Recently, murmurs began about one specific assertion that Health and Human Services Secretary Robert F. Kennedy Jr. would make in a soon-to-be-released report from the HHS. Kennedy, founder of the “Make America Healthy Again” movement and whose opinions are often born of pseudoscience and its online peddlers, has long been a vocal critic of vaccines (as was abundantly clear in his Senate hearing) and will now suggest, accordingly to reporting by the Wall Street Journal, that use of the common pain reliever acetaminophen during pregnancy is linked to autism. An assertion rejected by all major organizations overseeing maternal health guidance, and one unsupported by definitive scientific research.
Acetaminophen is a widely-used and relied-upon standalone medication (aka, Tylenol in the US and paracetamol abroad) during both pregnancy and not, that is also present in various cold and flu formulations. “It’s really one of the few medications we have to relieve pain and fever during pregnancy,” says Rachel Blake, MD, a Harvard-trained, board-certified OBGYN based in New York City. It’s the preferred option because alternatives like NSAIDs (like ibuprofen or Aleve) can be harmful, potentially causing kidney problems leading to low amniotic fluid and cardiac issues, especially beyond the late second trimester, explains Lucky Sekhon, MD, a double board-certified reproductive endocrinologist and infertility specialist and OBGYN at RMA of New York and author of the fertility guide The Lucky Egg. The recommended dosage is the same for both pregnant people and adults (325 to 600 mg every four to six hours, not to exceed 3,000 mg a day), and it’s suggested by doctors to take the lowest effective amount for the shortest duration of time to find relief.
The theory that prenatal acetaminophen exposure could correlate with increased risk of autism and ADHD, currently being hawked by RFK Jr., can be traced back to smaller observational studies (including NIH-funded research) and a more recent review of 46 epidemiological studies that found 27 reported positive correlations, says Sekhon. But, crucially, correlation does not equal causation, a point that’s driven home frequently not just by doctors and medical researchers, but also data scientists and economists (like Emily Oster, for one). The example frequently cited as an explainer is that while there’s a strong correlation between ice cream sales and shark attacks (they both go up in the summertime months), one doesn’t cause another. The largest and best-designed relevant study to date has been out of Sweden, which looked at prenatal acetaminophen and neurodevelopmental disorders in 2.5 million children. “No correlation was found after controlling for key confounding factors like genetics and familial environment,” says Sekhon, adding re-analysis of the data comparing siblings from the same household who were exposed versus not exposed in utero led to the correlation no longer being seen.
Many of the studies currently used are observational, says Sekkon. This means they rely on women recalling the past and the behaviors they engaged in or what they ate while pregnant, which can contribute to inaccuracy and bias in the results. “One of the toughest parts of the field of obstetrics is the lack of data,” says Blake. That’s because while we now require women to be included in trials (they were banned from them for years until FDA guidance changed in 1993), pregnant women remain largely excluded due to ethical concerns about fetal harm, says Abigail Bertelson, founder of Zenith Health, a new digital platform offering pregnant women access to clear, data-driven answers. “This has left us with substantial gaps in understanding of various medications during pregnancy,” says Bertelson, adding that what we need are large-scale prospective studies that follow thousands of women from early pregnancy through children’s development, collecting detailed data (medication, demographics, medical history, genetics) along the way. Something that, in the current political climate where cuts to research funding, particularly related to women’s health, are ever more frequent, feels impossible. “The irony is that sometimes the harm of not having safe, evidence-based treatments available during pregnancy can be greater than the risk of inclusion in research,” Bertelson adds.
And the risk of pregnant women leaving a fever untreated versus the potential, still unproven risk of taking acetaminophen is far greater and can be more dangerous. “Fever, especially high and prolonged, can increase miscarriage risk, fetal birth defects, and neurodevelopmental issues,” says Sekhon. Which is precisely why major organizations like the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal Fetal Medicine (SMFM) continue to recommend it as a safe treatment. “They all advise against altering clinical practice until definitive, prospective research provides clearer answers,” Sekhon adds.
Clear answers are something that RFK Jr., the HHS, and this administration have struggled to offer—and the damage of this kind of communication is immeasurable. “Instead of providing mothers with the evidence-based guidance we deserve, this administration continues to fuel distrust in health authorities—whether it’s through silence, mixed messaging, or a failure to meet the moment,” says Erin Erenberg, CEO of Chamber of Mothers, a national nonprofit advocating for mothers’ rights. “That erosion of trust leaves women vulnerable to misinformation.” And when government organizations are not aligned with medical professionals and healthcare providers, it only exacerbates the problem, adds Blake.
While this misinformation puts pregnant women’s physical health in jeopardy, because they may avoid medical advice or necessary relief out of misplaced alarm, says Sekhon, it also threatens their mental and emotional well-being. These types of announcements breed uncertainty, which, in turn, breeds stress and anxiety, says Lucy Hutner, MD, a New York–based reproductive psychiatrist, adding that 95% of her patients already feel guilt when they take any type of medication while pregnant, even when it’s helpful for them. “They already worry, what if something happens, then it’s all my fault,” says Hutner. That the data being lobbied into the public forum now is not rigorous science is part of the problem, but so is the abstract way it’s being communicated, which leads to confusion, says Hutner, and then distrust both in the medical system at large and your own doctor. A relationship that anyone who has been pregnant can tell you is one that’s vitally important to be able to rely on.
“These highly politicized narratives that swirl around us are difficult because they inevitably damage that trust,” says Hutner. How pregnant women are receiving those narratives is its own issue because so many are now living in different media universes and therefore getting different “facts,” making it harder to discern what’s true. Not to mention our algorithms can be unrelenting. “The minute you press on one piece of information, it gets reinforced over and over again, and we know that one of the things that promotes more anxiety is the reinforcement of a trigger,” says Hutner. “We’ve all been placed in these highly stress-inducing echo chambers.” It’s a place that, without definitive data that is clearly communicated to the public (something that the people currently in power are woefully incapable of), one that pregnant women may find themselves indefinitely stuck in. Says Bertelson: “Right now, pregnant women are caught between headlines and anecdotes.”
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