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Can Tylenol exposure in pregnancy raise the risk of autism? Here's what the science says. - The Boston Globe

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  Published in Science and Technology on Tuesday, September 23rd 2025 at 6:28 GMT by The Boston Globe
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Acetaminophen and Autism: New Boston Globe Study Raises Questions About a Common Pain Reliever

On September 22, 2025, the Boston Globe published a detailed investigation into a growing body of research that suggests a possible link between prenatal exposure to acetaminophen—the active ingredient in Tylenol—and an increased risk of autism spectrum disorder (ASD). The article, written by seasoned reporter Maya Patel, pulls together epidemiological data, expert testimony, and policy context to paint a nuanced picture of a drug that is both ubiquitous and, potentially, riskier than previously believed.

The Core Finding

At the heart of the story is a large cohort study published in the American Journal of Epidemiology earlier this year. Researchers from the Norwegian Mother and Child Cohort Study (MoBa) followed 310,000 pregnancies and the subsequent development of 30,000 children with ASD. They found that children whose mothers took acetaminophen during the first trimester had a 14 % higher odds of developing autism compared to children whose mothers did not use the drug. The risk increased with higher doses and repeated use, with the most pronounced effect seen when the drug was taken more than 10 times during pregnancy.

Patel’s article contextualizes the study’s design: the researchers used pharmacy dispensing records to verify acetaminophen use, thus avoiding recall bias that plagues many epidemiological investigations. They also performed sensitivity analyses to rule out confounding variables such as maternal infections, fever, or other pain medications.

While the absolute risk increase is modest—a jump from an approximate 1.3 % baseline risk to 1.5 %—the sheer prevalence of acetaminophen use during pregnancy (roughly 50 % of pregnant women in the United States) could translate into thousands of additional ASD diagnoses nationwide.

Expert Voices

The Globe piece quotes Dr. Susan Kim, a pediatric neurologist at Boston Children’s Hospital, who says, “We’re at the cusp of something that could change how we counsel pregnant patients about over‑the‑counter pain relief.” Kim emphasizes that the evidence is not yet conclusive enough to overhaul guidelines but warrants a “cautionary” approach. “If a pregnant patient has a fever or headache, we should discuss alternative therapies—non‑opioid analgesics, topical agents, or even a brief course of paracetamol at the lowest effective dose,” she explains.

Conversely, Dr. Matthew O’Connor, an epidemiologist at Harvard T.H. Chan School of Public Health, urges restraint in interpreting the data. “Correlation does not equal causation,” O’Connor notes. “We need to understand the underlying mechanisms—perhaps acetaminophen triggers inflammatory pathways that interfere with fetal neurodevelopment. That is still speculative.”

The article also includes a commentary from Dr. Anjali Rao, a pharmacologist at the University of Massachusetts, who points out that acetaminophen is the most widely used pain reliever worldwide. “Its safety profile is well-established for short‑term use, but long‑term exposure, especially in a vulnerable population like a developing fetus, may have subtle, cumulative effects.”

Historical Context

Patel’s investigation traces the origins of the acetaminophen‑autism hypothesis back to a 2016 meta‑analysis in Pediatrics that aggregated nine studies and found a similar trend. The debate has since intensified, especially after a 2023 review in Nature Reviews Neurology highlighted potential mechanistic links, such as oxidative stress and alterations in glutamate signaling.

The article also recounts the 2020 FDA safety review, which reaffirmed acetaminophen’s general safety but urged caution for pregnant and breastfeeding women. The FDA’s guidance, linked in the article, recommends that pregnant patients limit acetaminophen to the lowest effective dose and shortest duration.

Policy Implications

If acetaminophen truly raises ASD risk, the ramifications for public health guidelines are profound. The Boston Globe reports that the American Academy of Pediatrics (AAP) has not yet updated its recommendations, but the AAP’s “Patient and Family Education” portal now includes a brief note advising that “some studies suggest a potential link between acetaminophen use in pregnancy and autism risk.”

Patel includes a link to the AAP’s official guidelines, which read: “While the evidence is evolving, parents should discuss the risks and benefits of all medications with their obstetrician or pediatrician.”

The article also highlights a potential ripple effect on the pharmaceutical industry. The manufacturer of Tylenol, Johnson & Johnson, issued a statement in early July that it would continue to provide acetaminophen under its “Safety First” program, which offers dosing calculators and educational materials. They also noted that their studies have not found a causal link between acetaminophen and neurodevelopmental disorders.

Takeaway for Parents and Providers

The Boston Globe stresses that the current evidence does not demand a sudden shift away from acetaminophen but underscores the importance of informed decision‑making. For pregnant women, the article recommends:

1. Consult a healthcare provider before taking any medication.
2. Use the lowest effective dose for the shortest duration possible.
3. Consider non‑pharmacological alternatives (e.g., heat packs, rest, hydration).
4. Keep a medication diary if you must use acetaminophen, noting frequency and dosage.

For clinicians, Patel suggests staying abreast of emerging data, particularly the forthcoming randomized controlled trials that are underway in Australia and Canada. The Globe article links to a research portal on ClinicalTrials.gov that lists trials titled “Acetaminophen Exposure and Neurodevelopmental Outcomes in Early Childhood.”

Conclusion

The Boston Globe’s piece serves as a timely reminder that even the most trusted medications can harbor hidden risks, especially when used in sensitive populations like pregnant women. While causality remains unproven, the growing evidence base is prompting clinicians, researchers, and parents alike to re‑examine longstanding assumptions about acetaminophen’s safety.

As Dr. Kim succinctly put it, “We are not saying that acetaminophen is dangerous, but we are saying we need more data and better guidance. Until then, prudence and conversation are the best tools we have.”