If you didn’t know the name of Tylenol’s active ingredient, acetaminophen, before last month, you likely do now. Google searches for the term skyrocketed after President Trump told pregnant women to stop taking the drug because of what he said was a causal relationship with autism. That conclusion was assailed as a dangerous overstatement by many experts in the field. The controversy that followed kept search traffic high and amplified the spread of misinformation by some content creators.
The debate over acetaminophen’s safety isn’t new. It has long carried a different kind of risk that’s made it a scapegoat: overdose. As STAT has reported, the drug has been at the center of safety debates for decades, in part because even small miscalculations in dosing can lead to liver injury. OB-GYNs say that’s one reason they emphasize moderation — up to 3,000 mg a day in divided doses for most pregnant people — and consulting a provider before taking any medication.
Trump and the CDC
At a White House briefing on Sept. 22, Trump announced that the Food and Drug Administration would be changing its recommendations on the use of this pain and fever reliever during pregnancy. He cited a recent observational study that suggested a link between acetaminophen use during pregnancy and an increased incidence of autism — though it did not show causation. He declared that taking acetaminophen was “not good” for pregnant women and that they should “tough it out.”
His press conference, though, was accompanied by press releases from the Department of Health and Human Services that took a much less alarmist view. A release included the following statements:
- “Acetaminophen is the only over-the-counter medication considered safe for treating fever during pregnancy.”
- “Maternal fever itself carries risks, including neural tube defects and preterm birth.”
- “Evidence does not definitively establish causality [between the drug and autism], but the consistent associations raise concern.”
- “When used short-term and at appropriate dosages, acetaminophen remains widely regarded as safe. However, unresolved questions remain regarding chronic or late-pregnancy exposure.”
Digging into the studies
As the HHS statement suggests, the research on the subject is complicated with results that call for care in interpreting, especially when it comes to questions of correlation and causation.
Dr. Stephen Thomas, an infectious disease specialist and researcher, gives a familiar social media example: If one woman takes Tylenol during pregnancy and her child is later diagnosed with autism, while another woman doesn’t take Tylenol and her child isn’t on the spectrum, it’s tempting to conclude that Tylenol use caused the outcome.
“But why did you take the Tylenol?” Dr. Thomas said he might ask. “‘Oh, because I had this horrible infection.’ You can keep digging and say, ‘Well, geez, there’s all these other confounding factors.’”
Without controlling for these confounding factors, you can’t draw a direct causal link, he said.
A review of 46 studies published last month in Environmental Health concluded that the data on acetaminophen and autism are mixed, but that it may be worth warning pregnant people about potential risks. That “meta study” itself also came under criticism: Dr. Sheela Maru, an OB-GYN at Elmhurst Hospital and associate professor at the Icahn School of Medicine at Mount Sinai, said several of the studies included in the review had methodological problems. These include concerns about recall bias, gaps in exposure details, differences in how neurological assessments were conducted and the fact that several didn’t control for genetic confounders.
One of the study’s authors also noted a conflict of interest, having served as an expert witness in a lawsuit related to acetaminophen use and neurodevelopmental disorders.
Even if the review study does give you pause, the co-authors of this study haven’t taken Tylenol use off the table, nor suggested it’s ‘not good,’ as Trump has described it. “What we recommend is judicious use — the lowest effective dose [for] the shortest duration of time under medical guidance and supervision, tailored to the individual,” one of its authors, Dr. Ann Bauer, an epidemiologist at the University of Massachusetts at Lowell, told Politico.
What this means for pregnant people and their families
Sorting through the torrent of content that poured through social media after the press conference featuring Trump and HHS Secretary Robert F. Kennedy Jr. can be daunting. Along with attacks on Tylenol, many of Kennedy’s followers share his doubts about the safety of vaccines. But in the eyes of most doctors, vaccines are an important part of prenatal care: Pregnancy increases the risk of severe illness from diseases like flu and Covid-19. Vaccines protect the parent and pass antibodies to the baby for the first months of life. And the most highly regarded expert group on this — the American College of Obstetricians and Gynecologists — confirms they’re safe.
But headlines and social media posts can disproportionately impact communities of color. Black women, in particular, have historically been undertreated or perceived as feeling less pain than white women.
“I don’t think that, for the most part, Black and Brown women are going to stop looking for ways to get pain relief, even in the wake of this information, because I do believe that women have been able to advocate for themselves a little bit better,” said Annette Perel, a New York-based doula, lactation consultant and birth advocate. Most people are still checking in with their doctors, she says, who can reassure them that the data haven’t shown any causal connection.
However, misinformation can still cause harm for those not regularly consulting providers. “They’re going to be looking for alternate ways to cope with pain — and who knows what those measures are,” Perel said. “If it’s word of mouth, of ‘take this to help that,’ we don’t know what the effects or the efficacy of you taking that product, or the harm that it can cause … So we’re in very dangerous times.”
Navigating care: practical advice from doulas
Perel encourages pregnant people to consider midwifery care as another layer of support, not just OB-GYN care. Midwives provide well-woman care and pregnancy support, but access can be limited by insurance coverage. Local groups like Doulas en Español and the Asian Birth Collective can connect families with bilingual providers and translate critical information across cultures.
She recommends pregnant people use the BRAIN method to talk with providers:
- Benefits: What’s the benefit of taking (or not taking) a medication or vaccine?
- Risks: What are the risks?
- Alternatives: Are there other options?
- Intuition: What’s your gut telling you?
- If you do Nothing: What could happen if you wait or decline? How urgent is this decision?
Providers’ answers can reveal whether they take your concerns seriously. If you feel dismissed, seek a second opinion, Perel says. Doulas can act as connectors, suggesting supportive measures like chiropractic care or acupuncture and helping clients navigate questions about medication and vaccines.
For healthcare providers and advocates, Perel suggests hosting Q&A sessions online, sharing clear distinctions between opinion and fact and reminding patients of their rights. That includes the ability to contact a patient advocate. Partners attending prenatal visits can provide a second set of ears.
