Why might someone use acetaminophen during pregnancy?

Because nonsteroidal anti-inflammatory drugs (NSAIDs) are not recommended for anyone who is pregnant, acetaminophen has long been a go-to over-the-counter drug for anyone expecting. Taking Tylenol or generic acetaminophen can relieve pain and, important, fever.

“Acetaminophen or Tylenol is recommended if the pregnant patient has fever and or severe pain,” says Dr. Abdulla Al-Khan, vice chair and director of Maternal-Fetal Medicine and Surgery and the Center for Abnormal Placentation at Hackensack University Medical Center in Hackensack, N.J. “Cold oral hydration and ice packs only go so far to reduce a fever, which can be very dangerous to both the mother and the unborn fetus.” He adds that some of the serious complications that can occur with high temperatures include seizures, preterm labor and potential embryonic malformation.

“Pregnant patients commonly experience discomfort in pregnancy, including lower back, pelvis and lower extremity discomfort from the pregnancy itself, for which there are few pain relief options other than acetaminophen, especially as the use of NSAIDs is limited,” adds Dr. David Hackney, associate professor at Case Western Reserve University School of Medicine and division director of Maternal Fetal Medicine at University Hospitals Cleveland Medical Center.

What are the allegations regarding acetaminophen and a possible link to autism and ADHD?

In 2021, a consensus statement published in the journal Nature Reviews Endocrinology stated that there’s some experimental and epidemiological research suggesting acetaminophen could affect fetal development, potentially increasing the risk of issues like ADHD and autism, among others. The statement called for increased awareness of these issues and for more research to be conducted about these potential risks.

Since then, over 400 product liability lawsuits have been filed by lawyers against the manufacturers of acetaminophen, arguing that pregnant people should have been warned of said risks. Manufacturers, however, argue there’s no conclusive evidence to support these claims. As the Wall Street Journal reported last week, the matter is now before a U.S. District Court judge who will determine if the plaintiffs have enough admissible scientific evidence to proceed with their case.

What does the medical community think?

The experts who spoke to Yahoo Life say more research is needed before anyone can say with any certainty that there is an actual link between prenatal use of acetaminophen and a later diagnosis of autism or ADHD in their child.

“For autism and ADHD, there is a long history of epidemiologic associations in the past which have not been later demonstrated to be causative, so one must approach such associations with a degree of caution,” says Hackney. Al-Khan, meanwhile, says that while doctors aren’t denying the possibility, conclusive answers won’t be reached until more research is conducted.

“We don’t take this lightly in the scientific community, but this alleged correlation needs to be validated with scientific evidence,” says Al-Khan. “There are so many questions: What are the underlying conditions that necessitated the use of Tylenol in the first place? Could the conditions themselves have had an influence on the development of ADHD or autism over time? Right now, we just don’t know.”

“What's most important is that pregnant people and parents look closely at the facts when they're reading about these cases. It can be tempting to assign blame or presume innocence without understanding the data and evidence when the issue at stake is so highly charged,” she says.

What does the current research tell us about what causes autism and ADHD?

Despite the rise in cases in recent years, the causes of autism spectrum disorder are not well understood. The causes and risk factors of ADHD are also unknown, according to the Centers for Disease Control and Prevention. That said, both issues are being researched, and there are some general inklings as to some of the factors causing each (or, in some cases, both).

“We do know that genetics play a role, and factors like environmental toxins and prenatal nutritional status are also under study to determine their impact,” says Casares. “It makes sense that parents and patients want concrete answers to their questions about what's to blame when it comes to neurodivergence, but we don't have all the information yet.”

Dr. Zoe Martinez, clinical leader at Done, adds that additional risk factors for ADHD specifically include pre- and postnatal exposure to lead, low birth weight and prematurity. She also points to one study published in Pedatrics indicating that prenatal exposure to acetaminophen is correlated with higher rates of ADHD, especially when taken for longer than eight days. “Short exposure [to acetaminophen] if used as an antipyretic (fever reducer) may be protective,” she adds.

So should pregnant people avoid Tylenol or not?

When it comes to using any medication, it seems patients (pregnant or otherwise) should weigh the pros and cons. As there is no conclusive evidence, experts agree there’s no reason to experience severe pain, or risk severe complications from fever, in the hopes of avoiding the possibility of having a neurodiverse child.

According to Al-Khan, there are also a few circumstances under which a pregnant patient should not take acetaminophen, such as if they are allergic or have hepatic insufficiency, aka liver issues. “For the most part acetaminophen, if taken appropriately with physician guidance, should be safe,” he says. (People should also follow dosing guidance; Tylenol advises not taking more than 10 Regular Strength tablets (325 mg of acetaminophen) or 6 Extra Strength tablets (500 mg of acetaminophen) per day.

Hackney agrees and says his position on the use of Tylenol mirrors that of the American College of Obstetrics and Gynecology.

“Any pregnant patient should always avoid taking any medication if not necessary, as one wants to globally minimize medication use in pregnancy when possible,” he says. “However, as the research linking acetaminophen and neurodevelopmental outcomes remains unclear, acetaminophen is not contraindicated when beneficial.”

Furthermore, parents-to-be should remember that there is nothing “wrong” with neurodivergent children. Autism and ADHD are simply developmental disabilities, and children can grow to have perfectly wonderful, long lives.

“The most important thing you can do if your child has ADHD and/or autism is help them understand who they are — their strengths, their unique gifts and their opportunities for growth,” says Casares.