Is Tylenol Safe for Pregnancy? What to Know

The drug acetaminophen (brand name Tylenol) is a widely available over-the-counter analgesic (pain reliever) and antipyretic (fever reducer). This pain medicine (sold as paracetamol in many countries) is generally considered safe for use by pregnant women. Tylenol is very effective at alleviating a low-grade and high fever along with unpleasant body aches and pains that come with pregnancy. Tylenol (acetaminophen) can provide relief from mild to moderate pain associated with backaches, headaches, and muscle pains associated with flu-like symptoms. However, recently, an article published in Nature Reviews Endocrinology raises concerns that prenatal acetaminophen use during early pregnancy might have negative effects on fetal development and increase the risk of attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in children. Please continue reading to find out more.

Can I take Tylenol while pregnant to relieve pain?

Taking acetaminophen during pregnancy for treating pain is generally considered safe and is even the drug of choice by many healthcare providers. While this drug can cross the placenta and reach the developing baby, studies have found that acetaminophen does not increase the risk of birth defects or miscarriages when used at recommended dosages.

How much Tylenol is safe in pregnancy?

The recommended maximum dose of the pain medication Tylenol (acetaminophen) is 3,000-4,000 mg per day. Higher doses can cause liver damage and liver failure. You should limit the dose to less than 4,000 mg per day of acetaminophen during pregnancy. Take the lowest dose of acetaminophen for the shortest time. Talk to your healthcare provider before taking any medication during pregnancy.

Does Tylenol affect the baby during pregnancy?

An article in Nature Reviews Endocrinology in 2021 advises expectant mothers to exercise caution while using acetaminophen during pregnancy. There is some concern that fetal exposure to acetaminophen may increase the risk of certain neurological disorders such as attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). The potential behavioral problems discussed in this article can be an upsetting diagnosis for any family.

The article published in Nature Reviews Endocrinology is a consensus statement from a group of healthcare providers and scientists who conducted a review of studies and systematic review from 1995 to 2020 regarding the correlation between Tylenol (acetaminophen) use during pregnancy and the risk of developmental issues for the children later on in life.

Below are some key points of the risks associated with prenatal acetaminophen use that were analyzed in those studies that are concluded in the consensus statements.

Most studies in this comprehensive review reveal little risk associated with the “short-term” use of Tylenol.
These studies also emphasized that the risk associated with Tylenol use is more significant during late pregnancy, such as in the second or third trimester.
Notably, except for a prospective cohort study conducted by the Norwegian Institute of Public Health, the definition of short-term Tylenol use was not clearly identified in many studies. The data from the Norwegian Mother and Child Cohort study looking at 51,200 pregnancies shows that 28 days is considered “short-term” Tylenol use during pregnancy.

Does Tylenol (Acetaminophen) use by pregnant women cause birth defects or ADHD (attention-deficit hyperactivity disorder) in babies?

Based on a meta-analysis and systematic review of cohort studies, the evidence suggests that there may be a potential increased risk of ADHD and ASD in children whose mothers report taking acetaminophen during pregnancy.

However, two leading organizations representing specialists in obstetric care, the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) have not changed their recommendations about taking Tylenol during pregnancy. No causal relationship has been proven between neurodevelopmental disorders such as ADHD and ASD and acetaminophen use by pregnant women. The current data does not point to acetaminophen as a proven cause of either condition.

The consensus statement from ACOG and SMFM advises that while there may be a higher risk of ADHD or ASD, these conditions can arise due to many other causes. Brain development in children continues until the age of 15 months, and various other factors can influence the development of disorders such as ADHD and ASD.

There is no need for anxiety about acetaminophen use among pregnant women unless further research establishes a direct causal link between acetaminophen exposure and neurodevelopmental disorders.

Another fact to remember is that the risk of untreated fever can be significant. High fevers left untreated can cause brain damage and seizures. Even though further research on the effect of fetal exposure to fever, data from animal studies have shown an association between high fever during pregnancy and neural tube defects.

Are Tylenol and ibuprofen safe during pregnancy?

Tylenol (acetaminophen) and ibuprofen are over-the-counter medications widely used to treat mild to moderate pain. These drugs are present, often along with other medications, in many OTC products used to treat common complaints like headaches, backache, toothache, muscle aches, etc.

Acetaminophen use during pregnancy is generally considered safe. It is one of the few options for safe pain control and fever reduction in pregnant women. However, the FDA advises against NSAIDs use after the 20th week of pregnancy. Ibuprofen can cause low amniotic fluid and increase the risk of miscarriage. In addition, children born to women who used NSAIDs after the 20th week of pregnancy are at an increased risk of kidney problems.

During early pregnancy, specifically before the 20th week, the risk of NSAID use is unclear as studies provide different findings.

Tips on the safe use of Tylenol during pregnancy

More research is needed to establish the effects of acetaminophen (paracetamol) use during pregnancy. This drug is generally considered safe for maternal use in early and late pregnancy. Here are some tips on safe acetaminophen use in pregnancy:

Try natural ways for pain relief as much as possible. Non-drug approaches such as meditation, pregnancy-guided yoga, acupuncture, physical therapy, and prenatal massage are also effective in alleviating pain and ache due to pregnancy.
Keep in mind that promoting “natural ways” for pain relief does not include the use of herbal supplements as most of these supplements are not studied in pregnant women; therefore, their safety profile is mostly unknown for mothers and their unborn babies—also, the potential drug interactions between your current medications and herbal supplements can lead to concerning adverse effects. Talk to your doctor before trying natural methods of pain relief.
Always talk with your doctor before using any herbal supplement. Use Tylenol at the lowest effective dose for the shortest time.
Do not exceed the recommended maximum dose of 3,000 to 4,000 mg per day.
Read the labels on cold and flu medicines carefully. These multi-drug formulations are convenient but often contain acetaminophen, and you could easily take more acetaminophen than intended.
Call your healthcare provider without delay if you develop severe pain or a high fever that does not get better with acetaminophen or other serious symptoms such as shortness of breath.

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