By Dr. Nichole Barker, REI, Pinnacle Fertility Washington
As a physician caring for patients who are navigating fertility, I am frequently asked about the safety of common over-the-counter medications. This week, we have heard increasing concerns about whether acetaminophen (Tylenol) use during pregnancy or when trying to conceive could raise the risk of autism in children.
I want to address this topic thoughtfully and transparently, sharing what the research tells us, where the evidence falls short, and how I counsel my own patients.
Why Does This Matter?
Acetaminophen is one of the most common medications used during pregnancy to treat fever and pain. For decades, it has been considered a safe option, especially compared to other pain relievers that carry known pregnancy risks.
In recent years, however, some studies have suggested a possible association between prenatal acetaminophen use and neurodevelopmental conditions like autism spectrum disorder (ASD) and ADHD. This concern came back into public view after the President’s recent announcement that a forthcoming federal report would tie acetaminophen use in pregnancy to autism.
While I welcome ongoing research into maternal and fetal health, I want to reassure you that there is currently no proven causal relationship between acetaminophen use during pregnancy and autism.
What the Research Shows
Studies that may raise concerns
- Mount Sinai Systematic Review (2025): Researchers reviewed dozens of studies and concluded that prenatal acetaminophen use may be associated with higher rates of autism and ADHD. They recommended limiting prolonged use during pregnancy but stopped short of calling for a ban.
The study included in the most systematic review are important, but they are not conclusive. It highlights the need for more research, not a reason for panic.
Studies Showing No Causal Link
Some of the most robust evidence we have, particularly studies that compare siblings within the same family, shows no increased risk once genetic and environmental factors are accounted for:
- JAMA Swedish Sibling-Control Study: This study followed more than 2.4 million children and found that the apparent increased risk disappeared when comparing siblings. This study highlights weaknesses of previous studies that failed to control confounding variables.
These results suggest that much of the association observed in earlier research may be due to underlying factors, such as genetics or family environment, rather than the medication itself.
How I Advise My Patients
As a physician, I take every concern seriously, but I also want to protect patients from unnecessary fear. Here is my approach when counseling those who are pregnant or trying to conceive:
- Use acetominohpen judiciously. Take the lowest effective dose for the shortest time needed.
- Do not leave fever untreated. High fevers can pose risks to both the pregnant person and the developing baby.
- Avoid long-term daily use unless specifically advised. If you frequently experience pain, discuss it with your healthcare provider to explore potential underlying causes.
- Keep perspective. The current body of evidence does not prove that acetominophen causes autism.
Moving Forward
I support continued research into this question and encourage my patients to stay informed as new data emerges. But I also reassure them: based on what we know today, acetaminophen remains the safest first-line option for pain and fever during pregnancy.
Pregnancy is already full of worry; you do not need one more source of guilt or fear based on inconclusive science. Partner with your care team, ask questions, and make medication decisions that balance your health with that of your baby.