta\u2010analyses and low\u2010risk primary studies, effect estimates were substantially attenuated and, in several models, approached the null. High heterogeneity and substantial overlap were observed, particularly in analyses of primary studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretation<\/jats:title>\n                    <jats:p>The observed associations between prenatal paracetamol exposure and neurodevelopmental disorders are probably influenced by methodological limitations, including residual confounding and exposure misclassification. Current epidemiological evidence does not support a robust causal relationship, and paracetamol remains an appropriate first\u2010line treatment during pregnancy when clinically indicated.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dmcn.70512","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T07:01:54Z","timestamp":1790146914000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prenatal exposure to paracetamol and the risk of autism and attention\u2010deficit\/hyperactivity disorder: An umbrella review and meta\u2010meta\u2010analysis"],"prefix":"10.1111","author":[{"given":"Hoda","family":"Tayebi\u2010Hillali","sequence":"first","affiliation":[{"name":"Medical\u2010Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS) University of Santiago de Compostela  Santiago de Compostela Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda","family":"Blanco\u2010Su\u00e1rez","sequence":"additional","affiliation":[{"name":"Medical\u2010Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS) University of Santiago de Compostela  Santiago de Compostela Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Berta","family":"Rivas\u2010Mundi\u00f1a","sequence":"additional","affiliation":[{"name":"Medical\u2010Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS) University of Santiago de Compostela  Santiago de Compostela Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacobo","family":"Limeres\u2010Posse","sequence":"additional","affiliation":[{"name":"Medical\u2010Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS) University of Santiago de Compostela  Santiago de Compostela Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5349-1091","authenticated-orcid":false,"given":"M\u00e1rcio","family":"Diniz\u2010Freitas","sequence":"additional","affiliation":[{"name":"Medical\u2010Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS) University of Santiago de Compostela  Santiago de Compostela Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro","family":"Diz\u2010Dios","sequence":"additional","affiliation":[{"name":"Medical\u2010Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS) University of Santiago de Compostela  Santiago de Compostela Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10787\u2010013\u20100172\u2010x"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.semperi.2025.152074"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41574\u2010021\u201000553\u20107"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10654\u2010021\u201000754\u20104"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.aller.2016.10.014"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/dew285"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102222.2009.03378.x"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jogc.2025.103192"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph19042128"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyt183"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2013.4914"},{"key":"e_1_2_10_13_1","volume-title":"FDA has reviewed possible risks of pain medicine use during pregnancy","author":"U.S. Food and Drug Administration"},{"key":"e_1_2_10_14_1","volume-title":"Pharmacovigilance Risk Assessment Committee","author":"European Medicines Agency"},{"key":"e_1_2_10_15_1","unstructured":"The European Network of Teratology Information Services.ENTIS position statement on paracetamol (paracetamol) in pregnancy. 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