Tylenol: Does it Cause ADHD and Autism, or Is it Safe During Pregnancy?

Tylenol (acetaminophen, paracetamol)— most people reach for it for everyday headaches and fever like it's no big deal, and two-thirds of women have used it in pregnancy.

While not an entirely benign medication — overuse is one of the major contributors to liver disease and the most common cause of liver transplantation in the US every year. However, used appropriately, acetaminophen has long been considered generally safe for use during all stages of pregnancy, making it a first-choice pain and fever medication for pregnant women.

But concerns have been raised over the safety of this medication when it comes to fetal development, particularly in relationship to neurodevelopmental disorders (NDD) such as ADD, ADHD, and autism, when used by pregnant women. Given the large number of pregnant women using the drug, even a small increase in risk of adverse outcomes in offspring can have important implications for public health. So, it's important to take this seriously.

At the same time, it's critically important to recognize that we live in an era in which there's an unprecedented and rapid spread of not only information, but misinformation, poor interpretation of data, and fearmongering based on biased politics and hidden agendas – not true public interest.

So, is it safe to use Tylenol in pregnancy — or are we putting our children at risk?

Tylenol Use During Pregnancy, ADHD and Autism: Is There a Connection?

The questions about Tylenol safety first began to surface about a decade ago, but in 2018, significant concerns were raised when observational, cohort data was published suggesting a potential association between Tylenol use in pregnancy, and an increased risk of NDDs including ADD, ADHD, and autism in babies born to pregnant mothers who had used it. Based on this review, a team of 13 scientists cautioned against the use of pain relievers with acetaminophen by pregnant women, citing a growing body of research that suggests the drug may alter fetal development. 

Then in 2021, a consensus statement was published in the journal Nature Reviews Endocrinology, supported by 91 researchers, clinicians, and public health experts from around the world. They alerted the medical community that acetaminophen may be at least partially responsible for rising rates of male reproductive disorders (like undescended testes, an increased risk factor for infertility), as well as cognitive, learning, and behavioral problems among children (like ADHD, ADD, and ASD) over the past several years. Their concluding statement was a recommendation for pregnant women to avoid acetaminophen altogether unless otherwise prescribed it by a medical professional.

However, in medicine, there's an important maxim: Correlation does not equal causation, and when it comes to observational studies, this is often true. In other words, something can be true-true, and unrelated. Neurodevelopmental disorders are likely due to a complex constellation of factors. It's also important to keep in mind. there’s data to support an association between untreated maternal fever in pregnancy, especially when the fever is high, and neurodevelopmental disorders in those offspring, as well as maternal health complications.

Then, in 2024, publication of what was considered higher quality data than the previous study, led to a ‘switchback' on the concerns: The study, published in JAMA in April of that year, had used a sibling analysis across nearly 2.5 million children in Sweden born to singleton pregnancies (that’s one baby to a pregnancy) between 1995 and 2019. This means they compared children born from the same mother, with one being exposed to acetaminophen while in the womb and the other not. This data was self-reported, meaning mothers were asked several times during pregnancy to report their intake of acetaminophen, which was compared against the child’s medical records later on.

What did they find? In total, 185 909 children (7.49%) of children had been exposed to acetaminophen in this study. In models without sibling control, similar findings to previous data still ring true: there was a modest increased risk for autism, ADHD, and intellectual disability. However, in models with sibling control, they found no evidence that acetaminophen use during pregnancy was associated with autism, ADHD or intellectual disability. There was also no evidence of a dose-dependent pattern in models with sibling control, meaning more acetaminophen exposure didn’t increase the risk of diagnosis. 

While a sibling analysis is not a gold standard, double-blind, randomized control trial, it was an improvement on the previous observational or cohort based study designs where associations between Tylenol use and NDDs were found . 

Now, an even more recent report published in BMC Environmental Health in August, 2025, is throwing the findings into question once again. This carefully conducted review from researchers at the Icahn School of Medicine at Mount Sinai, in partnership with Harvard T.H. Chan School of Public Health, analyzed 46 studies encompassing more than 100,000 children to explore potential connections between prenatal acetaminophen use and neurodevelopmental outcomes, including autism (ASD) and attention-deficit/hyperactivity disorder (ADHD). This study applied the rigorous, transparent Navigation Guide methodology—a gold-standard framework for evaluating environmental health evidence—to systematically assess study quality, bias, and strength of evidence.

