Making Sense of the Acetaminophen and Autism Controversy

"The news has recently been awash with stories about the link between acetaminophen (paracetamol) and autism. The White House issued new guidelines to pregnant women to avoid taking the drug and use "the lowest effective dose for the shortest duration when treatment is required." The key evidence presented by the Trump administration is a new analysis, carried out by Harvard scientists, of multiple studies investigating neurodevelopmental disorders in children, which reported a higher incidence when mothers had taken paracetamol during pregnancy (Prada et al. 2025)."

"For a couple of decades, the medical literature has hosted a robust debate about the effects of paracetamol on neurodevelopment. Some studies find a correlation with various aspects of health at birth, others find no significant effect. Some mechanistic studies provide plausible ways that the drug might disrupt normal development; others point out the multiple confounding genetic and environmental factors that are hard to control for. The risks to the foetus of taking paracetamol are weighed against the risks of leaving fever or pain untreated. It's the classic, inevitable outcome of trying to understand the role of a single factor in a hugely complicated scenario. The results are noisy, confusing, and disputed."

News highlighted a contested link between prenatal acetaminophen (paracetamol) and autism, and the White House advised pregnant women to avoid the drug and use the lowest effective dose for the shortest duration. A Harvard analysis of multiple studies reported higher incidence of neurodevelopmental disorders when mothers took paracetamol during pregnancy. The literature contains mixed findings, plausible mechanistic concerns, and unresolved confounding genetic and environmental factors. Clinicians must weigh potential fetal risks of paracetamol against the harms of untreated fever or pain. Ambiguous and noisy evidence has left most authorities previously endorsing paracetamol when needed, while reactions to new guidance provoked political controversy and exposed how binary statements can erode patients' epistemic trust.

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