In an unexpected announcement, President Trump recently declared that the painkiller acetaminophen—Tylenol in the US and paracetamol everywhere else—could be a factor in the surge of autism. But was he right?
Is acetaminophen—the painkiller marketed as Tylenol in the US and as paracetamol in the rest of the world—behind the alarming rise in autism in our children? US President Donald Trump thinks so, and he has urged pregnant women to “tough it out” if they’re in pain or have a fever and avoid the drug.
Not for the first time, Trump rejects received wisdom. Pregnant women have always been assured the drug is safe, and it’s estimated that about half of women take it at some stage in pregnancy to counter pain or fevers, which can cause birth defects if the body temperature exceeds 37.5°C (99.5°F). Doctors continue to recommend the drug although its maker has warned against taking it while pregnant.1
Women have been taking the over-the-counter medication during pregnancy for at least 50 years, and meanwhile autism rates in the US have risen from 1 in 10,000 in 1980, to 1 in 150 in 2000, to 1 in 31 in 2022. Some experts reckon the surge is nothing to do with painkillers but is more the result of a much wider definition of autism, and just a few months ago US health secretary Robert F. Kennedy Jr said environmental factors were likely the main culprit.
But now the Trump administration is fingering acetaminophen as one of the major possible causes, and the pronouncement was vindicated by a major review by Harvard University that concluded acetaminophen was indeed a likely cause of autism (autism spectrum disorder, or ASD) and ADHD (attention-deficit/hyperactivity disorder).
The US drug regulator, the Food and Drug Administration (FDA)—repopulated by health secretary Kennedy with “people-first” bureaucrats—is now urging women to exercise caution and take the drug only as a last resort.
“The FDA is taking action to make parents and doctors aware of a considerable body of evidence about potential risks associated with acetaminophen,” said FDA commissioner Marty Makary. “The precautionary principle may lead many to avoid using acetaminophen during pregnancy, especially since most low-grade fevers don’t require treatment. It remains reasonable, however, for pregnant women to use acetaminophen in certain scenarios.”
Critics have argued that Trump’s announcement is alarmist, unscientific and dangerous and that acetaminophen is still the safest drug for pregnant women to use for pain and fever. Mel Merritt at the National Autistic Society said, “President Trump is peddling the worst myths of recent decades. Such dangerous pseudoscience is putting pregnant women and children at risk and devaluing autistic people.”
His views were echoed by the American College of Obstetricians and Gynecologists (ACOG), whose president, Steven J. Fleischman, said, “In more than two decades of research on the use of acetaminophen in pregnancy, not a single reputable study has successfully concluded that the use of acetaminophen in any trimester of pregnancy causes neurodevelopmental disorders in children.”
Dr Fleischman and others point to a major study by the Karolinska Institute in Sweden that was published last year. The researchers tracked 2.48 million children born between 1995 and 2019 and included their siblings for comparison. Of these, 185,909 children—around 7.5 percent of the total—had been exposed to acetaminophen in the womb. Rates of autism and ADHD barely differed between the acetaminophen and non-acetaminophen groups, the researchers concluded.2
Some scientists argue the study provides definitive proof that the painkillers don’t cause autism. However, the Harvard study—conveniently or coincidentally published two days after Trump’s announcement—says several red flags suggest it is not as scientific as its supporters would like to think.
For one, the use of acetaminophen is surprisingly low at 7.5 percent of pregnant women, and well below the average of 40–50 percent in other studies. This could be because the Swedish researchers didn’t actually record drug usage but instead relied on the memory of midwives.
It’s likely the researchers missed five out of every six acetaminophen users, while relying on sibling data only amplified the error, the Harvard team said. The result is an unreliable and unscientific conclusion.3
The Harvard team reanalyzed 46 studies that had researched a link between the painkiller and autism and found 27 of them had discovered a “significant” connection. Just four—including the Swedish study—found no association.
The study’s lead researcher, Andrea Baccarelli, dean of the faculty at Harvard T. H. Chan School of Public Health since January 2024 and professor of environmental health, was discussing the findings with health secretary Kennedy in the weeks before Trump’s announcement. He had given the White House team a statement noting his research found “evidence of an association” between prenatal exposure to acetaminophen and neurodevelopmental disorders. “That association is strongest when acetaminophen is taken for four weeks or longer,” Baccarelli said.
There is a question mark over Baccarelli’s involvement, however. Described as “Trump’s favorite scientist,” he served as a paid expert witness in a 2022 class-action lawsuit against Tylenol maker Kenvue. A group of parents filed the suit, claiming their children had ADHD and autism because they took the drug while pregnant.
Bacarelli acknowledged in an August 2023 deposition that he had been paid about $150,000 to testify for the plaintiffs. A federal judge dismissed the case, stating Bacarelli and four other experts’ testimonies were “unbalanced,” the New York Post reported.4
But Baccarelli is far from a lone voice. Researchers from the California Institute of Behavioral Neurosciences & Psychology came to the same conclusions. They reviewed 16 “high-quality” papers and found “all studies showed an association” between acetaminophen usage and neurodevelopmental problems in the child, and this became more emphatic with longer usage and higher doses.5
A research team from the Barcelona Institute for Global Health estimates that acetaminophen increases the risk of autism by up to 19 percent. They recruited 73,881 mothers and assessed their use of the painkiller for 18 months, both before and after birth.
