The recent announcement by the US President Donald Trump about the use of Tylenol in pregnancy and its links to autism has created significant concern for many mothers. I really dislike the comments that a drug is “bad” and mothers should just tough it out. Particularly coming from someone who has never lived through a pregnancy.
I was determined to find out what the real position was – is this drug as risky as painted or was it another overreach?
Turns out that there was a recent large scale review which is good quality that actually looked at this issue and the real position was different to what I expected. A recent August, 2025 research article in Environmental Health (1) does raise questions about whether Panadol is as harmless as once thought.
For years, Panadol (paracetamol, also known as acetaminophen) has been considered the safest option for pain and fever relief during pregnancy. Other common pain relievers such as ibuprofen and aspirin come with well-documented risks of miscarriage or birth defects, so doctors have routinely reassured women that Panadol is the “safe” choice.
This review used the Navigation Guide methodology, which is a structured and rigorous way of assessing environmental health risks. Instead of focusing on just one or two studies, the researchers reviewed 70 studies and found 46 studies in total which met the criteria. This included children exposed to Panadol during pregnancy and later outcomes such as:
ADHD (attention-deficit/hyperactivity disorder) ASD (autism spectrum disorder) Other neurodevelopmental disorders (NDDs) such as learning or behavioural challenges.
Most studies showed a link: 27 studies found significant associations between prenatal Panadol use and later NDD. 9 studies showed no link. (3) 4 surprisingly showed protective effects (though these were considered lower-quality). The higher-quality studies were more likely to find positive associations—that is, children exposed in the womb had higher risks of ADHD, ASD or related challenges. Dose and timing appear important: Several studies suggested that longer use, or use later in pregnancy (particularly the second and third trimester), was linked with stronger effects. Not just recall bias: Some of the better quality studies used biological markers (such as cord blood or meconium testing), which are not influenced by memory or self-reporting. These also found higher risks. (4) (5) Sibling studies were mixed: A few studies that compared siblings within the same family didn’t always show the same associations. But these studies had limitations, including very small numbers of “discordant” sibling pairs (where one sibling was exposed, and one wasn’t), and problems with accurately measuring Panadol use.
The authors conclude that there is evidence that Panadol use during pregnancy is associated with increased risks of ADHD, ASD and other neurodevelopmental disorders.
Does this mean no pregnant woman should ever take Panadol? Not necessarily. HIgh fevers, for example, can also be harmful during pregnancy, and Panadol may still be the safest available option in some cases. But the evidence suggests it should not be considered a completely risk-free medication.
Use sparingly: If you are pregnant, avoid regular or long-term use of Panadol. Seek alternatives first: Try non-drug strategies for pain or fever relief where appropriate (hydration, cooling and rest for fever, bodywork like osteopathy or massage for headaches and pain). Talk to your healthcare provider: Never stop medication suddenly if it’s needed, but do discuss whether use can be minimised or alternatives considered.
It’s important that women understand the risks and benefits of using medications during pregnancy. Concerns are being raised by these studies and if you already have a family history of autism or NDD then it provides insights into how to manage the risks by minimising use during pregnancy.
The research analysis in Environmental Health was based on a number of journal articles and separately I did a search of the EBSCO database and found the following articles if you would like more information. These include the studies reviewing cord blood and metabolites which were considered higher quality as they weren’t relying on recall.
This also includes the much cited Swedish study which does not show evidence of concern with use of tylenol in pregnancy. It is noted however that whilst its a large study with over 2.4 million records only about 10% were using tylenol in pregnancy according to prescriptions and ante-natal details. This compares with average use estimated at over 50% of pregnant women.
It’s also important that you use your critical thinking skills and make the right decision for you.
Source: Article by Christine Pope, Naturopath, Homeopath, Nutritionist
Prada, D., Ritz, B., Bauer, A.Z. et al. Evaluation of the evidence on acetaminophen use and neurodevelopmental disorders using the Navigation Guide methodology. Environ Health 24, 56 (2025). https://doi.org/10.1186/s12940-025-01208-0 Alemany S, Avella-García C, Liew Z, García-Esteban R, Inoue K, Cadman T, López-Vicente M, González L, Riaño Galán I, Andiarena A, Casas M, Margetaki K, Strandberg-Larsen K, Lawlor DA, El Marroun H, Tiemeier H, Iñiguez C, Tardón A, Santa-Marina L, Júlvez J, Porta D, Chatzi L, Sunyer J. Prenatal and postnatal exposure to acetaminophen in relation to autism spectrum and attention-deficit and hyperactivity symptoms in childhood: Meta-analysis in six European population-based cohorts. Eur J Epidemiol. 2021 Oct;36(10):993-1004. doi: 10.1007/s10654-021-00754-4. Epub 2021 May 28. PMID: 34046850; PMCID: PMC8542535. Ahlqvist, V. H., Sjöqvist, H., Dalman, C., Karlsson, H., Stephansson, O., Johansson, S., Magnusson, C., Gardner, R. M., & Lee, B. K. (2024). Acetaminophen Use During Pregnancy and Children’s Risk of Autism, ADHD, and Intellectual Disability. JAMA, 331(14), 1205–1214. https://doi.org/10.1001/jama.2024.3172 Ji, Y., Azuine, R. E., Zhang, Y., Hou, W., Hong, X., Wang, G., Riley, A., Pearson, C., Zuckerman, B., & Wang, X. (2020). Association of Cord Plasma Biomarkers of In Utero Acetaminophen Exposure With Risk of Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorder in Childhood. JAMA Psychiatry, 77(2), 180–189. https://doi.org/10.1001/jamapsychiatry.2019.3259 Anand, N. S., Raghavan, R., Wang, G., Hong, X., Azuine, R. E., Pearson, C., Zuckerman, B., Xie, H., & Wang, X. (2021). Perinatal Acetaminophen Exposure and Childhood Attention-Deficit/Hyperactivity Disorder (ADHD): Exploring the Role of Umbilical Cord Plasma Metabolites in Oxidative Stress Pathways. Brain Sciences, 11(10), 1302. https://doi.org/10.3390/brainsci111013
