Acetaminophen in Pregnancy

From the American College of Obstetrics & Gynecology

What is ACOG’s position regarding the use of acetaminophen in pregnancy?

ACOG supports the use of acetaminophen in pregnancy when taken as needed, in moderation, and after consultation with a doctor.

Acetaminophen has long been established as a safe pain reliever and fever reducer for use during pregnancy.

What should pregnant women be aware of when deciding whether to take

acetaminophen given the conflicting information from HHS and ACOG or their ob­                                                                                                              gyn?

Acetaminophen is well studied and proven to be safe for use in pregnancy, and is one of the only medicines available to pregnant women for pain relief and treatment of headaches and fevers. Science does not support claims that acetaminophen use during pregnancy leads to autism. In fact, robust recent data have reinforced that acetaminophen use during pregnancy is not associated with an increased risk of autism.

Failing to treat medical conditions that warrant the use of acetaminophen, such as maternal fever, persistent headaches, and pain, can be dangerous. When left untreated, these conditions can in some cases create severe risk of harm or death for the pregnant person and the fetus.

How long have researchers been studying the use of acetaminophen in pregnancy?

Researchers have studied the use of acetaminophen during pregnancy for more than two decades. None of the research conducted during that time has shown that there is any risk associated with appropriate use of acetaminophen in pregnancy. The FDA and the Society for Maternal-Fetal Medicine did their own reviews in 2015 and 2017 respectively and came to the same conclusion.

Have any research studies successfully proven or disproven a causal link between acetaminophen use in pregnancy and neurodevelopmental disorders such as autism?

Research hasn’t definitively proved a causal link between acetaminophen use in pregnancy and neurodevelopmental disorders. The vast majority of the studies done on acetaminophen use in pregnancy have not successfully concluded that acetaminophen causes neurodevelopmental issues. In fact, some studies have concluded that acetaminophen does not cause neurodevelopmental issues.

Instead, evidence shows that many factors can lead to neurodevelopmental disorders.

The two highest-quality studies on the topic-Gustavson et al. 2021 and Ahlqvist et al. 2024-represent the most reassuring and clinically useful evidence we have to date that acetaminophen use in pregnancy is safe.

What is the latest evidence or research available on acetaminophen in pregnancy?

Since the publication of the 2021 consensus statement in Nature that raised questions about acetaminophen use in pregnancy, 10 new studies have been published. However, nearly all of them have substantial limitations and not one has proven a causal relationship between the use of acetaminophen in pregnancy and neurodevelopmental disorders.

Notably, in 2024, a population-based study in JAMA that controlled for confounders such as genetics and environmental factors found no significant associations between acetaminophen use in pregnancy and children’s risk of autism, ADHD, or intellectual disability. The findings suggested that previously reported associations may be largely attributable to a genetic factor within a family that was not accounted for rather than a causal relationship.

What are the limitations of the 2025 systematic review that found evidence of an

association between acetaminophen exposure during pregnancy and increased                                                                                                              incidence of neurodevelopmental disorders including autism and ADHD?

Several studies included in the Prada et al. 2025 systematic review are not considered high quality and have at least one-if not several-of the following limitations:

• They rely on self-reported acetaminophen use, with considerable potential for recall bias, or biased reporting of events or experiences due to inaccurate or incomplete recounting

• They include limited or no information on dosage and duration of the acetaminophen exposure
• They feature a number of different kinds of assessment of neurodevelopmental milestones over time instead of using a single standardized, uniform assessment method
• They lack controls for confounding factors

When it comes to any scientific paper, it’s important to ask what it adds to our current scientific knowledge and understanding. In the case of Prada 2025, the study’s findings don’t change the current standard of care for the use of acetaminophen in prenatal, postpartum, or fertility care.

Why has it been difficult to determine definitively if acetaminophen use in pregnancy causes neurodevelopmental disorders?

Most studies done on this subject are retrospective studies, meaning they use past or preexisting data and are subject to human error-for example, recall bias- and confounding factors that can’t be controlled for. These limitations make it difficult to prove a causal relationship.

Moreover, we know that genetic factors and the environment can also play a role in impaired brain development during pregnancy and early childhood development. The environmental link to neurodevelopmental delay warrants exploration and has not been controlled for in a majority of studies on acetaminophen use in pregnancy.

Are there any other pain relief medications that a pregnant person could take instead of acetaminophen that would be safe?

There are a small number of alternatives to acetaminophen for pain relief and treatment of fevers or headaches during pregnancy, but many of those come with usage restrictions or contraindications. Acetaminophen is recommended for prudent use following consultation with a doctor and is readily available to most people who need it.

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