Which painkillers are safe during pregnancy, doctors say, after Tylenol-autism report

The Food and Drug Administration has updated the label for acetaminophen, the active ingredient in Tylenol, to warn of a possible link between prenatal exposure and a higher risk of neurodevelopmental disorders such as autism and ADHD. The update arrived as President Donald Trump cited the finding and urged pregnant women not to take Tylenol except in cases of extreme fever, and as the Department of Health and Human Services released findings on rising autism rates. Medical groups quickly pushed back, with obstetricians calling the connection uncertain and emphasizing that acetaminophen remains a commonly used and generally safe option when used as directed during pregnancy.

Medical experts say acetaminophen remains the preferred option for treating pain or fever during pregnancy when needed, with dosing guidance to minimize risk. Dr. Kecia Gaither, an OB-GYN and maternal fetal medicine specialist, notes that acetaminophen is typically considered safe when used within recommended limits. A common regimen is one or two regular-strength tablets every four to six hours, or one or two extra-strength tablets every six hours; the daily total should not exceed 3,000 milligrams, and prolonged daily use should be avoided unless advised by a clinician.

Image: Pregnant woman at pharmacy counter

ACOG has stressed that the conditions treated with acetaminophen during pregnancy — such as fever and headaches — are often more dangerous than any theoretical risk from the medicine. The group said treating maternal fever and pain is essential to reduce potential complications for both mother and fetus, and that the benefits of acetaminophen in appropriate doses generally outweigh potential concerns when used under medical guidance.

There has been mixed research on acetaminophen use in pregnancy and neurodevelopmental outcomes. A joint analysis by Mount Sinai and Harvard did not demonstrate a direct causal link between acetaminophen exposure and neurodevelopmental disorders, but it indicated the possibility of increased risk and underscored the need for further study.

NSAIDs such as ibuprofen and naproxen are generally not recommended in pregnancy. Low-dose aspirin (81 mg daily) may be used in specific cases to lower the risk of preeclampsia, typically starting in the second trimester and continuing until delivery, but it is not a general pain-relief strategy. High-dose or regular dosing for pain relief is not advised during pregnancy because of potential fetal risks. Dr. Kate McLean, chief medical officer and OB/GYN at Evvy, notes that aspirin’s use in pregnancy is a targeted, condition-specific intervention rather than a blanket remedy for pain.

Opioids like oxycodone and hydrocodone may be prescribed in pregnancy if medically necessary for procedures or severe pain, but they carry significant risks, including possible neonatal dependence, preterm birth and growth concerns. Dosing is highly individualized, and clinicians emphasize case-by-case decision-making with close monitoring.

In addition to pharmacologic options, clinicians encourage non-drug approaches as first-line relief when possible. Heat packs, gentle massage and prenatal yoga can help with minor discomfort, while lidocaine patches or certain topical NSAIDs may offer relief in select cases under strict medical guidance, given the limited safety data in pregnancy.

Pregnant women should consult their health care provider before taking any medicine, and caregivers advise seeking medical advice if pain or fever persists. Self-medicating or adjusting doses without professional input can pose risks to both mother and fetus, especially in the context of fever, inflammation or complicating conditions.

These developments come as clinicians balance evolving research with the practical realities of pregnancy care. While the FDA label update underscores potential concerns, doctors emphasize that the full risk profile remains nuanced and that acetaminophen continues to play a central role in managing pain and fever for many pregnant patients when used appropriately.

Image: U.S. Secretary of Health and Human Services at a press event