If you’re pregnant and in pain, there’s not really a lot of options. Aspirin is out, as is ibuprofen – and don’t even think about picking up the opioids. In fact, one of the only things you can rely on to help you deal with the aches and pains of growing a whole new human inside your body is paracetamol, or acetaminophen.
It’s long been the first port of call for pregnancy twinges in the US, Europe, and Australia – nearly two-thirds of pregnant people reported reaching for the Tylenol at some point during the nine-month baby build. However, according to a new consensus statement published in Nature Reviews Endocrinology, we might need more caution reaching for that supposedly “safe” painkiller.
“We reviewed the research on acetaminophen use during pregnancy from 1995 through 2020 and found a growing body of evidence that suggests the medication may alter fetal development, increasing the risk of the improper development of the reproductive organs and of neurological disorders, primarily attention deficit hyperactivity disorder (ADHD) and related behavioral abnormalities, but also autism spectrum disorder (ASD), language delays, decreased IQ and conduct disorders,” lead author Ann Bauer explained in a statement.
“Acetaminophen is one of the most commonly used medications during pregnancy and its use has been increasing. Research suggests that up to 65% of U.S. women and 50% of women worldwide use acetaminophen,” she continued. “Because use is so common, if acetaminophen is responsible for even a small increase in individual risk, it could contribute substantially to these disorders in the overall population.”
Pregnancy can be a stressful time as it is, so it’s important to note that the authors aren’t calling for a ban on acetaminophen during pregnancy – only for more caution to be employed in its use. Indeed, as an accompanying editorial notes, the study’s recommendations “might not substantially differ from current advice in some countries”: use the drug only when necessary, use the lowest dose you can for the shortest possible time, and consult your doctor, midwife, or OB/GYN if you need advice.
“[The] consensus statement is a balanced view of the potential risk/benefit of paracetamol in pregnancy,” commented Andrew Shennan, Professor of Obstetrics at King’s College London. “They point out that treating pain and fever could reduce pregnancy risks, and alternatives to paracetamol have got evidence of harm. The evidence that paracetamol is harmful is not strong but observations in humans regarding possible developmental issues are supported by animal studies.”
Although the potential effects of acetaminophen may sound scary, the editorial notes that “there seems to be a dose–response relationship” at play. In other words: the longer you use the drug – particularly if you use it for two weeks or more – the riskier it becomes.
The authors also suggest that “the timing of [acetaminophen] use in particular gestational windows might also be crucially important.” Shennan, who was not involved in the study, agrees that “by 10 weeks of pregnancy and it is unlikely a drug will cause significant harm in fetal development”.
However, the authors write, further research and greater awareness of these issues are essential, as pregnant people – and even medical professionals – are often under the impression that acetaminophen is essentially “risk-free.”
“We urge both medical and industry authorities to review the research and issue acetaminophen-specific guidance,” concluded Bauer. “While this guidance may not be dramatically different than their current guidance, we believe acetaminophen-specific guidance is warranted, as awareness of this research among both physicians and patients is limited and the incorrect perception of complete safety of this medication persists.”