At a glance
- No proven link to neurodevelopmental disorders: An umbrella review of 40 studies found weak and inconsistent evidence connecting paracetamol use in pregnancy to autism or ADHD, with most research rated low in quality.
- Family factors explain apparent risks: Large sibling-controlled studies from Sweden and Norway showed that when genetics and shared environment were considered, the supposed risks largely disappeared.
- Still safe when used as directed: Experts and regulatory bodies continue to recommend paracetamol as the safest option for pain and fever during pregnancy, stressing the importance of treating maternal illness and avoiding misinformation.
Paracetamol (also known as acetaminophen) has long been the go-to medication for managing pain and fever during pregnancy. It’s widely recommended by healthcare professionals and considered safe by regulatory agencies. But recent headlines have raised concerns about whether taking paracetamol while pregnant could increase the risk of neurodevelopmental disorders such as autism spectrum disorder (ASD) and attention deficit/hyperactivity disorder (ADHD) in children. So, what does the evidence really say?
What was studied?
Researchers conducted an umbrella review of nine systematic reviews, covering 40 primary studies published up to September 2025. The goal was to evaluate the quality of existing evidence and determine whether maternal paracetamol use during pregnancy is linked to ASD or ADHD in offspring.
Key Findings
The evidence was mixed and generally of low quality. While some studies reported an association between paracetamol use and neurodevelopmental disorders, the overall quality of evidence was poor. Seven reviews were rated “critically low” and two “low,” based on AMSTAR 2 criteria.
Confounding factors appear to play an important role. Many studies failed to properly adjust for familial and environmental influences, factors that are known to significantly affect child development.
Interestingly, sibling-controlled studies tell a different story. Two large studies from Sweden and Norway found that when familial factors were accounted for, the apparent risk of ASD and ADHD disappeared or was significantly reduced. This suggests that genetics and shared family environment, not paracetamol, are likely responsible for the associations seen in conventional cohort studies.
What does this mean for pregnant women?
Current evidence does not support a causal link between paracetamol use during pregnancy and ASD or ADHD. Regulatory bodies continue to recommend paracetamol as a safe option for managing pain and fever. In fact, avoiding treatment for high fever could lead to serious complications for both mother and baby.
Implications for Research
Future studies need to use more reliable methods to measure paracetamol exposure and neurodevelopmental outcomes. They should also address biases and confounding factors through sibling-controlled designs and combine multiple analytical approaches to minimise bias.
Implications for Clinical Practice
Healthcare professionals should reassure pregnant women that paracetamol remains a safe choice. Evidence-based communication is key, especially when misinformation can cause unnecessary anxiety.
Several experts in related fields have commented on the study, providing further reassurance:
Prof Grainne McAlonan, Professor of Translational Neuroscience, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, said:
“This paper is a welcome and careful assessment which rightly concludes the evidence does not clearly link use of paracetamol in pregnancy with autism of ADHD in the offspring. The methods are robust and clearly laid out. The emphasis on the importance of family history in increasing the likelihood of outcomes like autism and ADHD is appropriate. A strength is the close involvement of experts by experience.
I strongly endorse the authors’ concerns around “the historic and on-going underfunding in women’s health research, particularly in pregnancy”. This has opened the door to opinion over-riding fact and is worrying when it happens at policy level.”
In addition, Prof Dimitrios Siassakos, Professor in Obstetrics and Gynaecology, University College London, said:
“The high-quality methodology used in this new umbrella review confirms what experts around the globe have been saying.
The evidence that links paracetamol use in pregnancy to autism is tenuous and those studies which do report an association are confounded by the association of autism or ADHD with factors shared by families such as genetics, lifestyle etc.”
Lastly, Dr Steven Kapp, Senior Lecturer in Psychology, University of Portsmouth, said:
“The press release accurately covers that the state of evidence suggests paracetamol does not cause autism, ADHD, or intellectual disability. The highest-quality research found no relationship – for example, comparing siblings with millions of participants. Autistic and neurodivergent people are more likely to experience chronic pain, and they are also much more likely to have neurodivergent children – but paracetamol doesn’t cause neurodivergence. As a researcher and autistic person with ADHD, I think we should not be trying to prevent neurodivergence anyway, but make life better for neurodivergent people.”
Paracetamol is still considered safe during pregnancy. While research continues, the best advice remains clear: treat pain and fever when needed and consult your healthcare provider for personalised guidance.
MQ has recently compiled a Parent Pack of information and helpful tips for parents of young children, available here: How You Can Support Your Children's Mental Health | Guide
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