The use of Tylenol and pregnancy… what a fun (and tricky!) topic.
Tylenol is generally the only recommended medicine to treat fever and pain in pregnant women. Polls report that over half of expecting moms have taken it. It has long been viewed as the safe medication option.
But is it really safe? We’re going to go into the science and current research on the subject.
One quick thing to point out though: the main ingredient in Tylenol is acetaminophen. So we’re going to be using those two medication names interchangeably. Just to make it even more confusing acetaminophen is also called paracetamol.
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Is It OK to Take Tylenol When Pregnant?
Yes and no. Let’s [briefly] break it down a little here.
For pain and fever during pregnancy Tylenol is generally considered the safest medication option.
Other pain relievers like ibuprofen and aspirin are typically not recommended during pregnancy (unless specifically directed by your doctor and closely monitored) due to their associations with multiple serious prenatal problems including birth defects and miscarriage.
So by contrast, Tylenol is the “safe” pain relief option.
Also untreated pain and fever can pose their own risks during pregnancy and Tylenol is often the only medication advised for treatment.
While Tylenol is safer than it’s alternatives, it is not 100% safe during pregnancy, it’s not even 100% safe for non-pregnant individuals. No medication is 100% safe.
Just by reading the label you’ll see that acetaminophen can cause side effects. Also, too much can cause serious liver damage. Since acetaminophen in present in many combination drugs, it can be easy to take more than you realize if you aren’t checking those labels carefully.
During pregnancy specifically, there has been some research to suggest that Tylenol use might impact your child’s development.
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What Category Is Tylenol in Pregnancy?
The U.S. Food Drug Administration assigns pregnancy categories to drugs based on the risk assessment of fetal harm.
The FDA has marked Tylenol pregnancy category B during all three trimesters of pregnancy.
But what does category B mean?
Officially it means: “Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women.”
It’s important to note that conducting well-controlled studies on pregnant women is a problem due to ethical issues, so don’t get too worried about that. So basically, the available research hasn’t shown adverse effects to babies from the medication. Category B drugs are regularly prescribed during pregnancy.
If you’re looking for more information on pregnancy drug categories, it should be noted that the FDA has revised this category system for prescription drugs to include more information, but it is unchanged for over the counter medications (like Tylenol).
Does Tylenol Cross the Placenta?
Yes, Tylenol crosses the placenta so the fetus is exposed to the medication.
We know because according to this article, they were able to detect acetaminophen in the urine of newborns after being exposed in the womb.
Why does this matter?
Let’s start with the basics – the placenta is a special organ that develops inside your uterus during pregnancy. It’s attached to your baby via the umbilical cord and provides oxygen and nutrients while in utero.
The thing is that not everything mom ingests automatically reaches the fetus. Some substances are filtered out by the placenta. Acetaminophen, however, does cross the placenta and therefore is exposed to the fetus.
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Is There a Link Between Acetaminophen and ADHD?
There’s A LOT of interest right now looking at potential correlations between Tylenol and pregnancy to childhood behavioral issues (like ADHD). Super hot topic these days.
Experts are certainly divided on the safety of Tylenol during pregnancy and what the current available research shows.
McNeil Consumer Healthcare (the maker of Tylenol) points out that “no studies have definitely proved that taking acetaminophen while pregnant causes developmental problems in children”.
And that’s absolutely true. To be clear, no study has proven acetaminophen causes behavioral problems In children. They’ve shown consistent associations, but not direct causation.
So when it comes to looking at any correlation between Tylenol and pregnancy to ADHD, let’s turn to the studies. What do research and studies have to say on the subject?
Prenatal Exposure to Acetaminophen and Risk of ADHD (Pediatrics, Nov 2017)
This study looked to see if there is an association between maternal prenatal use of acetaminophen in the Norweigian population.
They really did their homework collecting data with this one. They analyzed not only mom’s use of acetaminophen, but also considered the reason the medication was used and adjusted for the familial risk for ADHD. And after all those factors they found “a modest association between any prenatal maternal use of acetaminophen” and the incidence of ADHD.
Let’s go into these results a little more. Moms who used acetaminophen for less than 7 days actually had a negative association with ADHD. Prenatal acetaminophen use for more than 7 days had an increased risk of ADHD that was directly correlated with the number of days the fetus was exposed to the medication. But the increased association with ADHD was tied to moms who used acetaminophen for fever and infections for 22 to 28 days. Over 29 days of prenatal acetaminophen use had a “substantially increased hazard rate of ADHD”, up to twofold.
So what’s the take home of this study, or, how much Tylenol is ok while pregnant? Short-term use of acetaminophen = no big deal. Be cautious with long-term use.
Association of Acetaminophen Use During Pregnancy with Behavioral Problems in Childhood (JAMA Pediatrics, Oct 2016)
So this study also looked at maternal prenatal acetaminophen use and a correlation to offspring behavioral problems (like ADHD).
They sent almost 8,000 mothers questionnaires both during pregnancy and then again when their children were 5 years old and analyzed the results. They found that prenatal acetaminophen use was associated with “higher odds of having conduct problems and hyperactivity symptoms”. This means associations (albeit, small) with ADHD, autism, and delayed developmental skills (like language).
Some important limitations of this study is that it didn’t look at how much acetaminophen moms were taking or why it was being taken.
Is There a Link Between Acetaminophen and Asthma?
There has been some debate over whether or not Tylenol use during pregnancy is associated with asthma. This seems to stem from a theory that asthma rates increased at the same time that acetaminophen use increased. There’s been several studies since and a lot of conflicting results.
For instance, this study from 2009 found no association between acetaminophen use and an increased risk of asthma and suggested that the associations observed by some researchers may have been due to not controlling for other factors.
To contrast, this large scale Norwegian study from 2016 did show an associate between acetaminophen use and an increased risk of asthma at age 3 and 7.
And yet another study linked the association between acetaminophen and increased risk of wheezing at age 5 with a specific gene in the DNA.
It seems more research is necessary to really know whether or not Tylenol use during pregnancy increases your child’s chances of asthma.
Can Tylenol Cause Miscarriage?
Reasearchers have found no link between Tyelonol use and miscarriage.
In fact a few studies (like this one and this one) specifically noted that they observed no association between Tylenol and increased risk of miscarriage.
This is a major reason that Tylenol is considered the pain reliever of choice during pregnancy. By comparison, many other pain medications have been associated with possible risk of miscarriage.
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Wrapping Up Tylenol and Pregnancy
To sum up, always remember that no medication is 100% safe during pregnancy, including acetaminophen.
However, untreated pain and/or fever in expecting women also isn’t safe and can pose a risk to the fetus. Since the FDA has assigned Tylenol pregnancy category B, it is considered the only recommended medicine to treat fever and pain in pregnant women.
Most medical professionals do agree that pregnant individuals should avoid medication when possible. Always follow the advice of your doctor when a medication is indicated.
So if you find yourself asking:
“Can I take Tylenol while pregnant for headache?”
“Is it ok to take acetaminophen 500 mg while pregnant?”
Then rest assured, Tylenol and pregnancy have not been linked to serious birth defects or miscarriage. More research is needed to explore some of the medical associations we mentioned above.
If you’re taking a combination medication, like Tylenol PM, during pregnancy – be sure to check the individual ingredients. In the case of a Tylenol PM pregnancy, it contains acetaminophen + diphenhydramine (which is also pregnancy category B). Therefore, Tylenol PM is OK for pregnant women.
Now if your asking, is ibuprofen safe during pregnancy? That’s a totally different story – the answer is NO. But that will have to be left for another time and another post.