In a White House briefing on September 22, President Trump claimed that using acetaminophen (a.k.a. Tylenol) during pregnancy “can be associated with a very increased risk of autism,” despite there being no new evidence for this and plenty of research that suggests the contrary.
Trump went so far as to say that if you’re pregnant, “ideally, you don’t take it at all,” except in cases of “extremely high fever” when you feel like “you can’t tough it out,” before doubling down again that you should “fight like hell not to take it.” This recommendation flies in the face of guidelines from major medical organizations including the American College of Obstetricians and Gynecologists (ACOG)—which released a statement yesterday reaffirming the safety and benefits of Tylenol use in pregnancy—and the Society for Maternal Fetal Medicine, both of which broadly support the drug’s usage during pregnancy. (Health officials from around the world have also pushed back on Trump’s announcement in the past day.)
But the problem isn’t just that Trump’s recommendation lacks scientific backing. It also threatens to take off the table the single safe option pregnant women have for pain and fever. And contrary to Trump’s statement that “there’s no downside in not taking it,” several obgyns and experts in maternal fetal medicine told SELF that telling pregnant women to muscle through pain and fever risks physical and psychological harm to both them and their babies.
There’s no research that proves Tylenol causes autism.
Much of the recent buzz on this topic centers on an analysis, published in August, for which researchers reviewed 46 existing studies on acetaminophen use during pregnancy and neurodevelopmental disorders (like autism and attention deficit hyperactivity disorder (ADHD)), only eight of which looked specifically at autism. (They didn’t conduct their own research or supply new data on the topic.) Overall, they determined the evidence suggests a possible tie between prenatal acetaminophen use and autism. But as they also noted in the review, this doesn’t necessarily mean one causes the other.
The first author on the study, Diddier Prada, MD, an epidemiologist at Mount Sinai, has since clarified to The New York Times that we “cannot answer the question about causation,” making a comparison to ice cream sales and crime: Both go up in the summer, but it doesn’t mean the ice cream consumption triggers the crime. Here, hot weather is the confounding variable leading to both outcomes. And there may be a host of similar confounders that contribute to both Tylenol use during pregnancy and the development of autism.
“Mothers who take Tylenol often do so because they have fever, for instance from an infection, or they have pain from other conditions and complications, perhaps even stress—and all of these themselves raise developmental risks,” Sura Alwan, MSc, PhD, an epidemiologist based in British Columbia and executive director of the nonprofit PEAR-Net Society (Pregnancy Exposures, Advocacy, and Research Network), tells SELF.
A recent large Swedish study was uniquely designed to “cut through that noise” by comparing siblings where one had been exposed to acetaminophen in utero and the other had not, Lucky Sekhon, MD, a double board-certified reproductive endocrinologist and ob-gyn at RMA of New York and author of fertility guide The Lucky Egg, tells SELF. This way, the researchers could control for a bunch of key confounders, like genetics, household environment, socioeconomic status, and maternal health history, all of which tend to be similar between siblings, Dr. Sekhon points out. The result? The “signal faded,” Dr. Alwan says: Exposed siblings were no more likely to have autism than those who weren’t.
Scientists who research autism pin the rise in cases over recent decades largely to improved diagnostic criteria for it—we’re now catching cases that were previously missed, particularly in women—as well as a mix of genetic and environmental factors.
Restricting the one safe painkiller for use during pregnancy risks both unnecessary suffering and fetal damage.
White-knuckling your way through fever or pain during pregnancy isn’t just a terrible way to exist (pregnancy is hard enough on the body as is); it can be actively dangerous. For instance, leaving a fever raging, especially during early pregnancy, “increases the risk of fetal malformation and pregnancy loss,” Veronica Gillispie-Bell, MD, MAS, a Louisiana-based board-certified ob-gyn and the vice chair of ACOG’s Clinical Practice Guidelines Committee–Obstetrics, tells SELF. A cooling blanket or cold shower won’t knock down your internal temperature or protect a fetus from the heat, Dr. Gillispie-Bell emphasizes.
