New Delhi, 26 August 2025: A new comprehensive review has reignited debate over the safety of paracetamol (acetaminophen) use during pregnancy. The analysis suggests that prenatal exposure to this widely used painkiller may be associated with an increased risk of neurodevelopmental disorders, including autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). While causation has not been confirmed, the findings prompt reconsideration of guidelines for expectant mothers.
The latest review employed a rigorous environmental-health framework to analyze 46 studies—including cohort studies, birth registries, and clinical data—spanning over 100,000 participants worldwide. The methodology rated study quality and risk of bias, finding that higher-quality research more often indicates an association between prenatal acetaminophen use and later development of ASD or ADHD in offspring.
What the Numbers Say
The review’s findings align with earlier studies reporting elevated risks:
- Some European analyses revealed that children exposed before birth had approximately a 19% higher chance of developing autism and a 21% higher chance of ADHD symptoms.
- A biomarker-based study found that higher acetaminophen levels in umbilical cord blood corresponded with roughly 2–3.5 times higher risk of both ASD and ADHD.
- Earlier systematic reviews of observational research also noted consistent associations—especially with longer or frequent usage.
That said, evidence is not unanimous. A large national cohort study using sibling controls (which help account for genetic and environmental factors) found no increased risk of autism, ADHD, or intellectual disability among children whose mothers took acetaminophen during pregnancy.
Strengths and Limitations
Strengths:
- Comprehensive, multi-study review using standardized evaluation methods.
- Diverse data sources and large sample sizes improve generalizability.
- Findings are corroborated by several lines of observational evidence.
Limitations:
- These findings are associative, not conclusive; confounding factors may explain associations.
- Sibling studies suggest effects may not persist when accounting for familial and environmental variables.
- Several reviews noted potential bias: mothers using acetaminophen may differ in stress levels, preterm delivery risk, or other health factors.
Because of these factors, researchers advocate caution—not panic—and stress the importance of maternal health and consultation with healthcare providers.
Balancing Pain Relief and Precaution
Paracetamol remains one of the few analgesics considered relatively safe during pregnancy, especially for treating fever, as alternative medications like NSAIDs can pose risks such as reduced amniotic fluid. However, this developing evidence suggests it should be used judiciously:
- Use the lowest effective dose for the shortest necessary duration
- Consult healthcare providers before starting or stopping medications
- Explore non-drug alternatives for managing minor aches or low-grade fever, such as hydration, rest, and monitoring
What Experts Recommend
Healthcare professionals emphasize that untreated fever or pain during pregnancy can itself pose risks to fetal development. So while caution is advised, abrupt discontinuation of pain relief is not recommended without medical guidance.
Public health guidelines may evolve as evidence accumulates—but for now, it remains prudent to prescribe acetaminophen thoughtfully, with attention to dosage and timing.
Contextualizing the Risk
- Neurodevelopmental disorders are influenced by complex interactions of genetics, environment, maternal health, and prenatal complications.
- Some risk factors—such as parental age, gestational diabetes, and certain medications—are more established.
- Paracetamol’s potential link may be one piece of a much larger puzzle, requiring balanced interpretation.
In essence, the new review reinforces earlier associations between prenatal use of acetaminophen and slightly elevated risks of autism and ADHD. Yet more robust studies—particularly those controlling for family-related confounders—show no clear causal link. The safest path forward involves using paracetamol only when medically necessary, under guidance, and remaining open to safer alternatives as research progresses.
