https://ranzcog.edu.au/news/paracetamol-use-in-pregnancy/
Paracetamol Use in Pregnancy Not Linked to Autism or ADHD, RANZCOG Asserts
The Trump administration has issued highly controversial claims regarding the causes of autism and ADHD, asserting that paracetamol (also known as acetaminophen) use during pregnancy increases the risk of children being diagnosed as neurodivergent.
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG, the College) joins leading clinicians and scientists worldwide in vehemently rejecting these claims. Robust scientific evidence shows no link between paracetamol use in pregnancy and autism or ADHD, with several large and reliable studies directly contradicting the administration’s statement.
Autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) are considered in the Diagnostic and Statistical Manual of Mental Disorders as disorders of neurodevelopment. Many people who meet the diagnostic criteria for these conditions consider that they are not disorders of neurodevelopment but, rather, different neurotypes as distinct from the most common or typical neurotype. RANZCOG acknowledges that people with these neurotypes face additional challenges in accessing standard models of health care and supports a neuro-affirming approach to providing care to all neurodivergent people.
The causes of neurodivergence are incompletely understood but are known to be complex and to include both genetic and environmental contributors.
Previous research raised concerns that exposure to paracetamol during pregnancy may increase the chance of the offspring being diagnosed with ASD or ADHD during childhood. The earlier studies showed an association between paracetamol exposure and these diagnoses but were importantly limited by a methodological inability to differentiate between the effect of paracetamol as a causative exposure as opposed to a statistical association.
The most recent and robust study to evaluate this association was published in 2024 by Ahlqvist et al.1 This study of 2.5 million Swedish children found that, when controlling for important factors including parental neurodivergent diagnoses and sibling relationships, there was no association between paracetamol exposure and offspring neurodivergence.
The use of medications during pregnancy should always balance the potential benefits against any potential harms, both of the medication and of the condition being treated, to the mother and the fetus. The Ahlqvist study provides conclusive evidence that paracetamol use during pregnancy does not increase the chance of neurodivergence in the offspring and therefore should be considered safe to use in pregnancy where there is a clear reason to do so.
Aspirin has a specific role in pregnancy for the reduction of complications including preeclampsia and in such cases has been clearly shown to be safe and effective. Women who have been advised to use low-dose aspirin in pregnancy by the health care provider should continue to do so. People who are uncertain about medication use in pregnancy should discuss this with their doctor or midwife.
Folinic acid (also known as leucovorin) has shown some potential to improve some of the communication difficulties experienced by children with ASD. These studies are small and are therefore unable to show conclusively that folinic acid therapy is safe and effective. RANZCOG supports further research being conducted to provide further evidence to guide such treatment.
RANZCOG continues to advise that people should be offered vaccination according to the standard schedules recommended in Australia and Aoteaora New Zealand for pregnant women and for children.
Authored by Associate Professor Scott White, Chair, RANZCOG Women’s Health Committee.
1. Ahlqvist VH et al. Acetaminophen use during pregnancy and children’s risk of autism, ADHD, and intellectual disability. JAMA 2024;331(14):1205-1214.
