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Researchers say paracetamol may be linked to a higher risk of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) in children
While the latest findings stop short of proving causation, Indian experts agree that the study strengthens the case for careful use in obstetric care. (Representational image)
Popping paracetamol during pregnancy? It may be time to check with your gynaecologist again.
A widely used painkiller during pregnancy, a paracetamol pill, may be linked to a higher risk of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) in children, according to a recent study.
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While the latest findings stop short of proving causation, Indian experts agree that the study strengthens the case for careful use in obstetric care. In clinical practice, the advice is shifting toward taking paracetamol only when truly necessary, for the shortest possible duration, and always under medical guidance.
According to the study titled “Evaluation of the evidence on acetaminophen use and neurodevelopmental disorders using the Navigation Guide methodology”, acetaminophen or paracetamol is the most commonly used over-the-counter pain and fever medication taken during pregnancy, with over 50 per cent of pregnant women using acetaminophen worldwide.
Published in the journal Environmental Health, researchers applied the navigation guide methodology to evaluate evidence from 46 human observational studies on prenatal exposure to acetaminophen. This is the first time the framework has been used to assess the drug’s potential impact on child neurodevelopment comprehensively.
What did the study find?
The researchers found that a significant number of high-quality studies showed positive associations between acetaminophen use during pregnancy and later diagnoses of ASD and ADHD in children. While some studies reported no link, and a handful even suggested possible protective effects, the overall weight of the evidence leaned toward a connection—particularly in the strongest and most rigorously designed studies.
“Higher-quality studies were more likely to report a positive association between prenatal acetaminophen exposure and neurodevelopmental disorders,” the authors wrote, noting that both ADHD and ASD showed “strong” levels of evidence under the navigation guide assessment.
The researchers highlighted that acetaminophen can cross the placental barrier and may influence fetal brain development through mechanisms such as oxidative stress, hormonal disruption, and epigenetic changes. “Acetaminophen freely crosses the placental barrier, reaching levels in fetal circulation similar to maternal circulation within less than an hour of maternal ingestion,” it said.
Given that acetaminophen is considered one of the safest options for pain and fever relief during pregnancy, its widespread use raises important public health questions.
While the study does not establish definitive causation, it underscores the need for caution. The authors called for more high-quality research to further clarify risks and for healthcare providers to carefully weigh the benefits and potential harms when recommending acetaminophen to pregnant women.
Indian experts say pregnant women may need to take caution
Experts point out that these findings don’t conclusively prove paracetamol causes autism. Rather, they indicate a possible connection that requires further study. The majority of such research used in this study employs self-reporting by mothers or measures drug concentrations in umbilical cord blood, both of which are sources of variability.
According to Dr Vinit Banga, director of neurology at Fortis Hospital, Faridabad, various recent studies have also raised alarm about the use of paracetamol (also known as acetaminophen) during pregnancy and its possible association with increased risk of autism spectrum disorder (ASD) in children.
“Paracetamol is frequently utilised as an antipyretic and painkiller and is usually considered safe to consume during pregnancy. However, mounting evidence suggests that continuous or persistent exposure to the drug throughout pregnancy may influence fetal brain development,” Banga said. “While the exact mechanisms are still unknown, scientists believe that paracetamol may interfere with the regulation of hormones or cause oxidative stress in the developing brain.”
Similarly, Dr Deepti Sharma, head, obstetrics and gynaecology at Amrita Hospital, told News18 that she approaches this study with both “scientific curiosity and clinical care”.
“This finding is significant because acetaminophen has often been the go-to pain reliever during pregnancy due to its perceived safety. However, recent biological insights—including placental transfer, oxidative stress, hormonal changes, and epigenetic effects—offer reasonable explanations for these links,” she said.
Sharma believes that while the study does not prove causation, it supports caution in obstetric care. “In practice, I would now advise pregnant patients to take acetaminophen only when necessary and for the shortest time possible, with medical oversight. Furthermore, this study highlights the critical need for updated clinical guidelines and the search for safer options.”
Banga from Fortis added that “occasional use for a limited duration, especially at the lowest dosage required, is still viewed to be comparatively low risk by most medical physicians”.
“Finally, before further research establishes a definite causal link, pregnant women should visit healthcare professionals before consuming paracetamol during pregnancy. Weighing on one side the benefits of pain relief against potential long-term risk to the child is the requirement for deciding treatment at this critical point,” he said.
About the Author
Himani Chandna, Associate Editor at CNN News18, specialises in healthcare and pharmaceuticals. With firsthand insights into India’s COVID-19 battle, she brings a seasoned perspective. She is particularly pass…Read More
Himani Chandna, Associate Editor at CNN News18, specialises in healthcare and pharmaceuticals. With firsthand insights into India’s COVID-19 battle, she brings a seasoned perspective. She is particularly pass… Read More
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