Reassessing Prenatal Acetaminophen Use: No Link to Autism or ADHD

A 43‑study review found no link between prenatal acetaminophen exposure and autism, ADHD, or intellectual disability.

Acetaminophen remains the recommended option for treating pain and fever in pregnancy, given the known risks of untreated maternal fever and pain. The evidence anchor is explicit: the review synthesized large cohorts and deliberately prioritized robust designs, including sibling comparisons, formal heterogeneity assessment, and standardized risk‑of‑bias appraisal. The reviewers applied established quality tools and sensitivity analyses to emphasize higher‑quality estimates and to limit distortion from smaller, unadjusted reports. Overall, pooled estimates showed no association between prenatal acetaminophen exposure and autism, ADHD, or intellectual disability, and that null finding persisted in analyses restricted to low‑bias studies.

Sibling‑comparison studies provide an intra‑familial contrast that controls for fixed family‑level confounders such as shared genetics and stable parental characteristics. By comparing siblings discordant for prenatal exposure, these designs remove confounding from household and parental traits that traditional cohort analyses may not fully capture. In this review, within‑family estimates consistently attenuated earlier associations, strengthening the inference that acetaminophen itself is unlikely to drive neurodevelopmental harm.

Why the difference from earlier reports? Prior signals likely reflected residual confounding (for example, maternal fever or chronic pain), measurement error in exposure assessment, and incomplete adjustment in smaller studies. The current synthesis reweighted evidence toward designs that mitigate those biases and down‑weighted higher‑risk reports, addressing the main methodological weaknesses that complicated earlier interpretations.

Current guidance on acetaminophen use in pregnancy remains unchanged and now carries stronger reassurance based on higher‑quality, within‑family evidence.

Key Takeaways:

• Pooled evidence from 43 studies finds no association between prenatal acetaminophen use and autism, ADHD, or intellectual disability.
• Sibling‑comparison (within‑family) designs attenuated prior associations, improving causal inference.
• Acetaminophen remains the recommended option for pain and fever in pregnancy when clinically indicated