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#19,023
Last September the WHO & Other Major Medical Stakeholders Pushed Back On A Suggested Acetaminophen/Autism Link after the White House issued an announcement suggesting that such a link existed.
Acetaminophen/Paracetamol have long been considered the safest analgesic & antipyretic drugs for pregnant women and their unborn child, with few safe alternatives currently available.
While a few studies have claimed a statistical link between acetaminophen use during pregnancy and autism (Link), none have found a causal link, and one of the most robust recent (2024) studies (see Acetaminophen Use During Pregnancy and Children’s Risk of Autism, ADHD, and Intellectual Disability) found:
Conclusions and Relevance Acetaminophen use during pregnancy was not associated with children’s risk of autism, ADHD, or intellectual disability in sibling control analysis. This suggests that associations observed in other models may have been attributable to familial confounding.We've previously looked at potential drivers of increased autism, and after genetics, environmental exposures, and increased recognition of those on the spectrum, fevers during pregnancy are frequently cited (see Molecular Psy.: Increased Autism Risk Linked To Prenatal Fever).
The concern is that discouraging the use of the only `presumed safe' option to reduce fevers could actually end up increasing the incidence of autism, instead of decreasing it.Admittedly, no medication is 100% safe for 100% of the population 100% of the time. As with everything in life, there there is always a risk-reward calculation involved: Is the risk (no matter how slight) worth the benefit?
While absolute statements on the absolute safety of any drug are impossible to make, over the weekend The Lancet has published a Systematic Review and Meta Analysis on Paracetamol/Acetaminophen exposure and child neurodevelopment.
This review incorporated 43 studies (17 of which were combined in the meta-analysis), and they report:
Current evidence does not indicate a clinically important increase in the likelihood of autism spectrum disorder, ADHD, or intellectual disability in children of pregnant individuals who use paracetamol as directed, supporting existing recommendations on its safety.
While additional research is still needed to better understand heavy or prolonged usage, these findings should be reassuring to anyone who chooses to use these drugs during pregnancy.
Taken together with large-scale sibling-controlled studies from Sweden and Japan published in 2024 and 2025, our findings support the safety of paracetamol when used appropriately during pregnancy. They reinforce the guidance of major professional and regulatory bodies, including the American College of Obstetricians and Gynecologists, the Royal College of Obstetricians and Gynaecologists, and the European Medicines Agency, which continue to recommend paracetamol as the first-line analgesic and antipyretic in pregnancy.
Avoiding paracetamol based on inconclusive or biased evidence might increase the risk of maternal fever or untreated pain, both of which can harm pregnancy outcomes. Future research should focus on improving exposure measurement, standardising outcome definitions, and integrating mechanistic and family-based designs to clarify any residual uncertainties.
I've posted the link and the abstract from the open-access meta-analysis below.
Prenatal paracetamol exposure and child neurodevelopment: a systematic review and meta-analysis
Francesco D'Antonio, PhDa,† ∙ Maria Elena Flacco, PhDb,† ∙ Lorenza Della Valle, MBBSc ∙ Smriti Prasad, MRCOGd ∙ Lamberto Manzoli, PhDf ∙ Athina Samara, PhDg,h,i ∙ et al.
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Summary
Background
Concerns have emerged about the impact of paracetamol use in pregnancy on child neurodevelopment, particularly in relation to autism spectrum disorder. We aimed to synthesise available evidence to investigate associations between prenatal paracetamol exposure and autism spectrum disorder, attention-deficit hyperactivity disorder (ADHD), and intellectual disability.
Methods
For this systematic review and meta-analysis, we searched MEDLINE, Embase, ClinicalTrials.gov, and the Cochrane Library from inception to Sept 30, 2025, for cohort studies reporting adjusted estimates of the risk of autism spectrum disorder, ADHD, and intellectual disability. Eligible studies used validated questionnaires or medical records to define outcomes, reported maternal comorbidities and treatments, and compared pregnancies with and without paracetamol exposure, whereas unadjusted studies were excluded. Quality assessment of the included studies was conducted using the Quality In Prognosis Studies (QUIPS) tool. The primary outcomes were the associations between prenatal paracetamol exposure and the likelihood of autism spectrum disorder, ADHD, and intellectual disability. Analyses were restricted to sibling-comparison studies with adjusted estimates, and odds ratios (OR) were calculated. Random-effects meta-analyses used the generic inverse variance method. Subgroup analyses were performed when possible (trimester, duration of use, offspring sex, and follow-up length). This study was registered with PROSPERO, CRD420251156690.
Findings
43 studies were included in the systematic review, and 17 studies in the meta-analysis. When considering sibling comparison studies, paracetamol exposure during pregnancy was not associated with the risk of autism spectrum disorder (OR 0·98, 95% CI 0·93–1·03; p=0·45), ADHD (0·95, 0·86–1·05; p=0·31), or intellectual disability (0·93, 0·69–1·24; p=0·63).
There was also no association between paracetamol intake during pregnancy and autism spectrum disorder (OR 1·03, 95% CI 0·86–1·23; p=0·78), ADHD (0·97, 0·89–1·05; p=0·49), or intellectual disability (1·11, 0·92–1·34; p=0·28) when considering only studies at low risk of bias according to QUIPS. This absence of association persisted when considering all studies with adjusted estimates and those with more than 5 years of follow-up.
Interpretation
Current evidence does not indicate a clinically important increase in the likelihood of autism spectrum disorder, ADHD, or intellectual disability in children of pregnant individuals who use paracetamol as directed, supporting existing recommendations on its safety.
