By Aaron Allen, The Seattle Medium
Acetaminophen, one of the most commonly used pain relievers during pregnancy, has long been considered safe. However, a new study published in Nature Mental Health suggests that prenatal exposure to the drug may increase a child’s risk of developing attention-deficit/hyperactivity disorder (ADHD). The findings contribute to a growing body of research examining the long-term neurodevelopmental effects of acetaminophen—best known as the active ingredient in Tylenol and hundreds of other pain and fever medications.
“This study confirms previous findings that prenatal exposure to acetaminophen is linked with a higher risk of the child developing ADHD,” said Brennan Baker, the study’s lead author and a postdoctoral scholar at Columbia University’s School of Public Health.
The study analyzed blood samples from 307 pregnant women collected between 2006 and 2011 to measure acetaminophen exposure. Researchers then followed the children born to these women for 8 to 10 years to track ADHD diagnoses. Among mothers who did not use acetaminophen during pregnancy, 9% of children were diagnosed with ADHD. However, for those who used acetaminophen, the ADHD rate rose to 18%.
Acetaminophen is widely used during pregnancy, with studies showing that 41–70% of pregnant women in the U.S., Europe, and Asia take the medication to manage pain or reduce fever. The U.S. Food and Drug Administration (FDA) has long classified acetaminophen as a low-risk drug for pregnancy, particularly because alternatives like aspirin and ibuprofen are known to pose fetal health risks.
“You may think about ibuprofen and aspirin—these are non-steroidal anti-inflammatory drugs, and they should not be used during pregnancy in general because they’re linked with adverse kidney and heart development of the fetus,” Baker explained. “So, the first-line therapeutic option for fever and pain in pregnancy is acetaminophen.”
While pain management during pregnancy is critical, the study’s findings suggest that medical professionals and regulatory agencies should reevaluate the long-term safety of acetaminophen use during pregnancy.
“This medication was approved decades ago and may need reevaluation by the FDA,” said Dr. Sheela Sathyanarayana, a UW Medicine pediatrician and senior author of the study. “Acetaminophen was never evaluated for fetal exposures in relation to long-term neurodevelopmental impacts.”
Although the study strengthens existing research on the possible link between prenatal acetaminophen exposure and ADHD, experts caution that it does not establish a direct cause-and-effect relationship. Many other factors—such as genetics, environmental influences, and maternal health conditions—also contribute to ADHD risk.
Baker agrees that ongoing research is essential, emphasizing the need for further studies and updated medical guidance.
“I think we need more research, and I think we need more awareness,” he said. “The FDA did release a statement reviewing the evidence, but that was years ago. I think the FDA and other medical associations need to continually review all available research and consider updating their guidance.”
Despite these findings, there are currently no widely recommended alternatives to acetaminophen for pregnant women. Managing pain and fever is crucial during pregnancy, as untreated high fevers can pose their own risks to fetal development.
Baker emphasized the need for continued discussion and awareness in the medical community and among expectant mothers.
“It’s really incredibly important that pain and fever are managed during pregnancy and in the safest way possible,” he said. “The current consensus among clinicians is that there are no safer alternative medications to treat fever and pain in pregnancy.”
Some parents and medical professionals continue to debate whether ADHD diagnoses have increased due to overdiagnosis rather than an actual rise in cases. Baker acknowledged this concern but reaffirmed that ADHD is a legitimate condition with measurable impacts on children’s lives.
“ADHD is real,” he said. “Of course, there is a concern of possible trends for overdiagnosis, where maybe people are seeking an ADHD diagnosis for their child in relation to helping with school and things like that. It’s possible. The prevalence is around 10% in the USA in children and lower in adults. A lot of kids grow out of it, but it’s definitely real.”
As research on prenatal acetaminophen exposure continues, medical professionals and regulatory agencies will need to carefully weigh the benefits and potential risks of the medication. Expectant mothers are encouraged to consult their healthcare providers before making any changes to their pain management plans. As scientific understanding evolves, continuous research and evidence-based recommendations will be essential in ensuring the safest options for both mothers and their children.
