Pregnancy, Paracetamol (Tylenol) and my opinion

Paracetamol (acetaminophen) is one of the most commonly used medications in pregnancy, with more than half of pregnant women worldwide reporting use. In most studies, the main reasons for taking it are headaches and general pain, not fever. Lets look at what the science is saying regarding its risk of influencing foetal development.

Lets go back to 2021

Concerns about paracetamol and neurodevelopment first gained major public attention in 2021, with this study. This lead to certain media releases, see these posts: RACGP and UNSW.

A panel of international experts reviewed evidence from human and animal studies and issued a consensus statement warning that paracetamol use during pregnancy may alter fetal development. They called for caution and more research, noting possible effects on child health. At that time, the panel highlighted several proposed biological mechanisms, including disruptions in fetal hormones (particularly sex hormones essential for brain development), depletion of glutathione which reduces the fetus’s ability to neutralise oxidative stress, and potential effects on inflammatory pathways. These mechanisms remain theoretical.

The 2025 study

More recently, a group of Harvard researchers undertook a large review of 46 studies on paracetamol use in pregnancy and the risk of autism and ADHD, found here. They found mixed results: most studies suggested a small increased risk, some found no association, and a few showed a reduced risk.

The most robust research in their review was a 2024 study of 2.5 million Swedish children born between 1995 and 2019. In the general population analysis, there was a small association between prenatal paracetamol exposure and autism or ADHD. However, when researchers compared matched full siblings—children who share both genetics and home environment—the association disappeared. This is important because siblings of autistic children have around a 20% chance of also being autistic, and household environmental factors also contribute to developmental differences. When one sibling was exposed to paracetamol in utero and the other was not, or when their exposure levels differed, researchers found no increases in autism, ADHD, or intellectual disability. The authors concluded that earlier associations were likely due to confounding factors such as genetics, maternal health conditions, stress, illness, or environmental influences, rather than the medication itself.

Beyond Paracetamol and and the risk of untreated maternal fever

Fever, however, is a different consideration. High fevers in pregnancy have long been recognised as a risk factor for harm to the developing child. As Dr Ian Musgrave from the University of Adelaide explains, fever itself is a known risk, and paracetamol is one of the few medications available to safely reduce fever during pregnancy. For this reason, fevers should be treated. Yet most pregnant women are not taking paracetamol for fever, (<6% are, in fact), most take it for pain or headache/migraine (around 70%).

Framing the risk as ‘fever is less safe than paracetamol’ is misleading, because fever is not the main reason this medication is being used.

The 2025 study and the Whitehouse

Recently, Donald Trump publicly urged pregnant women to avoid paracetamol except in cases of very high fever because of a possible link to autism. Regardless of one’s political position, medication decisions should never be guided by political figures.

Australia’s regulatory agency - the TGA and their clarification

In Australia, the Therapeutic Goods Administration (TGA) continues to classify paracetamol as Category A, indicating that it is considered safe for use during pregnancy when taken according to directions. Current evidence suggests that when used appropriately, paracetamol remains one of the safer options available for treating pain and fever in pregnancy. The most comprehensive recent research indicates that family factors, rather than paracetamol itself, likely explain the associations seen in some earlier studies.

My personal stance

The rise of neurodivergence and increasing Autism diagnosis is incredibly complex. It is more than likely not driven by one thing, but several.

It should be noted that every substance taken in pregnancy—pharmaceutical or natural—has the potential to influence fetal development. Continuing to take Paracetamol, specifically in spite of your political leanings is probably not prudent.

It is also important to remember that medical evidence evolves slowly. On average, it takes around 17 years for new research findings to make their way into standard medical practice. This means practitioners and parents alike need an openness to updating their understanding as evidence emerges.

In conclusion

If you would like personalised guidance on medication use, pregnancy health, or natural approaches to managing pain and wellbeing, you are welcome to book an appointment.

I offer evidence-based support integrating naturopathic care, fertility awareness, and pregnancy education. To make a booking or learn more, simply send a message on the contact me page - or book to arrange a consultation.

Love,

Liz