Tylenol: Is it safe for me to take?
As a Maternal-Fetal Medicine specialist, my job is to guide you through high risk situations. Many patients may ask “Is Tylenol safe for me to take during pregnancy?” Tylenol (generic name acetaminophen, also called paracetamol in many countries) is one of the most commonly used medications in pregnancy. In this blog we will cover:
- Is Tylenol safe for my baby?
- What about the headlines linking Tylenol to ADHD or autism?
- How much can I safely take?
What is Tylenol and what does it do?
Tylenol (acetaminophen) is:
- A pain reliever (analgesic)
- A fever reducer (antipyretic)
During pregnancy, we generally advise avoiding NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) like Ibuprofen, Naproxen, and regular strength Aspirin (low-dose Aspirin is often recommended for preeclampsia prevention if you have certain risk factors).
Is Tylenol generally considered safe in pregnancy?
Based on decades of experience and large studies:
- The American College of Obstetricians and Gynecologists (ACOG) recommends acetaminophen as the preferred option when medication is needed for pain or fever in pregnancy.
In 2021, a group of researchers published a “call for precaution” about acetaminophen and possible neurodevelopmental effects. ACOG reviewed this and issued a Practice Advisory stating:
- Current data DO NOT indicate that typical use of acetaminophen in pregnancy causes ADHD, autism, or other neurodevelopmental issues.
- The studies have important limitations and potential confounding.
- Pregnant patients should not avoid necessary treatment with acetaminophen when clinically indicated.
- Best practice remains to use the lowest effective dose for the shortest time needed, in consultation with your clinician.
Studies Suggesting Association With Behavioral Issues in Children
The Society for Maternal-Fetal Medicine (SMFM) and the American College of Obstetricians and Gynecologists (ACOG) have critically reviewed the studies suggesting an association between prenatal Tylenol use and behavioral issues in children. The consensus among experts is that these studies have major flaws:
- They are observational. They rely on moms remembering how many pills they took years ago.
- They don’t account for the illness. If a mom took Tylenol because she had a high fever or severe inflammation, was it the pill that affected the baby, or was it the high fever? We know that high maternal inflammation is a risk factor for developmental issues.
Because the evidence is inconclusive and weak, the medical guidelines have not changed.
The Risk of Doing Nothing
We must also talk about the risk of not treating your symptoms.
- Fevers: A high fever (hyperthermia) in the first trimester is linked to neural tube and heart defects as well as other anomalies. If you have a fever, taking Tylenol to lower it is safer for the baby than letting the fever run its course.
- Chronic Pain: Severe, untreated pain raises maternal blood pressure and stress hormones (cortisol), which can negatively impact the pregnancy.
The MFM Protocol: How to take it safely
While Tylenol is safe, it is medication that is processed by the liver. Therefore it is important to:
1. Use only as needed or prescribed
Do not take it preventatively. Take it only when you have symptoms.
2. Follow the 24-Hour Cap
Do not exceed the daily recommended limit. Be careful with combination drugs—if you are taking “PM” sleep aids or cold medicines, they often already contain acetaminophen.
3. Seek the Root Cause
If you have a headache that Tylenol does not touch, call your doctor. In the second and third trimesters, a persistent headache can be a symptom of Preeclampsia (high blood pressure). We need to rule that out immediately.
With appropriate use, Tylenol (acetaminophen) is still considered one of the safest options we have for pain and fever in pregnancy based on decades of use and current data. Contact your OB, primary care physician or maternal-fetal medicine doctor for guidance on your specific pregnancy.