There has been talk in the news lately about acetaminophen, which is commonly marketed under the brand name Tylenol in the United States and known as paracetamol in the UK, and whether it is safe to take during pregnancy. In this post, we’ll discuss the current expert perspectives and other things you should consider when treating aches and pains during pregnancy.
Historically, acetaminophen has been recommended to pregnant people over nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, because NSAIDs have been linked with adverse effects, including risks to the fetus. Last year, the U.S. Food & Drug Administration recommended that pregnant people limit NSAID use in the second half of pregnancy because it can lead to low amniotic fluid.
This September, an international group of scientists, public health researchers, and physicians published a consensus statement in the journal Nature Reviews Endocrinology.  In the statement, the authors point to data from both people and research animals that suggests that the use of acetaminophen during pregnancy might disrupt fetal development and potentially increase the risk of developmental disorders. Based on these results, they caution against acetaminophen’s “indiscriminate use, both as a single ingredient and in combination with other medications.” Instead, the authors recommend that, if acetaminophen is used, it should be at “the lowest effective dose for the shortest possible time” and in consultation with care providers.
Hearing this while you’re pregnant or have recently been pregnant and may have taken acetaminophen may be scary. The good news is that it’s unlikely that your baby was harmed or will be harmed by you taking acetaminophen. In an interview with Harvard Women’s Health Watch, Kathryn Rexrode, a women’s health physician at Harvard Medical School and Brigham and Women’s Hospital, explained that “the risk for an individual is low.” 
Luke Grzeskowiak, a pharmacist at Flinders University in Australia, and Debra Kennedy, an obstetrician and gynecologist at the University of New South Wales in Australia, published a response to this statement in The Conversation in September 2021.  Grzeskowiak and Kennedy explain that the studies on which these recommendation in the consensus statement are not definitive because it is hard to separate the effects of acetaminophen from the effects of pain and fever. They also highlight the contribution of dose—that is, the issues that have arisen with taking acetaminophen are greatest when it’s taken at the upper end of the recommended doses for two to four weeks at a time.
In their perspective, Kennedy and Grzeskowiak also explain that fever can lead to problems for the fetus, including miscarriage, and that untreated pain is associated with increased incidence of depression and anxiety. “I think we should obviously continue to gather data about the safety of Tylenol and all medications in pregnancy,” maternal-fetal medicine physician Kathryn Gray of Brigham and Women’s Hospital and Harvard Medical School told MedPage Today. “we shouldn’t be withholding Tylenol based on what we know” from pregnant people who need treatment, she continued. 
So what does this mean for you as a pregnant person who might have pain and fever? First, talk to your care provider. Because the risks are different for each individual, it’s a great idea to consult with someone who knows your medical situation well. Second, consider the risks you already take. Nothing is absolutely, 100 percent safe in the world. We have constant exposure to pollution, pesticides, and other challenges from the environment, but our bodies do a great job protecting our growing babies. If you have pain or fever, you don’t have to suffer. Talk to your doctor or midwife and consider the risks, but if you need pain medication during pregnancy, acetaminophen might still be a good choice for you. And there are some complementary pain relief modalities—exercise and acupuncture, to name a few—that might be a good option as well.
- Z. Bauer et al., “Paracetamol use during pregnancy — a call for precautionary action,” Nature Reviews Endocrinology, 2021.
- Bilodeau, “Is a common pain reliever safe during pregnancy?” Harvard Women’s Health Watch, 2021.
- Grzeskowiak and D. Kennedy, “Take care with paracetamol when pregnant — but don’t let pain or fever go unchecked,” The Conversation, 2021.
- D’Ambrosio, “Warning on Tylenol in Pregnancy No Cause for Alarm,” MedPage Today, 2021.