Untreated pain isn’t innocuous either. Dr. Gillispie-Bell and Dr. Sekhon point to how it can raise your blood pressure and spike stress hormones like cortisol, which can threaten healthy fetal development and may increase your risk of preterm labor. And speaking of blood pressure, one of the key signs of preeclampsia—a sudden rise in blood pressure during or after pregnancy—is “a headache that isn’t relieved by Tylenol,” Dr. Gillispie-Bell notes. So if pregnant women are advised to steer clear of the drug, it raises the risk that doctors miss cases of preeclampsia, which is already underdiagnosed—and can restrict fetal growth, increasing the risk of preterm birth and low birth weight, as well as a host of health conditions for the baby, including neurocognitive ones (like, yes, autism).
Should pregnant people opt for other OTC painkillers or fever reducers—which are not recommended during pregnancy—the outcomes could be just as bad, if not worse, than pushing through without treatment. Each of them has documented adverse effects: Non-steroidal anti-inflammatory drugs, or NSAIDs (like Advil and Aleve) can increase the risk of miscarriage in early pregnancy and later on, interfere with the baby’s developing heart and kidneys, Dr. Sekhon notes. And aspirin, while sometimes used in low doses in the second trimester for those at risk for preeclampsia, can pose a bleeding risk in the first trimester, Dr. Gillispie-Bell notes. (As for prescription options? Opioids, while used in certain situations during pregnancy, come with the risk of dependence as well as withdrawal in newborns and long-term developmental effects, Dr. Gillispie-Bell says, not to mention they don’t work for fevers.)
Hence why Tylenol—which Dr. Sekhon notes is “metabolized differently [than other painkillers] and doesn’t affect fetal circulation”—remains the first-line recommendation for pain and fever during pregnancy. Even the conclusion of the recent analysis recommends “judicious acetaminophen use—lowest effective dose, shortest duration” versus a “broad limitation.” This shouldn’t be interpreted as evidence of risk, Dr. Alwan notes, as it reflects the same guidance ACOG has long offered and that applies to “really any medication at any time,” she says: “Use it how it’s indicated and not beyond that.”
Casting blame on Tylenol for autism wrongly positions the condition as a problem—and levies unfair guilt on moms.
Throughout his announcement, Trump referred to autism as a “horrible, horrible crisis,” “severe problem” and “epidemic,” among other negative labels. This kind of language is ableist in that it pathologizes people with autism and suggests the need to cure or eliminate it. “It’s stigmatizing—and it’s not right,” Dr. Alwan says. For plenty of people with autism, the condition isn’t a problem at all but just a different way of seeing the world.
At the same time, pinpointing Tylenol use during pregnancy as the culprit for this “crisis” throws moms of children with autism under the bus. “I’ve spoken to women who have children with autism, and there’s a heavy burden of self-blame—they tell me they replay every choice they made in pregnancy,” Dr. Alwan says. The suggestion that if they took Tylenol in pregnancy, they might be the reason their kid has autism can have a huge “psychological impact,” Dr. Gillispie-Bell says. “No women should have to go through the guilt that could come from that when we don’t have the data to show this.” The science overwhelmingly suggests that autism has strong genetic roots and can be influenced by a variety of factors, “not a single decision or medication,” Dr. Alwan says.
More research to understand those factors, and the potential role of pregnancy exposures, is certainly needed—for the benefit of both people with autism and pregnant women. And that’s something Trump has promised (despite funding cuts that might suggest otherwise).
Related:
- 11 Health Conditions You Should Know About If You’re Black and Pregnant
- Which of the Pregnancy Food Rules Are Worth Paying Attention To?
- I’m a 30-Year-Old Engaged Woman—and Nothing About a $5K ‘Baby Bonus’ Makes Me Want to Have a Kid
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