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. for context, 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 fear mongering based on biased politics and hidden agendas – not true public interest.

We have a President who is telling women to “fight like hell not to take” pain relief in pregnancy and just “tough it out.” That’s not good medicine — and why is that an opinion we’d listen to? We already know that women's pain is too often overlooked and under treated. Further, we have a Secretary of Health and Human Services, who has no training or background in health care at all, hell-bent on proving that he knows that the causes of autism are Tylenol and vaccinations. Behind him we have a wealthy, influential movement known as Make America Healthy Again (MAHA), known for it's inaccurate and interpretation of data, literally made-up science, hyperbolic claims and conspiracy theories, and a whole lot of profiteering based on our health concerns.

What's especially dangerous about MAHA's messaging is its ability to weave in the concerns that pull on our heartstrings — we want to protect ourselves and our children from environmental toxins, food additives, and medication side-effects. But small facts woven into a web of misinformation, and laced with dose of fear mongering, is at the heart of why propaganda has always worked. And it will continue to if we don't sort fact from fiction and continue to support trustworthy research.

But let's unpack the issue at hand: 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?

First, if you don't know who I am – my name is Aviva Romm, I think it's important that I tell you. I'm a Yale trained medical doctor with a Yale Internal Medicine Internship with a residency in Family Medicine at Tufts. I am also a midwife. In total I have 40 years of cumulative experience in women's and children's health, and am formally trained in Integrative Medicine through the University of Arizona, as well as being a pioneer in the field. I have 4 children, all of whom I raised as naturally as possible, had 4 home births, and breastfed my children, as I joke, ‘practically until they went off to college.' I also midwifed my grandchildren at home, their mom a Harvard trained pediatrician with a Master's in Public Health, also from Harvard. I've written many books, including a NYT Bestseller, and a textbook, and I have written the Yale Pediatric Residency integrative medicine curriculum section, used in over 150 residency programs, for 15 years. I've been around the block and have seen fads, trends, misinformation, and conspiracy theories come and go. Rinse and repeat. I get why mamas want to go ‘all natural' and I practice a balanced, evidence-based care approach to integrative medicine. And when needed, I believe that, given the evidence we have to date, Tylenol can be used safely in pregnancy, in moderation, when needed.

Let's dig deeper.

The questions about Tylenol safety first began to surface about a decade ago, when I published the ‘first edition' of this article. I specifically remember the day, because my pregnant daughter-in-law was visiting, and had a headache. She asked if I had Tylenol, and told her I did not happen to – but that also a new study had just come out days before raising some concerns. Rather than immediately venture out for Tylenol, she decided to apply a few drops of lavender oil to her temples, at my suggestion, accept a neck massage, and she felt better.

It was in 2018 that significant concerns were really 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. Again, I wrote about this issue.

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. And yes, I went back in for another round of updates – to make sure you're always informed with the latest data.

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. More updates! Do we have a theme here? Yes – the data keeps shifting and evolving.

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 but, the authors cautioned, the conclusions did not mean that acetaminophen was causing autism — that other factors unique to the women themselves, for example, possible prenatal exposures, to infection, are important to consider. At the end of the day the authors suggest that “Appropriate and immediate steps should be taken to advise pregnant women to limit acetaminophen consumption to protect their offspring’s neurodevelopment.”

Again, this doesn't mean that Tylenol has any causal relationship to autism – but as with anything in pregnancy, when in doubt, limit or avoid it if you can, until we have more information. This is true with most pharmaceuticals, as well as herbs and supplements in pregnancy.

Did the the FDA or the “Tylenol Company” or Say Not to Use Tylenol?

The answer to both of these questions is definitively, no. In the FDA Responds to Evidence of Possible Association Between Autism and Acetaminophen Use During Pregnancy, Marty Makary MD, and Trump's appointed FDA Commissioner stated: “The FDA is taking action to make parents and doctors aware of a considerable body of evidence about potential risks associated with acetaminophen.” He added, “Even with this body of evidence, the choice still belongs with parents. The precautionary principle may lead many to avoid using acetaminophen during pregnancy, especially since most low-grade fevers don’t require treatment. It remains reasonable, however, for pregnant women to use acetaminophen in certain scenarios.”  

Misinformation is floating around on the internet, that Kenvue, the parent company that produces Tylenol, stated that Tylenol should not be used in pregnancy. The company asserts, however, that comments made back in 2017 in a social media post about using their products during pregnancy have been entirely distorted, and they, continue to recommend Tylenol as the safest option for pain and fever in pregnancy when medically necessary, with the caveat of always checking with a healthcare provider first.

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.

And yes, here I am again, updating this information for you.

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, for fever, pain, etc. I do not think a pregnant mother who is suffering from either needs to avoid any Tylenol at all costs. It's what I've suggested to the women in my care as a midwife and medical doctor for decades.

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!

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

Are there 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 to moderate 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 medical or 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, and make sure your blood pressure is in a healthy range, while later in pregnancy make sure pre-eclampsia is properly ruled out.

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.

Here are 4 tips that you can safely try 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. Avoid chiropractic neck treatments in pregnancy.

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.

You may also consider working with an integrative Obstetrician or Family Doctor, 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.

And please, please, be savvy and know who to trust. I can tell you from my vantage point — it's not the MAHA movement, RFK Jr, or our current administration when it comes to health information.