At some point in their pregnancy, many people will look for safe pain management strategies because… well, growing a human can get uncomfortable! And we know that fever in pregnancy can lead to its own complications.
More than 50% of pregnant women in the United States reported using acetaminophen – sold under brand names like Tylenol and Paracetamol – making it the most common over-the-counter pain medication.
In this article, I want to break down some concerns around Tylenol and other acetaminophen drugs during pregnancy.
Prefer audio? You can listen to Episode 57 of The Missing Pillar of Health Podcast on your favourite podcast app or the player here:
What is acetaminophen?
Acetaminophen (also known as paracetamol in some countries) is the active ingredient in more than 600 medications used to relieve mild to moderate pain and reduce fever.
Unlike Ibuprofen, it has long been considered safe for use during pregnancy when used as directed.
For clarity, Ibuprofen is an anti-inflammatory, whereas acetaminophen does not reduce inflammation. In 2020, the FDA issued a drug safety communication that pregnant people should avoid using NSAIDs – or non-steroidal anti-inflammatory drugs – after 20 weeks of pregnancy. This includes Ibuprofen, and was based on a data review that found an increased risk of kidney problems in the fetus and low amniotic fluid levels.
So, the most commonly recommended alternative is acetaminophen, sold under various brand names, like Tylenol.
It’s most often used for the treatment of headache, muscle pain, back pain and infection. Studies have suggested that it’s regularly used where it might not even be effective, including conditions such as chronic pain, back and knee pain, and headache.
Why 91 Doctors & Researchers Suggest Caution
A recent Consensus Statement signed by 91 doctors and researchers is encouraging more research to evaluate the risks associated with its use, particularly for pregnant people.
The scientists are concerned about mounting research that suggests prenatal exposure to acetaminophen could increase the risks of some neurodevelopmental, reproductive and urogenital disorders.
They reviewed epidemiological and animal studies from 1995-2020, largely because the FDA has yet to review acetaminophen’s potential effects on fetal reproductive systems.
Now, before I go any further about some of the research, I want to say that there is zero blame or shame if you use these drugs and/or have a child with a neuro-atypical diagnosis. These issues are complex, multi-faceted, and many children with these diagnoses are thriving – so please don’t take this as a criticism of you or your child. I’m simply sharing the research so you can use it to make informed decisions going forward.
Study findings include:
- Maternal acetaminophen use during pregnancy is associated with a higher risk for ADHD-like behaviors in children, particularly when used in more than one trimester.
- Various animal and human studies have suggested that acetaminophen is a hormone disruptor and may be linked with neurodevelopmental disorders.
- Increased chance of autism in children born with higher levels of acetaminophen in the cord blood.
- Linked to language development delays in young girls.
- Increased risk of undescended testicles and reduced anogenital distance, which are risk factors for reproductive disorders in later life (you can learn more about that with my interview with one of the authors of the Consensus Statements, Dr. Shanna Swan, in episode 35 of the Podcast).
The Take-Away: Can Tylenol be Used Safely?
It’s important to note that based on the collection of studies, the timing and length of acetaminophen use are critical factors. Use for acute pain management is unlikely to cause harm. And even long-term use isn’t a guarantee to cause issues.
The Consensus Statement acknowledges that there are gaps in the research, but that based on the findings precautionary action should be taken to reduce unnecessary use of acetaminophen during pregnancy.
They also acknowledge that there are some circumstances where the benefits outweigh the risk. High fever during pregnancy can result in neurological effects in children, while persistent pain can cause anxiety, depression and high blood pressure in pregnant women.
One of the authors said that a lack of alternative medications has, in part, made regulators concerned that issuing stronger warnings about acetaminophen could discourage women from taking needed medication.
At a press briefing he said: “But I think what we believe is that it’s important to empower women to make their own decisions together with their clinicians or pharmacist.”
The ultimate recommendation from the Consensus Statement is that pregnant people should be cautioned at the beginning of pregnancy to forgo acetaminophen unless medically necessary and when necessary, the lowest effective dose for the shortest possible time is taken.
They acknowledge that additional work is necessary, and are calling for epidemiological studies to better understand the risk. As these take time, they believe it is prudent to take precautionary action now.
If you are looking for alternatives, here’s an article by Dr. Aviva Romm where she walks through some other options.
Now, if you’ve been taking Tylenol during pregnancy, don’t freak out. The studies are evolving and while the increased risks from the studies I outlined in some cases are quite substantial, the chances are still quite low for an individual pregnant person that it will cause lasting issues.