The American College of Obstetricians and Gynecologists (ACOG) is firmly defending acetaminophen as a safe and necessary medication during pregnancy, pushing back against recent federal warnings that link the common painkiller to autism and neurodevelopmental disorders. Medical experts say the evidence behind these warnings doesn't hold up to scientific scrutiny, and that avoiding acetaminophen during pregnancy could actually put pregnant people and their babies at greater risk.

What Does the Research Actually Show About Acetaminophen in Pregnancy?

Over more than two decades of research on acetaminophen use during pregnancy, not a single reputable study has successfully concluded that the medication causes neurodevelopmental disorders in children. In fact, the two highest-quality studies on this subject, including one published in JAMA last year, found no significant associations between acetaminophen use during pregnancy and children's risk of autism, attention-deficit/hyperactivity disorder (ADHD), or intellectual disability.

The studies frequently cited as evidence of a causal link between acetaminophen and autism contain significant methodological limitations. These include lack of control for confounding factors, such as the underlying conditions that prompted medication use in the first place, and reliance on unreliable self-reported data rather than medical records. When researchers don't account for these confounding factors, it becomes impossible to know whether the medication or the condition being treated is responsible for any observed outcomes.

"Suggestions that acetaminophen use in pregnancy causes autism are not only highly concerning to clinicians but also irresponsible when considering the harmful and confusing message they send to pregnant patients, including those who may need to rely on this beneficial medicine during pregnancy," stated Steven J. Fleischman, MD, MBA, FACOG, president of ACOG.

Steven J. Fleischman, MD, MBA, FACOG, President of the American College of Obstetricians and Gynecologists

Why Is Acetaminophen Actually Important During Pregnancy?

Acetaminophen is one of the few pain and fever management options available to pregnant patients, making it essential for treating several serious pregnancy-related conditions. The conditions that doctors treat with acetaminophen during pregnancy include:

• Maternal fever: Untreated fever during pregnancy can be harmful to both the pregnant person and the developing fetus, potentially leading to serious complications.
• Headaches as an early warning sign of preeclampsia: Preeclampsia is a dangerous pregnancy complication characterized by high blood pressure and protein in the urine, and headaches can be an early indicator that requires immediate attention.
• General pain management: Pregnancy-related pain from various causes needs to be addressed to maintain the pregnant person's health and well-being.

When considering medication use in pregnancy, medical professionals weigh all potential risks against the benefits. The data from numerous studies have shown that acetaminophen plays an important and safe role in the well-being of pregnant people. The conditions that acetaminophen treats are far more dangerous than any theoretical risks and can create severe complications and even death for both the pregnant person and the fetus if left untreated.

How Should Pregnant People Approach Pain and Fever Management?

Rather than avoiding acetaminophen entirely, pregnant people should work with their healthcare providers to make informed decisions about medication use. The key is understanding that medication decisions during pregnancy require careful consideration of both the risks of the medication and the risks of leaving a condition untreated. For conditions like fever, headaches that could signal preeclampsia, or pain that interferes with daily functioning, the benefits of acetaminophen typically outweigh theoretical risks that lack strong scientific support.

Pregnant people should not make medication decisions based on headlines or social media warnings without consulting their obstetrician or midwife. Healthcare providers can review individual circumstances, discuss the specific reasons a medication is being considered, and help patients understand the actual evidence behind safety concerns. This personalized approach is far more reliable than blanket warnings that don't account for the complexity of pregnancy care.

The controversy over acetaminophen highlights a broader challenge in pregnancy medicine: balancing caution with the reality that untreated medical conditions during pregnancy carry their own serious risks. Federal health agencies have a responsibility to base major health announcements on solid scientific evidence rather than studies with significant methodological limitations. For pregnant people facing fever, pain, or other conditions that acetaminophen can treat, the safest approach remains working closely with their healthcare team rather than avoiding a medication that decades of research have shown to be safe and beneficial.