The question of an association between the use of acetaminophen during pregnancy and occurrence of attention-deficit/hyperactivity disorder (ADHD) in children has been long-studied.  A recent large study appears to underscore that the use of the drug in pregnancy is not associated with increased risk of intellectual disability.

The new study, published in JAMA Network, responds to the frank question of whether acetaminophen use in pregnancy increases the risk of neurodevelopmental disorders.  Acetaminophen is the active ingredient in Tylenol brand pain-reliever and other products.   In the study, researchers note a consensus statement issued in 2021 that recommended pregnant women avoid acetaminophen given the potential risks to their baby of autism or developmental disorders. The question of using acetaminophen has continued among medical providers, researchers, and concerned parents trying to avoid risk to their unborn child.

In their own research, present-study researchers note, “Multiple biases may explain the associations observed in previous studies between acetaminophen use and neurodevelopmental disorders.” That is, that confounding familial factors behind the use of the drug could be at issue, not the drug itself.

The rigorous new study reviewed nationwide data from Sweden’s national health registers of more than 2.4 million children and their siblings born in Sweden from July 1995 to December 2019.  Researchers followed the subjects through December, 2021 and reviewed prenatal records, including medical and clinical records. Given the size and duration of the study, some children were followed to 26 years of age. The advantage of this study was its comparison with sibling data which provided comparison between similar genetic and familial background, rather than basic statistical modeling.

Consider these findings:

  • About 7.5 percent of the patient cohort were exposed to acetaminophen during pregnancy.  The use of acetaminophen was more common among birth parents with diagnoses of psychiatric conditions, neurodevelopmental disorders, smoking, and higher BMI, among other factors.
  • “Sibling control analyses found no evidence that acetaminophen use during pregnancy was associated with children’s risk of autism, ADHD, or intellectual disability.”
  • Study authors suggest earlier studies which found an association between acetaminophen use in pregnancy and neurodevelopmental disorders could be attributable to familial or other factors.

Co-author Dr. Brian Lee, with Drexel University Dornsife School of Public Health said, “This sort of analysis helps us to control for genetics. Since other studies have shown that women with a higher genetic liability for neurodevelopmental disorders like ADHD are more likely to report taking acetaminophen during pregnancy as well as to suffer from indications for use of pain-relievers during pregnancy, we felt that it was extremely important to understand this component.”

The causes of autism and neurodevelopmental disorders remain complex. Studies like these and others to come help clarify guidance to healthcare providers and the parents who rely upon them.

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