Is Tylenol Safe During Pregnancy? Separating Fact from Fiction

The Food & Drug Administration (FDA) recently released a statement referencing a study that suggested a link between acetaminophen use during pregnancy and neurological disorders such as autism and attention deficit hyperactivity disorder (ADHD) in children.

This news has caused anxiety among pregnant women, who have long relied on the medication more commonly known as Tylenol to manage pain and fevers during pregnancy.

But as University Hospitals OB/GYN and Director of Fetal Intervention Ellie Ragsdale, MD, explains, the safety of Tylenol has been rigorously studied and researchers have found no causal link between acetaminophen and autism.

The Research Behind the Tylenol-Autism Link

Dr. Ragsdale says the study cited by the FDA relied on self-reported data from patients and lacked controls for critical factors such as genetic and environmental influences. The study also didn’t conclusively prove that Tylenol use causes autism, and its validity has been widely questioned within the scientific and medical communities. 

In contrast, much larger and more rigorous studies tell a different story, says Dr. Ragsdale. One of the most important studies on this topic comes from Sweden, involving over 2.5 million children. The study used siblings to control for genetic factors and offers more reliable data. This study found no association between the use of acetaminophen during pregnancy and neurodevelopmental disorders such as autism or ADHD.

Experts don’t know the exact cause of autism. It’s likely influenced by a combination of genetics, environmental factors and biological influences. There is no single cause, and despite many theories, no credible scientific evidence has ever established that acetaminophen use in pregnancy causes autism, says Dr. Ragsdale.

Is Tylenol Safe to Use in Pregnancy?

The short answer is yes, says Dr. Ragsdale. Acetaminophen has been used safely in pregnancy for decades. It is currently the only pain reliever and fever reducer recommended during all three trimesters of pregnancy.

Other common over-the-counter pain relievers like ibuprofen (Motrin and Advil) and naproxen (Aleve) fall into a class of medications called NSAIDs, or non-steroidal anti-inflammatory drugs. NSAIDs can carry significant risks during pregnancy. In early pregnancy NSAIDs can interfere with fetal kidney development, and later in pregnancy they can cause serious heart complications or fetal death.

Because of these risks, NSAIDs are typically avoided during pregnancy unless specifically prescribed for a narrow range of conditions during mid-pregnancy, says Dr. Ragsdale.

Not Using Tylenol If Indicated Has Risks, Too

It’s important to remember that fever itself is dangerous during pregnancy, says Dr. Ragsdale. High fevers, especially in early pregnancy, are linked to serious birth defects like spina bifida and other neural tube defects. Inflammation and unmanaged pain can also contribute to complications like preterm labor.

For mothers who feel hesitant or afraid to take Tylenol "just to be safe," it’s important to weigh the real risks of avoiding treatment, especially when dealing with fever or severe pain.

“Tylenol is the only safe and effective pain medication and fever reducer that we have to use in pregnancy,” says Dr. Ragsdale “There are certain instances in which Tylenol is really needed for the safety of the pregnancy. Untreated symptoms can sometimes pose greater risks than taking an appropriately dosed, well-studied medication like acetaminophen.”

Questions About What’s Safe in Pregnancy? Ask Your Provider

It’s natural for expectant moms to agonize over decisions both big and small, and how they will affect their unborn child. Dr. Ragsdale says it’s important to discuss all these concerns with your primary care doctor, OB/GYN or midwife. They will be able to give you the most up-to-date recommendations on medications you can safely take during pregnancy, along with the risks and benefits of taking them.

“We understand the fears, and we understand that you're hearing these scary things from all different avenues,” says Dr. Ragsdale “Please ask the questions, we're happy to discuss them. And know that you matter – your pain, your discomfort and your health matter. And the providers taking care of your pregnancy truly have the best interest of you and your baby at heart.”

Related Links

Led by nationally recognized maternal fetal specialists, genetic counselors and neonatologists, the high-risk pregnancy team at University Hospitals provides exceptional care for pregnant women, from the moment a condition is diagnosed, through pregnancy, delivery and the post-partum period.

For more information related to pregnancy, childbirth and postpartum and newborn care, visit University Hospitals OB/GYN & Women's Health pregnancy resources section.