Paying attention to what you put into your body while pregnant is very important for both you and your growing fetus. It can be intimidating to see long lists of foods and medications to avoid during pregnancy, and you may ask yourself, “Well what is safe?” Acetaminophen, the pain reliever found in medications like Tylenol, has long been considered safe for pregnant women to take and is the most widely used medicine during pregnancy.
However, studies suggest that acetaminophen use in pregnancy may be associated with autism spectrum disorder (ASD) or attention-deficit/hyperactivity disorder (ADHD) in children.
This may be scary, especially if you took acetaminophen during a current or past pregnancy. However, many OB/GYNs and associations such as the American College of Obstetricians and Gynecology are reassuring patients that acetaminophen is safe to take during pregnancy, the benefits are likely to outweigh any known risks, and the studies that suggest an association between certain neurological disorders and acetaminophen use may be misleading.
The Flaws in the Research
The main takeaway is that while an association has been reported between prenatal acetaminophen use and conditions such as ASD or ADHD, it has not been shown that acetaminophen causes these conditions. That’s an important difference.
“This research is causing a lot of concern among pregnant women for a relationship that we don’t know truly exists,” says Erin Clark, MD, an associate professor in the Department of Obstetrics and Gynecology at University of Utah Health.
Clark explains that there are significant flaws in the current studies, including:
- Self-reporting has the potential for recall bias. When you receive an upsetting diagnosis about your child, it’s easy to immediately start thinking about things you did during pregnancy to pinpoint a cause. You might be more likely to recall taking acetaminophen during pregnancy if you have a child with ASD or ADHD, especially if you are primed to believe there is a relationship there. Similarly, you are less likely to recall it if you don’t have an affected child.
- The reason for taking acetaminophen might be the true risk factor. Studies have failed to take into account why people were using acetaminophen during pregnancy. Acetaminophen is often used to treat fever or inflammation. Fevers can be a symptom of an underlying viral or bacterial infection. Infection or inflammation, not the treatment, could be what is actually associated .
- Diagnosis of neurobehavioral disorders continue to evolve. According to the Society for Maternal-Fetal Medicine, the causes for disorders like ASD and ADHD are unknown, and there is the potential for other contributing factors that are not measured in these studies, such as genetic predisposition.
To Medicate or Not to Medicate
Not treating a fever, illness, or pain can have negative effects on both mother and baby. Avoiding medication altogether doesn’t necessarily mean you are entirely avoiding risk.
“I encourage people on an individual basis to weigh risk and benefit of taking it versus not taking it, rather than assuming avoiding exposure is associated with no risk,” Clark says.
For example, an untreated migraine in pregnancy has real ramifications. That person may have hours or even days of pain during which they’re not going to eat as healthy, they’re not going to exercise, and they’re not going to sleep well—all things that are important for a healthy pregnancy. And they’re not going to be as functional at home and at work.
The bottom line is that an untreated migraine can negatively affect the overall health of the pregnant person and her family. "If you need a pain medication, acetaminophen has the best safety profile in pregnancy,” Clark says.
If you are experiencing pain or fever during pregnancy and wonder if acetaminophen is right for you:
- Talk to your provider about your specific reason for taking it
- Consider other non-medication therapies that might work for you
- As with all medications, take the lowest effective dose for the shortest time needed
If your pain or fever is not alleviated after several days of taking acetaminophen, call your doctor. You may have something more serious that requires medical care.
So, if you took acetaminophen during pregnancy, don’t panic. Acetaminophen is considered by most health care providers to be the pain and fever reliever of choice during pregnancy.