The Society for Maternal-Fetal Medicine published new clinical guidance this week affirming that acetaminophen, better known by its brand Tylenol, should be the “first-line” defense against pain and fever during pregnancy.

The directive contradicts the Trump administration’s notice to physicians last year cautioning against the use of the primary pain reliever recommended for pregnant women, following the president’s unsupported claims that the medication could lead to autism in children.

The national professional association for maternal-fetal medicine specialists, clinicians and scientists continues to recommend acetaminophen as the “first-line medication” to treat pain and fever during pregnancy. The federal government’s statements prompted the organization to review its 2017 guidance finding acetaminophen safe to use during pregnancy.

“Although some studies have reported associations between maternal acetaminophen use and adverse neurodevelopmental outcomes in offspring, methodological limitations preclude conclusions about causality, and the biological mechanism for such an effect remains unestablished,” reads the statement, following a comprehensive review of recent and historical scientific literature.

The organization’s guidance cautions patients to “use the lowest effective dose of acetaminophen for the shortest duration necessary,” while emphasizing that untreated maternal fever carries well-documented risks to the fetus, especially in the first trimester.

At a news conference last September, President Donald Trump said his administration had found acetaminophen use during pregnancy to be a likely contributing environmental cause of autism.

Health and Human Services Secretary Robert F. Kennedy Jr. has directed the U.S. Food and Drug Administration to shift its research into autism toward potential environmental causes.

Even though medical experts and the drug manufacturer have said there is no proven link, the FDA immediately said it would initiate a process for a label change for Tylenol and similar products to “reflect evidence suggesting that the use of acetaminophen by pregnant women may be associated with an increased risk of neurological conditions such as autism and ADHD in children.”

The label has not yet changed. But the September news conference has had consequences.

A month later, Texas’ Republican Attorney General Ken Paxton, who is running for U.S. Senate, sued Johnson and Johnson, alleging the pharmaceutical company failed to warn pregnant consumers about the risk of taking Tylenol.

And a study in The Lancet published in March found that emergency department orders for acetaminophen for pregnant patients fell 10% in the months following Trump’s statement, while there was no change in the acetaminophen orders for comparable women who were not pregnant.

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Stateline reporter Sofia Resnick can be reached at sresnick@stateline.org.

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