Taking paracetamol during pregnancy does not increase the risk of autism or ADHD

Expectant mothers do not need the stress of questioning whether medicine most commonly used for a headache could have far reaching effects on their child’s health. This thorough and clear study approached the question by conducting both a substantial systematic review of the literature and a meta-analysis of eligible studies. Importantly, it prioritized sibling design studies to account for family history, which is crucial. This confirmed that there is no relationship between taking paracetamol in pregnancy and a higher likelihood of autism, ADHD or intellectual disabilities in the offspring.  While the impact of last year’s announcement has been extensive, I hope the findings of this study bring the matter to a close.

The investigators have been thorough in their discussion of the limitations of the research and justifiably robust in their defense of the role paracetamol has as a treatment option when needed for pregnant women with pain or fever.

“After studies that are of lower quality and do not account for the important differences between mothers who use or don’t use paracetamol during pregnancy are excluded, reassuringly, the remaining studies do not suggest paracetamol use in pregnancy is associated with an increased risk of any of the neurodevelopmental conditions considered.

“This is a timely and well conducted systematic review, which gathers together and analyses all the previously conducted relevant studies designed to determine whether paracetamol use during pregnancy increases the risk of autism spectrum disorder, attention-deficit hyperactivity disorder (ADHD), and intellectual disability. The investigators made the decision to focus only on studies where either 1) comparisons were made between siblings whose mother had pregnancies with and without exposure to paracetamol; 2) the study was judged to have a low risk of bias; or 3) studies with at least 5 years of follow up. By doing this, they automatically excluded studies that were of lower quality and where no account was taken of important differences between mothers who use or don’t use paracetamol during pregnancy. Those studies typically observe an apparent harm associated with paracetamol, but which is almost certainly due to important differences between the women included, rather than being caused by paracetamol. By excluding these studies, the authors have reduced the unhelpful “noise” they tend to generate. 

The evidence supports the conclusion by D'Antonio and colleagues that Tylenol/paracetamol does not cause autism, ADHD, nor intellectual disability. Its scientific rigour included accounting for cofounders such as having a sibling with the condition, as these neurodivergences run in families. Parents of disabled children might be more likely to take paracetamol because of pains related to parenting stress or their own chronic conditions (which neurodivergent parents are more likely to have). The sibling control in these studies shows that the medication does not cause their child's disability. As a neurodivergent researcher and advocate, I think an implication is that society needs to stop going down rabbit holes of seeking false prevention of developmental disabilities. Instead, we should focus more on making the world a better place for disabled people.