Dr. Heidi Leftwich, a maternal-fetal medicine specialist at UMass Memorial Health, said she has gotten many more questions about acetaminophen from some of her pregnant patients in recent weeks.
The safety of the fever and pain reliever “comes up periodically,” especially when there’s a news story about it, said Dr. Allison Bryant, a maternal-fetal medicine specialist at Mass General Brigham.
Rather than scare them or dictate what they should do, Bryant said, she favors “shared decision-making” with her patients, with them “at the center” of her guidance.
At a news briefing Monday, President Donald Trump promoted unproven claims that taking acetaminophen during pregnancy was linked to a risk of autism in children. The Food and Drug Administration has sent a letter telling doctors to “consider minimizing the use of acetaminophen,” the active ingredient in Tylenol and a wide range of other over-the-counter medications, for routine low-grade fevers in pregnant women.
Trump’s announcement came after several weeks of reports about the warning. Pregnant women experiencing pain or fever should “tough it out,” Trump said.
Dr. Laura Riley, chief of obstetrics and gynecology at Weill Cornell Medicine in New York, said patients have come in since Trump’s briefing anxious and unsure what to do. “There was a lot of head-shaking,” Riley said.
Are doctors changing their guidance about acetaminophen?
More than half of women worldwide use acetaminophen during pregnancy. It is used in hundreds of products, including cough and cold treatments. Doctors said in interview that their advice hasn’t changed, in spite of the Trump administration’s concerns.
“We normally advise women with pain or fever to take acetaminophen, unless there is some other reason why we think it might be unsafe,” such as when women have allergies or pre-existing liver disease, Bryant said.
Riley said the most common reasons pregnant women take acetaminophen are fever, headache and low back pain.
“I’m telling women not to do anything differently than what we started with, which was Tylenol is one of the best pain relievers that we have in pregnancy,” she said.
Untreated fever, especially in the first three months of pregnancy, increases the risk of miscarriage, birth defects and premature birth, according to the Society for Maternal-Fetal Medicine.
Fever in the second and third trimesters can trigger contractions and may be associated with early labor, Riley said, so “it’s important to treat.”
Emily Heumann, 31, was 10 or 12 weeks pregnant when she spiked a fever of 104 degrees because of a viral infection. She’d developed hand, foot and mouth disease — a highly contagious virus that typically spreads among children — after she was infected by her 4-year-old son. The infection causes sores in the mouth and a rash on the hands and feet.
Heumann said that although her son experienced only minor symptoms that went away quickly, she experienced severe pain for 10 days, especially because of sores in her throat and inside her ears.
Her doctor told her that it was important to bring her temperature down and suggested she take acetaminophen, often sold under the brand name Tylenol.
“If the Tylenol didn’t work, they said to go to the emergency room,” said Heumann, who is now 36 weeks pregnant.
Bryant suggests that women with questions about any medication during pregnancy talk to doctors they trust and who know them well.
Both the American College of Obstetrics and Gynecology and the Society of Maternal Fetal Medicine continue to recommend acetaminophen as safe for pregnant women and say the bulk of medical evidence doesn’t show a link to autism. Bryant noted that the groups base their advice on the total body of evidence about acetaminophen and neurodevelopment disorders, not just one study.
“That guidance is not likely to change anytime soon,” Bryant said.
Leftwich said she feels comfortable talking with her patients about the treatment of fever and pain with acetaminophen during pregnancy. “This is a very important conversation to have with a trusted physician.”
Untreated pain in pregnancy can be risky, too
Riley said that after Trump warned about acetaminophen use during pregnancy, she’s had patients asking, “‘the next time I get a headache, what should I do?’”
Her response: “Take Tylenol.”
“There’s no reason for you to tough it out,” Riley said. “That’s not an appropriate way of managing pain.”
If women ask Bryant about research suggesting a link between acetaminophen and autism, she tells them that the strongest, most rigorous study to examine the question found no association between acetaminophen use during pregnancy and autism, attention-deficit/hyperactivity disorder or intellectual disability.
An important feature of that study of more than 2.4 million children, published last year in JAMA, is that it included siblings of children with autism as a control group. Autism tends to run in families, with twins or siblings of people with autism having a higher risk.
Leftwich said Heumann’s doctor did right by putting the patient first and keeping her needs in mind.
“Instilling undue fear in pregnant individuals could lead to inadequate management of fever and pain,” Leftwich said, adding that untreated pain is associated with depression, anxiety and high blood pressure, which can increase the risk of preterm births.
Heumann said she is grateful that her doctor suggested acetaminophen for her fever, which began to fall within an hour of her taking the medication. Acetaminophen also helped relieve the intense pain from the infection.
“It was one of the worst things I’ve ever experienced,” said Heumann, 31, who lives in central Florida. When she tried to sleep at night, “laying on the sores was especially painful. The throat pain was the worst.”
Lowest dose for the shortest amount of time
Leftwich said she advises pregnant women to be cautious when they use any medication.
“It’s really important to talk about the judicious use of any medication,” she said. “You should use the lowest dose possible to get the treatment that you need, for instance, for fever reduction or pain control. I would say the same about Tylenol as I would for any other medication.”
Heumann said pregnant women have enough to worry about without adding unproven risks.
“Every mom I know feels guilt regularly,” she said. “We want what’s best for our kids so badly, and no matter what we do, most of us worry … if what we’ve done is the right thing. This just adds one more thing for moms to worry about. And it’s based in misinformation, which is so dangerous.”
Kati Woock, who developed frequent migraines during her pregnancy five years ago, said her doctor reassured her that taking acetaminophen — one of the ingredients in her usual migraine treatment — was safe.
“Sometimes with a migraine, I can’t even be vertical,” said Woock, 36, who lives in Illinois.
Woock said she was with family members when she developed the first migraine of her pregnancy, which occurred mainly during the first three to four months.
Her family told her, “You shouldn’t take anything when you’re pregnant because you’re going to hurt the baby,” Woock recalled. “I was kind of nervous about it, but I decided that my doctor probably knew what she was talking about.”