Acetaminophen is sold under the brand name Tylenol, which is a common medication prescribed during pregnancy.
The use of acetaminophen during pregnancy may be associated with neurobehavioral problems in offspring. A study published today in PLOS One reports that children who had been exposed to acetaminophen in utero experienced sleep issues and attention problems at age 3.
“These findings corroborate previous studies reporting associations between prenatal exposure to acetaminophen and attention problems in offspring and also show an association with sleep problems at age 3 years. Because use of acetaminophen during pregnancy is common, these results are of public health concern and suggest caution in the use of medications containing acetaminophen during pregnancy,” the study authors wrote.
In undertaking their study, the researchers used data from 2,423 mother-child pairs in Pennsylvania. The mothers reported any medications used with 41% reporting that they had used acetaminophen during pregnancy. The women were also asked to report their prenatal stress. The most common reason for taking the acetaminophen, which is sold under the brand name Tylenol, during pregnancy was headache or migraine, followed by allergies or a cold.
Behavioral problems in children were measured using syndrome scale scores from the Child Behavior Checklist. These included sleep difficulties and attention problems. Researchers reported that the children who had been exposed to acetaminophen in the womb scored higher on these scales than their peers.
“The fact that neurological dysfunction underlies both sleep and attentional issues in children suggest that an important mechanism of influence may be the impact of acetaminophen on prenatal neurology, which may impact the regulation of attention and sleep in the preschool period,” the authors wrote. “On this note, acetaminophen is associated with reduced brain connectivity of the amygdala, a part of the brain responsible for self-regulation,” they added.
The study notes that more than 50% of pregnant women globally use acetaminophen during pregnancy. The medication may be used in the treatment of mild to moderate pain, as well as to reduce fever. Last year, the American College of Obstetricians and Gynecologists (ACOG) issued a statement that noted “ACOG and obstetrician-gynecologists across the country have always identified acetaminophen as one of the only safe pain relievers for pregnant individuals during pregnancy.”
Dr. Ilina Pluym, a maternal and fetal medicine doctor at UCLA Health, says that the study will not alter her practice of recommending acetaminophen to pregnant women when needed.
“As the study described, there were many limitations, including the fact that these results are based on surveys mothers completed which require maternal recall of medication use and maternal interpretation of child behavior,” Pluym told Healthline. “I routinely recommend acetaminophen for my patients when there is a medical indication such as pain or fever and this study will not change my practice. There is previously published abundant safety data on acetaminophen use in pregnancy and withholding treatment for a maternal illness poses risk to the pregnancy as well,” she added. “Acetaminophen is my analgesic of choice for maternal fever, headaches, or other muscle aches.”
Before deciding whether or not to take a medication during pregnancy, the Office on Women’s HealthTrusted Source advises women should speak to their doctor. Many medications can cause problems during pregnancy and this limits what can be taken safely.
“When it comes to pain management, we can’t use the class of drugs nonsteroidal in the first trimester, you can’t use the nonsteroidal in the second trimester. So if a woman has a headache or some kind of pain, the only fallback we have is acetaminophen,” Dr. G Thomas Ruiz, the OB/GYN Lead at MemorialCare Orange Coast Medical Center in California, told Healthline.
Nonsteroidal drugs also referred to as NSAIDs, include medications such as ibuprofen (Advil, Motrin), aspirin, and naproxen (Aleve). These medications can cause blood flow problems and bleeding issues.
Experts say medication use in pregnancy is about weighing risks and benefits, and for now, acetaminophen still has a role to play.
“Medication use in pregnancy is always a balance between keeping both the mother and baby safe. Not infrequently mothers are withheld indicated medications due to unwarranted fear of risk to the baby,” Pluym said. “We shouldn’t use the medication in pregnancy without a clear reason, but if a mother is febrile and ill, she needs to be treated to prevent further decompensation not only to herself but to also decrease the stress the illness poses to the pregnancy and the baby.” “Short of non-medication intervention such as ice packs, massage, rest, support belts, physical therapy or acupuncture, acetaminophen should remain the first line medication to treat pain or fever in pregnancy. Alternatives are limited,” she added.
Parvathy Sukumaran 
