Authors: Rhea Manohar, MPH; Meghan Etsey, Teresa Lazar, MD MSEd on behalf of AMWA’s  Gender Equity Task Force

Recent discourse has raised alarms about acetaminophen (also known as Paracetamol or Tylenol) use during pregnancy, citing possible links to neurodevelopmental disorders such as autism and ADHD. Widely shared headlines warn, “women can just suffer,” a phrase that suggests direct, proven harm. Meanwhile, acetaminophen continues to be among the few, if not only, over-the-counter analgesic/antipyretic that is consistently recommended in pregnancy. Understanding both the science and the impact of messaging is essential to protect both maternal and fetal health.

Multiple recent large-scale studies provide insight into what is known, and what remains uncertain, about acetaminophen’s risks in pregnancy. A population-based Swedish cohort study of 2,480,797 children born between 1995-2019 compared those whose mothers used acetaminophen during pregnancy with those who did not. Even in those that accounted for genetic and environmental confounders through siblings, there was no statistical association between prenatal acetaminophen use and risks of autism, ADHD, or intellectual disability (Ahlqvist et al., 2024). In more than 20 years of research, leading obstetrical authorities reaffirm that no reputable study has established causality between acetaminophen in any trimester and neurological disorders in offspring. Many studies suggesting associations have methodological limitations, self‐report bias, lack of confounding adjustment, or small sample sizes (ACOG, 2025). While some studies show associations under certain exposures or frequent use, the strongest and largest evidence do not support a clear causal link between standard acetaminophen use in pregnancy and disorders like autism or ADHD.

It is not just about whether acetaminophen might carry risk; it is also about what happens when it is not used. Fever during pregnancy, especially in the first trimester, is a well‐recognized risk factor for miscarriage, congenital anomalies, including neural tube defects (Roberge et al., 2017; Xu et al., 2024). Ignoring or failing to treat high fever, infection, severe pain or inflammation may carry greater harm than the theoretical risks of acetaminophen use.

Given that alternatives, such as NSAIDs, are contraindicated or limited due to known fetal risks (e.g., for renal function, ductus arteriosus closure, bleeding), acetaminophen remains frequently the only acceptable option for analgesia and antipyresis, especially in the third trimester. Organizations such as ACOG and WHO continue to affirm that acetaminophen serves a critical role when used appropriately. Additionally, standards are evolving to better care for women in high risk situations during pregnancy, such as the use of baby aspirin for preeclampsia (Roberge et al., 2017).

The implications of the broad reach of this type of messaging are multifaceted from both a medical and public health point of view. Phrases implying definitive harm, “women can just suffer rather than take acetaminophen”, may discourage pregnant individuals from using medication even when clinically indicated. This can lead to untreated fevers or pain, which themselves can impact the health of both mother and fetus. People with limited access to prenatal care, health literacy, or safe medical advice may be especially affected. Misinformation or overcautious messaging may exacerbate disparities by leading some to avoid care, delay seeking help, or use unsafe alternatives.

When developing messaging, it is critical to take into account the interpretation of science by the public with respect to terminology, linking causation, and building long-term trust in medical institutions. Many findings are observational with potential biases: recall bias, indication bias (i.e., the reason acetaminophen was used, fever or pain, might itself contribute to outcome), and familial confounding. When public narratives fail to emphasize these limitations, associations risk being interpreted as causal claims. Persistent, unqualified warnings may diminish trust in health care and public health institutions. If patients believe guidelines shift frequently due to alarmist claims, they may become skeptical of further recommendations—even when evidence is strong.

To balance the risks and benefits, while avoiding fear‐driven harm, several steps are recommended:

  1. Messaging with nuance. Public health bodies and media should avoid absolute language. Instead: “when medically indicated,” “lowest effective dose,” and “shortest necessary duration.” Emphasize what is known, what remains uncertain, and differentiate between correlation and causation.
  2. Clinician guidance. Obstetric care providers should counsel patients regarding the relative safety profile of acetaminophen, and the absence of strong evidence for neurodevelopmental harm under standard use.
  3. Clear labeling and regulation. If labeling changes occur (as FDA is initiating), wording should reflect balance, avoiding panic. Regulatory agencies should consult with maternal‐fetal medicine experts, epidemiologists, and patient advocacy groups to ensure accessible language.
  4. Research investment. Support longitudinal, prospective cohorts with precise measurement of dose, timing, indication (why acetaminophen was taken), and control for confounders. Prioritize randomized controlled trials where ethical, mechanistic studies, and sibling or within‐family designs.
  5. Public literacy and media responsibility. Journalists and health communicators should contextualize new studies when reporting to the public. Headlines should reflect study design, sample size, and limitations. Public health campaigns may help counter misinformation, with emphasis on safe practices during pregnancy and when to seek care.

