Quick Read
- A new meta-analysis in The Lancet Obstetrics, Gynecology & Women’s Health finds no causal link between acetaminophen use during pregnancy and autism or ADHD.
- Acetaminophen, also known as Tylenol or paracetamol, remains the recommended first-line option for pain and fever in pregnancy when used as directed.
- The review focused on robust sibling-comparison studies, which control for shared genetics and family environment.
- Earlier observational studies may have shown a link due to confounding factors like underlying conditions (fever, infection) rather than the medication itself.
- Major medical organizations like ACOG continue to advise acetaminophen use as needed, following label instructions.
Expectant parents can breathe a sigh of relief. A major new review, published this Friday in the esteemed journal The Lancet Obstetrics, Gynecology & Women’s Health, has delivered a clear message: using acetaminophen as directed during pregnancy does not increase a child’s risk of autism, attention-deficit/hyperactivity disorder (ADHD), or intellectual disability. This comprehensive evaluation stands as a significant rebuttal to prior mixed findings and recent public warnings that have caused considerable anxiety.
Acetaminophen, widely known by its brand name Tylenol or as paracetamol, remains one of the most frequently recommended medications for managing pain and fever during pregnancy. Doctors have long considered it the first-line option, but a series of earlier studies had presented conflicting results. These studies, some suggesting a potential association with an elevated risk of developmental disorders, left many pregnant individuals uncertain about its safety, creating a challenging dilemma for those needing relief from common ailments.
The new meta-analysis meticulously examined findings from approximately 60 studies, making it one of the most thorough assessments of the evidence to date. Crucially, the researchers found no link to developmental disorders in children when pregnant individuals used acetaminophen according to label instructions. Dr. Asma Khalil, a study co-author and professor of obstetrics and maternal fetal medicine at St. George’s Hospital in London, emphasized this point to ABC News, stating, “The clearest takeaway is that the best-quality evidence does not support a causal link between taking paracetamol during pregnancy and autism or ADHD in children.” She further reassured, “Pregnant women should feel reassured that paracetamol remains the recommended first-line option for pain or fever in pregnancy when used as directed.”
This review comes after a period of heightened public debate and concern. In September 2025, President $1 Trump advised pregnant women to “Don’t take Tylenol,” asserting an “associated with a very increased risk of autism” claim, which he subsequently reiterated on social media without presenting supporting evidence. The Food and Drug Administration (FDA) also issued a note to doctors regarding a possible link at that time, though it clarified there was no evidence Tylenol *causes* autism and that the association was an ongoing scientific debate. Major medical groups quickly expressed concern that such warnings might deter pregnant women from using a beneficial and often necessary medication.
A key strength of this new review lies in its focus on sibling-comparison studies. This research design involves comparing siblings born to the same mother, where one pregnancy included acetaminophen use and another did not. By analyzing individuals who share genetic predispositions and family environments, researchers can more effectively isolate the effects of the medication from other confounding factors. In these sibling-comparison analyses, exposure to acetaminophen during pregnancy showed no association with autism spectrum disorder, ADHD, or any other intellectual disability, a conclusion that held firm even in studies with more than five years of follow-up.
The authors of the review suggest that this robust methodology may help clarify why earlier observational studies appeared to indicate a possible link. They point out that people do not take acetaminophen randomly; they take it for symptoms such as fever, infection, inflammation, or pain. These underlying conditions themselves can be linked to fetal brain development, creating a potential for researchers to mistakenly attribute the effects of the underlying illness to the medication itself.
Jessica B. Steier, who leads the science communication group Unbiased Science and was not involved in the review, highlighted the dangers of not treating symptoms like fever during pregnancy. She told ABC News, “Untreated fever has documented associations with serious pregnancy and fetal risks.” Steier added that alternative pain medications, such as NSAIDs (nonsteroidal anti-inflammatory drugs) and opioids, carry their own distinct pregnancy risks, reinforcing acetaminophen’s position as the safest option when medication is required. She also cautioned that studies linking acetaminophen to autism can be easily misinterpreted, especially when amplified on social media, contributing to unnecessary alarm.
Despite the strong findings, an official from the Department of Health and Human Services (HHS) expressed a dissenting view to ABC News, stating that the new analysis “does not resolve an important public health question; it sidesteps it. By excluding the vast majority of relevant evidence, privileging one study design known to bias results toward the null, and misrepresenting statistical power, the authors engineer a finding rather than evaluate causality.” However, the authors of the review acknowledge some limitations, noting that few studies utilizing sibling-based designs prevented them from accounting for all potential variables that could influence painkiller use or contribute to neurodevelopmental disorders.
Nonetheless, the new review’s findings align squarely with the guidance provided by several leading professional medical organizations, including the American College of Obstetricians and Gynecologists (ACOG). ACOG consistently advises pregnant individuals to use acetaminophen when necessary, adhering strictly to label instructions, seeking medical guidance for persistent, severe, or recurring symptoms—especially fever—and paying close attention to the underlying reasons for medication use. As Dr. Khalil aptly summarized, “It’s always sensible to use paracetamol appropriately in pregnancy: the lowest effective dose for the shortest time, and avoid unnecessary prolonged use without medical review.”
This latest meta-analysis significantly re-calibrates the scientific understanding of acetaminophen use in pregnancy, providing a much-needed evidence-based counterpoint to politically charged rhetoric and less rigorous observational studies. By emphasizing the robust methodology of sibling-comparison studies and clarifying the confounding role of underlying maternal conditions, the review offers substantial reassurance to healthcare providers and expectant mothers, underscoring that when used as directed, acetaminophen remains a safe and crucial tool for managing common pregnancy discomforts. The continued debate, however, highlights the ongoing challenge of translating complex scientific findings into clear public health guidance amidst a cacophony of misinformation.