Acetaminophen During Pregnancy: A Scientific Look

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President Trump recently voiced anxieties regarding the employment of acetaminophen while carrying a child and the threats of autism, but esteemed medical establishments have refuted such claims.(Image credit: damircudic/Getty Images)ShareShare by:

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On Monday (Sept. 22), President Donald Trump cautioned those who are pregnant to stay away from acetaminophen, the dynamic component in Tylenol, due to a contentious piece of scholarship by a Harvard principal and others. As a result, various wellness organizations — including the American College of Obstetricians and Gynecologists (ACOG), the Society of Obstetrics and Gynecology of Canada, the American Academy of Pediatrics (AAP) and the World Health Organization (WHO) — have put out statements countering Trump’s declaration that Tylenol use in pregnancy “may be linked with a heightened chance of autism.”

Trump similarly encouraged guardians to refrain from giving Tylenol to babies, which led the AAP to put out an affirmation stating, “decades’ worth of investigations have determined that acetaminophen is secure for youngsters when utilized per guidelines. Deceptive assertions that the medicine isn’t safe and is connected to elevated instances of autism give a perplexing, risky message to guardians and soon-to-be parents.”

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Have investigations revealed a causative association between acetaminophen consumption in gestation and autism?

No, according to the WHO, ACOG and AAP. No studies have demonstrated that acetaminophen is the reason for neurodevelopmental problems.

Although wellness authorities advocate for restricting acetaminophen utilization in pregnancy to only when warranted, some of the most assuring information originates from a 2022 article in the journal The Association for Child and Adolescent Mental Health and a 2024 JAMA investigation that scrutinized almost 2.5 million Swedish youths delivered between 1995 and 2019. Neither one uncovered a causative link.

The Swedish investigation revealed a slight statistical correlation between an expectant individual’s utilization of acetaminophen and a higher likelihood of autism and attention-deficit hyperactivity disorder (ADHD). Nevertheless, that correlation was absent once siblings in the same family whose mothers either did or didn’t utilize acetaminophen were compared, according to lead author Brian Lee, an epidemiologist at Drexel University’s Dornsife School of Public Health, in an email to Live Science.

That renders it improbable that acetaminophen brings about autism. Conversely, other elements, or confounders, make individuals more prone to utilize the analgesic when pregnant and more prone to give birth to a youngster with autism. “Association isn’t causation,” Lee stated.

What’s probably behind the association is that individuals who take acetaminophen are doing it to deal with a medical problem like an infection, temperature, headache or migraine, and “each of these elements has been observed to be tied to autism risk in the youngster,” Lee stated.

Moreover, scientists are aware that a substantial genetic part underlies autism, and women with genes that elevate the chance of neurodevelopmental ailments tend to state more pregnancy pain and acetaminophen utilization. The child inherits that very same genetic risk of a neurodevelopmental condition, Lee included.

Nonetheless, on Sept. 22, the U.S. Food and Drug Administration disclosed that it plans to issue a physician notice and start a safety label modification for acetaminophen, while the U.S. Department of Health and Human Services (HHS) will introduce a public service announcement campaign, HHS declared.

During a recent media briefing, Trump linked acetaminophen utilization during pregnancy to autism and encouraged expectant women to restrict its utilization unless deemed medically essential. One expert informed Live Science that the link stems from flawed research. If data doesn’t suggest that acetaminophen consumption during pregnancy is the reason for autism, what’s the source of that belief?

Trump administration personnel cited an August analysis co-authored by epidemiologist Dr. Andrea Baccarelli, dean of Harvard’s T.H. Chan School of Public Health, as proof for their assertions, which amalgamated data from numerous studies on acetaminophen and neurodevelopmental ailments.

The New York Times conveyed that Baccarelli received $150,000 as a witness for plaintiffs in suits against Tylenol producers — testimony that was eventually discarded on the grounds that it was scientifically unsound. Lee, for his part, is notably hesitant of the study.

“Sadly, the evaluation of the paper was done so outwardly poorly this instance that one must challenge the author’s objectivity,” Lee conveyed in an email.

Lee elaborated that Baccarelli’s work “cherry-picked and misrepresented the literature,” underweighting studies that accounted for subjects like genetics or maternal wellness that may amplify autism risk, while overweighting studies that neglected such subjects.

The defects in Baccarelli’s study are analogous to those that plagued prior research hinting that coffee consumption led to lung malignancies. According to him, this presented an issue since smokers tend to consume substantial amounts of coffee. An investigation that failed to adjust for smoking would lead one to infer that coffee triggers lung cancer, while smoking is, in fact, the culprit.

“The identical occurrence is unfolding here,” Lee stated.

What purpose does acetaminophen serve during pregnancy?

According to Nature, acetaminophen stands as one of the most often prescribed drugs during pregnancy across the globe. As reported by Nature, acetaminophen not only has the potential to help the expectant individual by reducing pain and temperature, but it can also avert unfavorable wellness repercussions for the fetus that may otherwise emerge due to maternal indications.

Are there secure substitutes for acetaminophen for pregnant individuals?

For pain relief and treating fevers or headaches while pregnant, very few options exist outside of acetaminophen. ACOG reports that many possible substitutes — including nonsteroidal anti-inflammatory (NSAIDs) drugs, such as ibuprofen (Advil), naproxen (Aleve), and aspirin — are used subject to certain constraints or contraindications. Following consultation with a physician, acetaminophen is advised for careful utilization and is easily accessible to the majority of individuals who need it.

ACOG states that ibuprofen and naproxen are okay for migraines solely in the second trimester if acetaminophen doesn’t yield results, but for no more than 48 hours at a time. ACOG reports that NSAID utilization in the third trimester may lead to birth defects.

According to ACOG clinical guidelines, low-dose aspirin has been utilized in specific instances, most often to lower the chances of or stall the onset of preeclampsia. As per a 2021 article in the journal Human Reproduction Update, low-dose aspirin has similarly been utilized to address recurrent miscarriages and fetal growth limitation.

What perils arise from untreated fever during fetal development?

According to a systematic review and meta-analysis featured in the journal Molecular Autism, 10 investigations involving 10,304 youths with neurodevelopmental conditions like autism, ADHD, and intellectual disability revealed that fevers throughout pregnancy were associated with a greater risk of neurodevelopmental conditions in youths. A somewhat small-scale investigation discovered that pregnant individuals afflicted with influenza had reduced odds of giving birth to a youngster with autism if they utilized a fever reducer as opposed to not. This alludes to the possibility that an underlying problem, like fever or infection, might be a factor contributing to the heightened risk for neurodevelopmental ailments in youths.

Theresa Sullivan BargerLive Science Contributor

Theresa Sullivan Barger is an award-winning freelance journalist who covers health, science, and the environment. Her stories have appeared in The New York Times, The Boston Globe, Los Angeles Times, AARP, CURE, Discover, Family Circle, Health Central, Next Avenue, IEEE Spectrum, Connecticut Magazine, CT Health Investigative Team, and more. Based in central Connecticut, she is an advanced master gardener who is passionate about gardening for wildlife, especially pollinators and songbirds.

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