paracetamol (paracetamol, EFVDAS)

[Paracetamol use during pregnancy and child neurodevelopmental disorders: what sibling studies add, and the limitations that suggest causal triangulation].

Boujenah Jérémy J

Prenatal exposure to paracetamol and risk of autism spectrum disorder: systematic review and meta-analysis of observational studies.

Oliveira Juliana Almeida JA, Lemos Maria Julia MJ, Queiroz Laura Fonseca LF, Sciorilli João Vitor JV et al.

This meta-analysis aimed to assess the ASD risk in offspring exposed to prenatal acetaminophen compared to non-exposed offspring. A systematic search was conducted across PubMed, Embase, and Cochrane Central Register of Controlled Trials databases up to October 2025. Studies were included if they involved pregnant women, compared exposed versus non-exposed groups, were RCTs or cohort studies, and reported ASD outcomes. Data was extracted independently by two authors, with discrepancies resolved by consensus. Statistical analyses used odds ratios (ORs) with 95% confidence intervals, Cochran Q, and I² statistics with a random-effects model. Study quality was appraised using the ROBINS-E tool. Eight studies, involving 2,560,208 patients, were included. Pooled results showed an 18% increased risk of ASD diagnosis (p <0.0001) and a non-significant 16% increase for ASD symptoms (p=0.1719). Dose-response relationships and gender-specific effects were reported by studies, while familial confounding and "some concerns" to "high" risk of bias were identified. A consistent, albeit modest, association was found. These findings emphasize the necessity for careful benefit-risk assessments and informed dialogue with expectant mothers regarding pain and fever management during pregnancy.PROSPERO: CRD420251160888.

Bioactivity-guided identification of a quercetin-rich ethyl acetate fraction from Ipomoea pes-tigridis L. conferring robust antioxidant defense and hepatoprotection against paracetamol-induced liver injury.

Bheemreddy Thrinitha T, Murali Radhakrishnan R, Srinivasan Nagarajan N, Manichandrika Paturi P

The present study evaluated the hepatoprotective potential of Ipomoea pes-tigridis L. whole-plants extracts in paracetamol-induced hepatotoxic rat model. Sequential Soxhlet extraction yielded petroleum ether, ethyl acetate, and methanolic extracts, which were assessed at 200 mg/kg following of acute toxicity confirmation (2000 mg/kg). Paracetamol administration (2 g/kg) significantly elevated lipid peroxidation (TBARS: liver 2.99 ± 0.04 vs. control 1.44 ± 0.02 nmol MDA/g) and reduced antioxidant defences, including superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), glutathione S-transferase (GST), and glutathione (GSH) (p < 0.01). Pre-treatment with the ethyl acetate extract markedly restored antioxidant enzymes activities (e.g. hepatic SOD 5.83 ± 0.02 vs. 3.39 ± 0.03 in paracetamol group), and normalise total protein levels (7.21 ± 0.04 vs. 4.70 ± 0.02 g/dL), comparable to silymarin. Histopathology confirmed near-complete preservation of hepatic architecture. These findings demonstrate that the quercetin-rich ethyl acetate extract of Ipomoea pes-tigridis L. confers significant antioxidant-mediated hepatoprotection against paracetamol-induced liver injury.

Pharmacologic treatment strategies and association with major neonatal outcomes for patent ductus arteriosus in preterm infants.

Tutak Ercan E, Cındık Nimet N, Doğan Eser E, Ayhan Yunus Emre YE et al.

Patent ductus arteriosus (PDA) is common in preterm infants. Although pharmacologic treatment promotes ductal closure, its impact on clinically meaningful outcomes remains uncertain. This study aimed to evaluate the association between different pharmacologic PDA treatment strategies and major neonatal outcomes. This retrospective cohort study included preterm infants born at <32 weeks' gestation who received pharmacologic treatment for clinically significant PDA following an integrated echocardiographic and clinical assessment in a tertiary-level neonatal intensive care unit between 2018 and 2024. Infants were categorized by treatment strategy (ibuprofen only, paracetamol only, or sequential therapy), treatment timing, and number of treatment courses. The primary outcome was a composite of bronchopulmonary dysplasia (BPD) and/or mortality. Secondary outcomes included intraventricular hemorrhage, necrotizing enterocolitis, retinopathy of prematurity, and sepsis. A total of 76 preterm infants were included, with a median gestational age of 28 weeks (IQR 26-30) and mean birth weight of 1,076 ± 343 g. Infants were treated with ibuprofen only (n = 31, 40.8%), paracetamol only (n = 27, 35.5%), or sequential therapy (n = 18, 23.7%). The composite outcome occurred in 39 infants (51.3%) and did not differ significantly across treatment groups. In multivariate analysis, gestational age emerged as the strongest independent predictor of BPD and/or mortality (adjusted OR 0.54, 95% CI 0.38-0.77; p = 0.001), while treatment category was not independently associated with outcomes. Pharmacologic PDA treatment strategies were not independently associated with BPD and/or mortality in this retrospective cohort. Gestational age showed the strongest association with the primary outcome; however, residual confounding and limited statistical power preclude causal or equivalence conclusions.