President Trump recently expressed concern about the use of acetaminophen during pregnancy and the risk of autism, but major medical organizations have refuted this claim. (Image: damircudic/Getty Images)
On Monday (September 22), President Donald Trump warned pregnant women to avoid acetaminophen, the active ingredient in Tylenol, due to a controversial study conducted by a Harvard University dean and other experts. In response, several health organizations, including the American College of Obstetricians and Gynecologists (ACOG), the Canadian Society of Obstetricians and Gynecologists, the American Academy of Pediatrics (AAP), and the World Health Organization (WHO), issued statements refuting Trump's claim that taking Tylenol during pregnancy “may be associated with an increased risk of autism.”
Trump also advised parents not to give Tylenol to infants, prompting the American Academy of Pediatrics (AAP) to issue a statement saying, “Decades of research have shown that acetaminophen is safe for children when used as directed. Misleading claims that this medication is unsafe and linked to increased rates of autism send a misleading and dangerous message to parents and parents-to-be.”
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Have any studies found a causal link between acetaminophen use during pregnancy and autism?
No, according to the WHO, the American Board of Obstetricians and Gynecologists, and the American Academy of Pediatrics. No studies have shown that acetaminophen causes neurodevelopmental disabilities.
While health experts advocate limiting paracetamol use during pregnancy to only when necessary, some of the most encouraging data comes from a 2022 study published in the journal The Association for Child and Adolescent Mental Health and a 2024 JAMA study that included nearly 2.5 million Swedish children born between 1995 and 2019. Both studies found no cause-and-effect relationship.
A Swedish study found a small statistical association between acetaminophen use by pregnant women and an increased risk of developing autism and attention deficit hyperactivity disorder (ADHD). However, this association disappeared when comparing siblings from the same family whose mothers either used or did not use acetaminophen, lead study author Brian Lee, an epidemiologist at the Dornsife School of Public Health at Drexel University, wrote in an email to Live Science.
This makes it unlikely that acetaminophen causes autism. Rather, there are other factors, or factors, that increase the likelihood of taking painkillers during pregnancy and the likelihood of having a child with autism. “The association is not causation,” Lee said.
The link is likely explained by the fact that people taking acetaminophen do so to treat conditions such as infection, fever, headache, or migraine, and “all of these factors have been found to be associated with a child's risk of developing autism,” Lee said.
Moreover, scientists know that autism has a significant genetic component, and women with genes that increase the risk of neurodevelopmental disorders tend to report more pain during pregnancy and take acetaminophen more often. This same genetic risk for neurodevelopmental disorders is passed on to their child, Lee added.
However, on September 22, the U.S. Food and Drug Administration announced it would issue a notice to physicians and initiate a change to the safety labeling for acetaminophen, while the U.S. Department of Health and Human Services (HHS) would launch a public campaign, HHS said.
At a recent press briefing, Trump linked acetaminophen use during pregnancy to autism and urged pregnant women to limit its use unless medically necessary. This link is based on flawed research, one expert told Live Science. If the evidence doesn't support the idea that acetaminophen use during pregnancy causes autism, where did this idea come from?
To support their claims, Trump administration officials cited an August analysis co-authored by epidemiologist Dr. Andrea Baccarelli, dean of the Harvard T.H. Chan School of Public Health. The analysis combined data from multiple studies on acetaminophen and neurodevelopmental disorders.
The New York Times reported that Baccarelli received $150,000 as an expert witness for plaintiffs in lawsuits against Tylenol makers. His testimony was ultimately dismissed as scientifically unsound. Lee, for his part, is highly skeptical of the study.
“Unfortunately, in this case, the review of the article was so flagrantly poor that it raises questions about the authors' objectivity,” Lee wrote in an email.
Lee explained that Baccarelli's work “selected and distorted the literature” by underweighting studies that took into account issues such as genetics or maternal health that may increase the risk of autism, and overweighting studies that did not.
The limitations of Baccarelli's study are similar to those that cast doubt on earlier studies suggesting that coffee consumption causes lung cancer. This was problematic because smokers tend to drink a lot of coffee, he said. If the study had been conducted without adjusting for smoking, it could have concluded that coffee causes lung cancer, when in fact, it was smoking that caused it.
“The same thing is happening here,” Lee said.
What conditions is acetaminophen used to treat during pregnancy?
According to the journal Nature, acetaminophen is one of the most commonly used medications during pregnancy worldwide. According to the journal Nature, acetaminophen not only benefits the pregnant woman by reducing pain and fever, but can also prevent negative consequences for the fetus that could otherwise arise from the mother's symptoms.
Are there safe alternatives to acetaminophen for pregnant women?
There are very few alternatives to acetaminophen for pain relief, fever reduction, and headache treatment during pregnancy. This is because many potential alternatives, including nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil), naproxen (Aleve), and aspirin, have restrictions or contraindications, according to ACOG. Acetaminophen is recommended for use with caution and consultation with a doctor and is available to most people who need it.
If acetaminophen doesn't help, ibuprofen and naproxen can be used for migraines only during the second trimester and for no more than 48 hours at a time, according to ACOG. Taking NSAIDs during the third trimester can cause birth defects, according to ACOG.
Low-dose aspirin is used in special cases, most commonly to reduce the risk of or delay the development of preeclampsia, according to clinical guidelines from the American Board of Obstetricians and Gynecologists (ACOG). According to a 2021 study published in the journal Human Reproduction Update, low-dose aspirin is also used to treat recurrent miscarriage and fetal growth restriction.
What is the danger of fever if left untreated during fetal development?
A systematic review and meta-analysis published in the journal Molecular Autism included 10 studies involving 10,304 children with neurodevelopmental disorders such as autism, ADHD, and intellectual disability. It found that fever during pregnancy is associated with an increased risk of neurodevelopmental disorders in children. One relatively small study found that pregnant women with influenza who had fever were less likely to have a child with autism if they took antipyretics compared to those who did not. This suggests that an underlying cause, such as fever or infection, may be a factor in the increased risk of neurodevelopmental disorders in children.
Teresa Sullivan Barger, Live Science contributor
Teresa Sullivan Barger is an award-winning freelance journalist covering health, science, and the environment. Her work has 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 other publications. Based in central Connecticut, she is an experienced master gardener with a passion for gardening for wildlife, especially pollinators and songbirds.
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