Night Doc Med Talk

Another big announcement from President Trump: avoid taking acetaminophen, commonly known by its brand name Tylenol, when you’re pregnant. His claim being that Tylenol, if taken during pregnancy, “can be associated with a very increased risk of autism.”

This is pretty jarring news to myself and my colleagues. Did I miss a groundbreaking study that was released while I was snoozing? Did a principal investigator with a flair for the dramatic sneak his study past all of our academic docs and professional societies in order to release it directly to The White House? These were the questions running through my head as I watch Trump reiterate “Don’t take it!”

While the general population has many options in terms of medications, pregnant women’s options are much more limited – relatively speaking. Moms have to be aware that their unborn child will often react to medications differently and be vulnerable to a different set of side effects than her. We know, for example, that women who have taken ibuprofen, another over-the-counter pain reliever, have an increased risk of miscarriage and certain birth defects. We also know, based on decades of physician experience and observational studies, that women who have taken acetaminophen did not have these same complications.

As far as I can tell, there has been no new conclusive evidence that has shown a causation or even a strong correlation between acetaminophen use in pregnancy and the development of autism later in the child’s life.

There are obvious fetal benefit of taking acetaminophen when it’s indicated. One of the biggest reasons its use is for the treatment of fever during pregnancy. We know that fever can lead to adverse fetal outcomes including oral clefts, congenital heart defects, and neural tube defects. Bringing the mother back to normal body temperature has been shown to reduce these risks. As ibuprofen (and other NSAID medications) is contraindicated, acetaminophen is the only remaining option in pregnancy.

For the mother, pregnancy is not a vacation. It’s often normal to have discomfort or even pain. I can align with the thought that one should not take medication if they don’t have to. It should be up to the woman to decide if the discomfort or pain is tolerable or if it necessitates the use of medication to alleviate it. Medications, as with most things in life, has its pros and cons. We often explain this as its risks and benefits. No medication is completely harmless, but if taken when indicated for the appropriate indications, its benefits outweighs its risks. This holds especially true for acetaminophen, as any doctor will tell you.

I can’t speak to the motivations behind this White House announcement. If I were to venture a guess, I’d think there is more political motivations rather than public health motivations in this announcement. I would encourage pregnant women to take acetaminophen as directed and as needed for its intended indications – most commonly pain or fever. If mothers should have any questions or concerns, it’s worth having a discussion with your doctor, who is much more likely to have you and your child’s personal interest at heart as compared to our politicians.