Of the studies reviewed, 27 found significant associations with outcomes such as ADHD, autism spectrum disorder (ASD), or other NDDs. Nine studies found no association, and four suggested possible protective effects. Importantly, the higher-quality studies—those with stronger designs and fewer sources of bias—were more likely to report links between prenatal acetaminophen exposure and later NDDs. While the review cannot prove that acetaminophen directly causes these conditions, the overall weight of evidence suggests that frequent or prolonged use during pregnancy may carry some risks, and that further research is both needed and warranted.

The authors cautioned that the conclusions did not mean that acetaminophen was causing autism; other factors unique to the women themselves are important to consider, though it is unclear what these might be the authors do, however, conclude that “Appropriate and immediate steps should be taken to advise pregnant women to limit acetaminophen consumption to protect their offspring’s neurodevelopment.”

So, What's a Mom to Do?

All mothers want to do everything we can to protect our babies from any possible risks, and all of this information puts mothers in a tough decision-making position when it comes to fever and also pain treatment in pregnancy.

The beauty of research is that we’re constantly learning, acquiring new insights, and gathering higher quality data from more thoughtfully run studies. Ultimately, until we know more, sometimes when data is so contradictory, it may be best to err on the side of practical caution.

I think the safest approach at this time is to be sensible and thoughtful – to use Tylenol only sparingly and judiciously when truly needed during pregnancy – as I've suggested to the women in my care as a midwife and medical doctor for decades now. Nor do I think a pregnant mother who is suffering from pain needs to necessarily avoid any Tylenol at all costs.

The bottom line is that the best choice is the one you’re most comfortable with. 

Importantly, mothers should not be retroactively beating themselves up for having used Tylenol in pregnancy – the factors that contribute to neurodevelopmental issues are vast and complex — and to date we have no evidence to suggests that modest use of Tylenol in pregnancy is harmful to our babies. Even if you did require a higher amount, you did what was needed at the time, and there is no fault or blame in that!

Natural Alternatives to Tylenol in Pregnancy 

Headaches and fever can both occur during pregnancy and other commonly used pain medications like ibuprofen are not recommended for use. So, what can you do? 

With fever, if a low fever, it may be enough to use simple comfort measures at home, but for higher fevers, again, discuss options with your healthcare provider, and it still seems that acetaminophen is a safe and appropriate choice for short term use at a low dose.

If you’re experiencing a headache, or having a fever and choose to take acetaminophen, statistically speaking you’re in the clear. Tylenol is still considered the safest prenatal option for fever and headache. With headaches, particularly if they are recurring, it’s important to address any root causes with your healthcare provider, making sure you’re getting enough sleep, adequate hydration, addressing stress and nutrition, including protein and iron, and looking into environmental allergies or other triggers.

Here are 4 safe, natural tips that you can safely use to help reduce headaches in pregnancy:

1. Apply 1-2 drops of lavender oil or peppermint oil to the temples. These have been shown to safely and effectively reduce headaches and can be used topically in pregnancy. Alternatively, take a warm relaxing bath with 5-7 drops of lavender essential oil added to the bath water.

2. Take 2 ginger capsules if you feel a headache coming on and repeat again in a few hours. It is a natural anti-inflammatory and pain-relieving herb that’s considered safe in pregnancy in a dose of up to 2 grams per day.

3. Many headaches are a result of neck and shoulder tension, so don't overlook the value of addressing posture, sleeping positions, a change of pillows, and massage for headache prevention and relief.

4. If you suffer from migraines, Riboflavin (Vitamin B2) at 400 mg/day has been found effective for prevention, and safe for daily use in pregnancy. You can also do a migraine journal to identify and remove any potential triggers.

If you have a sudden onset headache, a more severe headache than usual, any visual changes or upper abdominal pain with your headache, or a history of high blood pressure, please see your midwife or physician promptly as these can be signs of more serious illness, like pregnancy induced hypertension or preeclampsia.

You may also consider working with an integrative physician, midwife, or nurse practitioner skilled in pregnancy care, and join me online in the Mama Pathway community for ongoing support and answers to questions like those in this article.