The American College of Obstetricians and Gynecologists (ACOG) reaffirmed the safety of acetaminophen use during pregnancy in response to a recent announcement by the US Department of Health and Human Services suggesting possible neurodevelopmental risks.

Steven J. Fleischman, MD, MBA, FACOG, president of ACOG, noted that more than 20 years of research, including large population-based cohort studies, have not demonstrated a causal association between acetaminophen exposure during pregnancy and autism spectrum disorder, attention-deficit/hyperactivity disorder (ADHD), or intellectual disability in children.

Among the most robust investigations, a study published in JAMA in 2024 analyzed maternal acetaminophen use across trimesters and followed children for neurodevelopmental outcomes. Researchers found no statistically significant associations between prenatal exposure and risk of autism, ADHD, or intellectual disability. Another large-scale cohort study with comparable methodology reported similar null findings, reinforcing the lack of evidence for causality. Fleischman emphasized that these high-quality studies stand in contrast to lower-tier evidence, such as a recent systematic review published in August, which relied heavily on self-reported data and lacked adequate adjustment for confounders.

“Acetaminophen is one of the few options available to pregnant patients to treat pain and fever, which can be harmful to pregnant people when left untreated,” said Fleischman.

Maternal fever, adverse fetal outcomes, and untreated pain—including headache as a symptom of preeclampsia—can pose serious risks to both mother and fetus. Fleischman stated that discouraging the use of acetaminophen without credible evidence introduces unnecessary danger, noting that the therapeutic benefits outweigh any theoretical concerns when appropriately administered.

Source: The American College of Obstetricians and Gynecologists