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Pregnancy is a blessed event, but it is accompanied by discomfort and, at times, outright pain. The golden rule during these 9 months is to avoid all but absolutely necessary medications. Over the years, the pain and fever medication of choice has been acetaminophen, better known as the brand Tylenol.
Now, some government officials are warning that acetaminophen during pregnancy might be linked to the later development of neurodevelopmental disorders including autism and autism spectrum disorders. Let’s review what we do know about this issue.
In 2024, epidemiologists, neonatologists, and obstetrician-gynecologists at Sweden’s famed Karolinska Institute published a study of nearly 2.5 million Swedish mothers, children and their siblings in the Journal of the American Medical Association or JAMA. It failed to show any statistically significant increased risk for autism, ADHD-hyperactivity, or intellectual disability associated with acetaminophen use during pregnancy once familial-genetic and shared environmental factors were properly factored.
This year, public health researchers from New York’s Mount Sinai Medical Center, the University of Southern California, The University of Massachusetts, and Harvard’s School of Public Health published their meta-analysis of 26 studies of more than 3.4 million mother-child pairs across North America, Europe, and Asia.
They concluded that the evidence was “suggestive but not sufficient to infer causality” between acetaminophen use during pregnancy and later neurodevelopmental disorders. Potential study shortcomings included: data regarding maternal drug use relied upon recall; there was data heterogeneity across studies; and there were numerous potential confounding factors.
The investigators advise that pregnant women could continue to use acetaminophen if needed, but at the lowest effective dose and for the shortest necessary duration. They did not recommend complete avoidance of the medication.
The bottom line is that acetaminophen, Tylenol, continues to be recommended as the first-line medication for pain and fever during pregnancy in guidelines from the American College of Obstetricians and Gynecologists, Britain's Royal College of Obstetricians and Gynecologists, and other medical organizations. These organizations warn against the use of ibuprofen, naproxen and other nonsteroidal anti-inflammatory drugs as their use has been associated with birth defects.
Clinicians continue to emphasize the need to treat fevers during pregnancy. Failure to do so increased risks of childhood heart conditions, abdominal wall defects, and improper development of the brain and spinal cord. Untreated pain and fevers are also associated with miscarriage, preterm birth, and low birth weight.
Bottom line: use acetaminophen only when necessary during pregnancy and stop taking it as soon as the need no longer exists. Everything you put into your body, whether it be medications or food, is a double-edged sword. This is particularly true during pregnancy.
https://www.medscape.com/s/viewarticle/explainer-tylenol-safe-take-during-pregnancy-2025a1000nky?ecd=wnl_tp10_daily_250910_MSCPEDIT_etid7706152&uac=210582CN&impID=7706152
https://pubmed.ncbi.nlm.nih.gov/38592388/
https://ehjournal.biomedcentral.com/articles/10.1186/s12940-025-01208-0
#acetaminophen #tylenol #pregnancy #pain #fever #birthdefects