Acetaminophen remains one of the most widely used and recommended analgesics and antipyretics during pregnancy due to its relatively favorable risk profile, especially when compared with alternatives. Large, well‐designed studies have not demonstrated a definitive causal link to autism, ADHD, or intellectual disability, particularly when controlling for familial and genetic confounding. Meanwhile, untreated fever, pain, or inflammation in pregnancy carry proven risks.

Messages that cause fear, such as “women can just suffer”, without clarifying context, risk driving behaviors that may inadvertently raise dangers for both mother and fetus. Public health and clinical guidance must balance caution with clarity, prioritize evidence over sensationalism, and ensure pregnant individuals receive accurate, usable information that allows for safe decision-making.

References: 

  1. ACOG. (2025, September 22). ACOG affirms safety benefits acetaminophen pregnancy. https://www.acog.org/news/news-releases/2025/09/acog-affirms-safety-benefits-acetaminophen-pregnancy
  2. Ahlqvist, V. H., Sjöqvist, H., & Christina Dalman, C. (2024, April 9). Acetaminophen use during pregnancy and children’s risk of autism, ADHD, and intellectual disability. JAMA network. https://jamanetwork.com/journals/jama/fullarticle/2817406 
  3. Roberge, S., Nicolaides, K., Demers, S., Hyett, J., Chaillet, N., & Bujold, E. (2017). The role of aspirin dose on the prevention of preeclampsia and fetal growth restriction: systematic review and meta-analysis. American journal of obstetrics and gynecology, 216(2), 110–120.e6. https://doi.org/10.1016/j.ajog.2016.09.076
  4. Xu, M., Wang, R., Du, B., Zhang, Y., & Feng, X. (2024). Association of acetaminophen use with perinatal outcomes among pregnant women: a retrospective cohort study with propensity score matching. BMC pregnancy and childbirth, 24(1), 268. https://doi.org/10.1186/s12884-024-06480-5

About the Authors

Rhea Manohar, MPH, MS3

Rhea Manohar is a third year medical student from St. George’s University. She has a Masters in Public Health with a concentration in Maternal and Child Health from George Washington University Milken Institute of Public Health and a Bachelors of Science in Microbiology, Immunology, and Public Health from the University of Miami. She served as Co-VP of OB/GYN Education for St. George’s University’s Women in Medicine chapter in St. George, Grenada where she developed and implemented hands-on workshops to further reproductive health issues and bolstered medical students abilities to navigate physician-patient communication. Prior to medical school, she was a Research Associate for Fors Marsh Group, where she led qualitative and quantitative public health research and campaign development for federal agencies (e.g., CDC, NIH, DHHS, CPSC). She is also a member of the Gender Equity Task Force and Reproductive Health Coalition within the American Medical Women’s Association. When she is not pursuing medicine, you can find her reading, exploring artistic passions, and spending time connecting with friends and family.

Meghan Etsey, MS4

Meghan Etsey is a fourth year medical student from St. George’s University. She has a Bachelors of Arts in Biology and a Bachelors of Arts in Nutrition and Dietetics from Bluffton University in Bluffton, Ohio. She served as the President of the St. George’s University’s Women in Medicine chapter in St. George, Grenada where she expanded relationships with the community and worked towards educating women and helping the youth. She is also a member of the Gender Equity Task Force and Sex and Gender Health Collaborative Committees within the American Medical Women’s Association. When she is not pursuing medicine, you can find her with her friends and family on different road trips and adventures exploring the world. 

Teresa Lazar, MD MSEd is the clerkship director of the Advanced Clinical Experience in Obstetrics and Gynecology and Assistant Professor at the Donald and Barbara Zucker School of Medicine at Hofstra Northwell (ZSOM). She obtained her medical degree and completed her residency in obstetrics and gynecology from the State University of New York Health Science Center in Brooklyn and graduated with a Master of Science in Education degree in health professions from Hofstra University. Dr. Lazar was recognized with the APGO Excellence in Teaching Award and is a member of the Academy of Medical Educators and Alpha Omega Alpha Honor Medical Society at the ZSOM. Currently, a member of the American Medical Women’s Association Gender Equity Task Force and the Education Committee. Dr. Lazar is board certified by the American Board of Obstetrics and Gynecology, areas of clinical interest include general obstetrical care, gynecologic care and pelvic ultrasounds. Additionally, she is passionate about medical education, faculty development, communication, and leadership. She is fluent in both English and Spanish.