Adam’s Journal
Last month, the Food and Drug Administration urged physicians to exercise caution in recommending or prescribing acetaminophen during pregnancy, linking its use to autism and ADHD. This followed statements from the president and other high-level federal officials fingering the pain reliever as a cause of autism. What does the scientific evidence say?
Dr. Scofield Prescribes
The scientific evidence is far from settled on any link between autism or other neurological conditions and the use of acetaminophen – the active ingredient in Tylenol – during pregnancy. However, it is clear that a mother’s failure to take Tylenol during a pregnancy can, in certain circumstances, lead to birth defects.
For example, fever during pregnancy has been associated with a variety of birth defects, including faulty development of the brain, spinal cord and heart. While those who are not pregnant can use medications such as aspirin and ibuprofen to treat a fever, during pregnancy, those medications can lead to low amniotic fluid or kidney problems in a baby. So, those who are pregnant have only one option that’s considered safe: Tylenol.
The use of any medication involves a risk-benefit analysis. Here, there is a pronounced benefit for pregnant mothers with fevers who use Tylenol: It reduces the fetus’ risk of birth defects. Indeed, taking Tylenol during the first trimester of pregnancy has been associated with decreased levels of birth defects.
In addition, taking Tylenol for a fever helps the mother, as high fevers can be dangerous and even life-threatening if left untreated.
Tylenol can also serve as a safe and effective pain reliever. And inadequate treatment of maternal pain has been shown to have significant negative impacts on the fetus, potentially leading to altered neural development and increased risk of premature birth.
So, what are the risks of using Tylenol?
While the FDA and federal officials have called out autism and neurodevelopmental dangers to fetuses, almost 4 dozen research studies on the topic have failed to establish a conclusive link. A review of those studies led by researchers at Harvard University earlier this year, though, did find a slight association between mothers’ Tylenol use during pregnancy and children’s development of conditions like ADHD and autism.
However, the study did not look at causation. And other research has pointed to genetics as a potential culprit.
For that and other reasons, the study’s senior author cautioned against a blanket rejection of Tylenol during pregnancy. “We recommend judicious acetaminophen use – lowest effective dose, shortest duration – under medical guidance, tailored to individual risk-benefit assessments,” he said.
The American College of Obstetrics and Gynecology has reaffirmed its support for Tylenol use as needed during pregnancy, stating that “the current weight of evidence does not support a causal link between prenatal acetaminophen use and neurodevelopmental disorders.”
Like any drug, Tylenol should be used judiciously. But given the significant risks posed by fevers and pain during pregnancy, it remains the safest and best option for treating these conditions.
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Dr. Hal Scofield is a physician-scientist at the Oklahoma Medical Research Foundation, and he also serves as Associate Chief of Staff for Research at the Oklahoma City VA Medical Center. Adam Cohen is OMRF’s senior vice president and general counsel. Send your health questions to contact@omrf.org.