They then assessed the children for symptoms of autism and ADHD at ages four to 12. They found nearly 13 percent of the children had autism and 12 percent had ADHD, although the association was not so strong in children who took acetaminophen in their first few years.6
But regarding the drug’s use in a child’s first years, researchers at the Ronin Institute in New Jersey found the exact opposite: Children given acetaminophen—the common children’s medication Calpol contains 20 percent paracetamol—were much more likely to develop autism. The drug could be responsible for up to 40 percent of the risk in boys, the researchers concluded. They surveyed 1,515 families and assessed its use in the child’s first two years.7
And a 2020 study by Johns Hopkins researchers monitored almost 1,000 mother-child pairs for 20 years and found that the higher the levels of acetaminophen in a baby’s umbilical cord blood, the more likely they were to have autism or ADHD. Those with the highest levels were more than three times as likely to have autism than those with the lowest levels.8
So, why is this coming to light only now? One reason could be that researchers haven’t ever specifically looked for neurodevelopment problems in the fetus, say researchers from Duke University. Of the 3,096 papers they reviewed, 218 claimed paracetamol was safe for use with infants or children, but only 52 included actual safety experiments and none monitored neurodevelopmental issues.
No trial considered total exposure to the drug since birth, and so the effects of drug exposure on long-term neurodevelopment couldn’t be accurately assessed. Overall, most studies tracked the well-being of the child for just three days or less.9
Although critics argue that most of the studies establish correlation and not causation, if acetaminophen is directly responsible for the autism surge, there’s a biological mechanism to explain it. The drug is known to reduce levels of glutathione, which supports neurodevelopment by acting as a potent antioxidant and neuromodulator, protecting neurons from oxidative stress and regulating glutamate receptor function, which is crucial for proper brain cell communication and survival.
The body also needs glutathione to detox harmful substances in the environment and in vaccines, such as aluminum and mercury, and studies show autism in some people is linked to an inability to remove these substances from the body.10 So ubiquitous environmental toxins and the ever-expanding vaccine schedule, combined with common use of acetaminophen for pain and fever, particularly after vaccinations, may be doing more harm.
There’s no conclusive proof that acetaminophen causes autism, but there’s enough evidence of a strong association that women should use the painkiller sparingly during pregnancy. The Harvard researchers noted that the risk of autism increased if the mother was taking the painkiller for more than four weeks without a break, and at higher doses. Autism risk also increased if it was taken during the third trimester, when the brain of the unborn child is developing.
Perhaps, as the Trump administration advises, acetaminophen should be reserved for times when the woman’s fever is high and threatens the baby’s healthy development. Otherwise, seeking out alternatives to reduce fever and pain is a better option (see below). If there is doubt, always opt for the precautionary principle.
Here are a few non-drug ways to bring down your temperature.
Take supplements
Increase the amount of vitamin C you take to reduce oxidative stress. Sipping lemon juice in lukewarm water helps, but also take high-dose supplements. Adding garlic and ginger to food can also bring down body temperature.
Drink plenty of water
A fever induces dehydration, so stay hydrated. Sipping water every 10 minutes or so is a good approach. You can also use a wet sponge to cool the skin or take a lukewarm bath or shower.
Eat well
Ditch sugary and processed foods and eat plenty of natural and nutritious food. But don’t overeat, as your digestive system doesn’t operate as well when you have a fever.
Add soups to your diet, and pack them with spices and herbs, such as basil. Broths can also bring down body heat. Freshly pressed fruit juices should be the drink of choice.
If you’d rather avoid taking painkillers during pregnancy, here are some alternative options to consider. Check with your doctor or midwife before trying anything new.
Warm baths can ease aches, pains, cramps and swelling. Just make sure the water isn’t too hot. Adding a few drops of lavender essential oil to the bath may provide further relief, but avoid the use of essential oils in the first trimester.
Massage is known to promote relaxation and soothe pain during pregnancy as well as labor.1 Find a massage therapist near you who offers prenatal massage.
Acupuncture appears to relieve pregnancy-related lower back and pelvic pain by improving blood circulation, relaxing muscles, reducing inflammation and regulating hormones.2 To find an acupuncturist near you, visit acunow.org.
Magnesium is generally safe to take during pregnancy and may help relieve headaches and migraines.3 It can also alleviate pregnancy-induced leg cramps.4
Suggested dosage: Check with a practitioner about the right form and dosage for you, especially if you’re already taking a prenatal supplement that includes magnesium
Yoga can relieve pregnancy-related lower back and pelvic pain.5 Join a prenatal yoga class or check YouTube for some simple yoga poses to ease pain in pregnancy.
Homeopathy can be a safe way to alleviate pain in pregnancy. Consult with a homeopath who can recommend the right remedy for you.
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