Everything Medical Experts Want You To Know About Taking Tylenol During Pregnancy

According to a report from The Wall Street Journal, Health and Human Services Secretary Robert F. Kennedy Jr. plans to announce that taking acetaminophen (commercially known as Tylenol) during pregnancy is linked to autism, as part of a larger report he promised would identify the cause of autism by September. This comes as a new paper from researchers at Mount Sinai, which analyzed 46 previous studies on acetaminophen use in pregnancy, found “evidence consistent with an association between acetaminophen exposure during pregnancy and increased incidence of neurodevelopmental disorders.” However, the medical community has previously come to a consensus that all of these studies use questionable data. The American College of Obsestricians and Gyneologists (ACOG) and the Society for Maternal Fetal Medicine have also released joint statements about this body of research, emphasizing that it doesn’t prove that the medication itself causes any harm.

Headlines about RFK Jr.’s report and this new study are likely to generate fear and anxiety in pregnant people, who have no alternate over-the-counter pain medication to take while they’re expecting — ibuprofen has been linked to a host of risks, from birth defects to miscarriage. And while “doing your own research” is great and all, how many of us are actually trained to read a scientific study and even understand what it’s saying, let alone draw an educated conclusion? So, Scary Mommy spoke with an expert on Tylenol safety and pregnancy to break down everything you’re seeing in the news right now.

What does this new study say about taking Tylenol during pregnancy?

If you’re seeing headlines about Mount Sinai’s new study, here’s the deal: a team of researchers took 46 past studies about taking Tylenol while pregnant and analyzed them using something called the Navigation Guide Systematic Review methodology, which is the best method of evaluating environmental factors, like what medication you take, and their effects. A press release from the hospital said their work “found that prenatal exposure to acetaminophen may increase the risk of neurodevelopmental disorders, including autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD), in children.”

In an email exchange with Scary Mommy, the study’s lead author says this does not mean they think pregnant women taking Tylenol is causing their kids to develop autism, ADHD, or any other neurodevelopmental disorders. “Our rigorous evaluation...shows an association between acetaminophen use during pregnancy and neurodevelopmental disorders. That being said, association does not mean causality. There is an urgent need for increasing research in environmental and toxicological factors, in order to understand all the factors that contribute to autism, ADHD, and other NDDs,” said Dr. Diddier Prada, assistant professor of population health sciences and policy, environmental medicine and public health at the Icahn School of Medicine at Mount Sinai.

That research often identifies this association between Tylenol use and ASD/ADHD, but can never confirm it as a cause, is the rub.

What do other experts think?

Following the news of RFK Jr.’s intent to revive the Tylenol and autism discourse, doctors took to social media to remind followers that this issue has previously been put to bed. They explain that the studies connecting the two did not account for confounding factors, i.e. other things in the lives of the participants that could have affected the results. Dr. Vicki Chan specifically notes that research should answer for the reasons why women in the study took Tylenol. Could their fevers, pain, or underlying conditions actually be increasing the risk of NDDs, and explain why there appears to be an association between taking Tylenol and autism or ADHD?

When studies do try to account for these things, the data falls apart under scrutiny, experts say. “Association is not causation. And every time you try and figure out parts of that, where it's coming from, it doesn't pan out,” says Dr. Sarah Običan, director of Maternal-Fetal Medicine and co-director of USF Health and the Tampa General Hospital Fetal Care Center. “In a data study like this where it puts a lot of papers in together, the quality of the papers that are put in matters. And even so, statistically speaking, you may actually not have a correct result.”

Običan has served as an expert witness in litigation related to Tylenol’s use during pregnancy, so she has analyzed all existing research on the subject. She is also part of an international group of physicians who have published a response refuting studies saying Tylenol causes ADHD and autism. She says this new paper’s legitimacy depends on how good the data it analyzed was, and that data has been called into question repeatedly.

As Scary Mommy previously reported, RFK Jr. has a history of citing old and debunked studies, some from as far back as the 1950s, in his effort to find the environmental toxins he believes are causing autism and “pressure” those responsible to remove them.

What Experts Say Is Missing From This Conversation

RFK Jr.’s assertion that taking Tylenol while pregnant increases the risk of developing of autism or other types of neurodivergence is problematic in many ways — not just because the data behind the claim is shaky. Most importantly, we know the primary cause of autism is genetics.

“It's the number one reason why patients have whatever we have, physical disease or neurodivergence. It's just us, right? It's what we are made of,” Običan says. The Autism Science Foundation says 15% to 20% of people with ASD have an identifiable genetic cause, while the rest either have a number of small genetic variations or a mutated gene plus some “environmental factors.” Those factors may include things like maternal medical conditions, age of parents at conception, or viral infections. (Like medications, these have all been associated with autism, but not determined to be causes.)

Običan says this persistence to link medication use to autism and ADHD perpetuates stigma about neurodivergence, painting it as a bad outcome to be avoided at all costs. It also implies that women are to blame for those so-called bad outcomes when they happen to their children, either because they were clueless about the risks of treating their pain while pregnant or because they were selfish enough to do it anyway. This hearkens back to the “refrigerator mother,” an early 1900s theory wrongfully placing responsibility for autism on mothers.

It also presents an ethical issue: Pregnant people have very few pain and fever control options while expecting, Običan adds, and there’s little research being done to find alternatives for them should we take Tylenol away on a hunch. “We tell patients, ‘Don't use opioids because that's really a problem in this country,’ and we tell them, ‘You can't use anti-steroidals,’ because ibuprofen can really cause harm, either for growth or for bleeding. Then, we don't have any other choice [but Tylenol].”

All decisions about whether or not to take a medication while pregnant require you to consider the risks of taking it, sure, but there are also risks to not taking a medication in some instances. Fever is associated with increased risk of birth defects, and we have no clue what effect untreated chronic pain may have on a fetus, Običan says (to say nothing of how it would affect the mother). You should be thinking about the full picture when making your own health choices.

Is it still safe to take acetaminophen while pregnant?

In short, yes. Both Prada and Običan agree here. Običan always recommends taking the lowest dose of medication, only as needed, during pregnancy. Prada says, “We strongly recommend pregnant women be very cautious and always seek professional advice before using any medication.”

In a statement posted across their social media platforms, ACOG reinforced their existing guidelines, saying, “When pain relief is needed during pregnancy, acetaminophen should be used in moderation, and after consulting your doctor.’

If you are concerned about the potential risks of taking Tylenol while pregnant, Običan encourages you to talk to your OB-GYN and trust them — they are trained to read scientific literature, assess it, and summarize it for you. “When the ACOG and SMFM do that, and your doctor does that, have a little bit of trust. It’s not that [they can’t] be wrong, it's just that all the available data that one has at this point in time points a certain way.”