Recent debates have emerged about the safety of paracetamol (acetaminophen) use during pregnancy and its possible link to autism spectrum disorder (ASD). Recently, US Health Secretary Robert F. Kennedy Jr announced concerns regarding prenatal exposure to this common pain and fever medicine. However, scientific research remains inconclusive and does not confirm a causal relationship.
Scientific Research on Paracetamol and Neurodevelopment
Large-scale studies have explored the association between prenatal paracetamol use and neurodevelopmental disorders such as autism and ADHD. A 2024 Swedish study involving 2.5 million children found no direct causal link between in utero exposure and these conditions. Conversely, a 2025 meta-review of 46 studies suggested a possible association but did not establish causation. Researchers emphasise that observed risks may result from confounding factors including genetics, environmental influences, maternal health, and other medications.
Medical Guidelines for Pregnant Women
Leading obstetric organisations recommend paracetamol as the first-line treatment for pain and fever during pregnancy. The American College of Obstetricians and Gynecologists (ACOG) and the Royal College of Obstetricians and Gynaecologists (RCOG) endorse its cautious use at the lowest effective dose for the shortest duration. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen are discouraged, especially in the third trimester, due to risks of birth defects and complications.
Risks of Untreated Fever and Pain in Pregnancy
Untreated maternal fever and pain pose risks to foetal development. They are linked to birth defects such as heart anomalies, abdominal wall defects, and neural tube defects. Additionally, untreated symptoms increase the chances of preterm birth, low birth weight, and miscarriage. For the mother, persistent fever and pain can cause hypertension, dehydration, and mental health issues including depression and anxiety.
Considerations on Confounding Factors
Recent European and Japanese studies show the importance of accounting for confounders in evaluating paracetamol’s effects. Factors like parental genetics, environmental exposures, and maternal illnesses may influence neurodevelopmental outcomes. This complicates attributing risks solely to paracetamol use. Careful interpretation of data is essential to avoid unwarranted alarm.
Recommendations for Pregnant Women
Pregnant women are advised to consult healthcare providers before taking any medication. Paracetamol remains the safest option for managing pain and fever when used responsibly. Avoiding unnecessary or prolonged use is prudent. Monitoring and managing maternal health comprehensively reduces risks to both mother and child.
Questions for UPSC:
- Critically analyse the impact of maternal health and medication use on foetal neurodevelopment with suitable examples.
- Explain the role of confounding factors in epidemiological studies related to drug safety during pregnancy.
- What are the challenges in establishing causal links in public health research? How can these be addressed?
- With suitable examples, comment on the importance of medical guidelines in ensuring maternal and child health during pregnancy.
