Acetaminophen (Tylenol) in Pregnancy: What Expectant Mothers Need to Know

If you're pregnant, you've probably heard conflicting information about whether it's safe to take acetaminophen (Tylenol). Recent headlines have understandably caused anxiety for many expectant parents. The good news? The best available evidence continues to support the use of acetaminophen as the first-choice medication for pain and fever during pregnancy.

Here is a summary of Zipursky et al.'s comprehensive review of the latest and most robust evidence on this subject, published in the June 2026 edition of the Canadian Medical Association Journal.

1. Acetaminophen has an excellent safety record

Acetaminophen (Tylenol) use in pregnancy has been studied more extensively than any other medication and has the strongest safety record for both pregnant individuals and their babies. That's why it continues to be recommended by obstetricians and medical organizations as the first-choice treatment for pain and fever during pregnancy.

2. There is no evidence proving that acetaminophen causes autism or ADHD

Although some prior low-quality observational studies suggested a small association between tylenol use in pregnancy and ADHD or autism, subsequent high-quality research studies that controlled for potential confounding factors have not demonstrated any convincing link. This suggests that genetic and environmental factors other than tylenol use in pregnancy are to blame.

3. There is no clear link between acetaminophen and birth defects

A few small observational studies published more than a decade ago suggested a possible link between acetaminophen use during pregnancy and certain congenital abnormalities in boys. However, more recent and better-designed studies have not found the same association. The earlier studies relied on parents recalling medication use months or years after pregnancy, which can introduce errors and bias. Overall, the current evidence does not support a clear causal relationship between acetaminophen use during pregnancy and congenital abnormalities in boys.

4. Untreated fever during pregnancy may be dangerous

Fever itself may be harmful during pregnancy, particularly during the first trimester. Some observational studies have found associations between maternal fever and neurodevelopmental conditions, such as autism and ADHD, as well as certain congenital abnormalities, including neural tube, heart, and oral cleft defects. Some studies have also suggested that treating fever with acetaminophen may reduce the risk of congenital abnormalities. However, all of these studies are generally small and have important limitations, including reliance on mothers recalling medication use after pregnancy. In addition, it is difficult to separate the potential effects of the fever itself from those of the underlying illness. As a result, we do not know for certain whether treating fever with acetaminophen reduces the risk of adverse outcomes.

Bottom Line:

Current evidence does not support a causal link between acetaminophen use in pregnancy and adverse outcomes in children.

If you need treatment for pain or fever during pregnancy, acetaminophen remains the safest and best-studied option.

As with any medication in pregnancy, use the lowest effective dose for the shortest time needed, and discuss any concerns with your healthcare provider.

References:

• Bandoli G, Palmsten K, Chambers C. Acetaminophen use in pregnancy: examining prevalence, timing, and indication of use in a prospective birth cohort. Paediatr Perinat Epidemiol. 2020;34:237–246.

• Smith GN. Acetaminophen use in pregnancy and the purported link to neurodevelopmental disorders. J Obstet Gynaecol Can. 2025;47:103140.

• Ahlqvist VH, Sjöqvist H, Dalman C, et al. Acetaminophen use during pregnancy and children's risk of autism, ADHD, and intellectual disability. JAMA. 2024;331:1205–1214.

• Sheikh J, Allotey J, Sobhy S, et al. Maternal paracetamol (acetaminophen) use during pregnancy and risk of autism spectrum disorder and attention-deficit/hyperactivity disorder in offspring: umbrella review of systematic reviews. BMJ. 2025;391:e088141.

• Smith R, Zipursky JS. Safety of acetaminophen use in pregnancy: review of existing evidence. Am J Obstet Gynecol MFM. 2026;8:101925.

• Antoun S, Ellul P, Peyre H, et al. Fever during pregnancy as a risk factor for neurodevelopmental disorders: results from a systematic review and meta-analysis. Mol Autism. 2021;12:60.

• Dreier JW, Andersen AMN, Berg-Beckhoff G. Systematic review and meta-analyses: fever in pregnancy and health impacts in the offspring. Pediatrics. 2014;133:e674–e688.

• Zipursky JS, Smith R, Bogler T. Five things to know about… Acetaminophen in pregnancy. CMAJ. 2026;198:E835. doi:10.1503/cmaj.260138.