This sheet is about exposure to acetaminophen in pregnancy and while breastfeeding. This information is based on published research studies. It should not take the place of medical care and advice from your healthcare provider.
What is acetaminophen?
Acetaminophen (also known as paracetamol) has been used to treat fever and mild to moderate pain. Acetaminophen is available alone and in combination with other medications that have been used to treat symptoms of colds, flu, headache and osteoarthritis. Acetaminophen comes in different forms, including liquids, tablets, capsules, and suppositories. A common brand name is Tylenol®.
Acetaminophen is in many combination products. Always check the labels to see if they contain acetaminophen. Adding up the amount of acetaminophen in medications can help make sure you are not taking more than is recommended by your healthcare providers within 24 hours.
Sometimes when women find out they are pregnant, they think about changing how they take their medication, or stopping their medication altogether. However, it is important to talk with your healthcare providers before making any changes to how you take your medication. Your healthcare providers can talk with you about the benefits of treating your condition and the risks of untreated illness during pregnancy.
Acetaminophen is still considered by many healthcare providers and organizations to be the pain reliever and fever-reducer of choice during pregnancy. It has been suggested to use acetaminophen only as needed and take the lowest effective dose, unless your healthcare provider has given other instructions.
I take acetaminophen. Can it make it harder for me to get pregnant?
It is not known if acetaminophen can make it harder to get pregnant.
Does taking acetaminophen increase the chance of miscarriage?
Miscarriage is common and can occur in any pregnancy for many different reasons. Taking acetaminophen at the recommended dose is not expected to increase the chance of miscarriage. One study found that using acetaminophen during pregnancy did not increase the chance of miscarriage, no matter when it was taken during pregnancy or for how long.
Does taking acetaminophen increase the chance of birth defects?
Birth defects can happen in any pregnancy for different reasons. Out of all babies born each year, about 3 out of 100 (3%) will have a birth defect. We look at research studies to try to understand if an exposure, like acetaminophen, might increase the chance of birth defects in a pregnancy. When used at recommended dosages, acetaminophen has not been shown to increase the chance of birth defects.
Does taking acetaminophen in pregnancy increase the chance of other pregnancy-related problems?
Pregnancy-related problems including preterm delivery (birth before week 37) and low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth) were not found in a report that reviewed medical literature with acetaminophen use in over 36,000 pregnancies.
A study of over 24,000 pregnancies found that women who reported using acetaminophen had a higher risk of pregnancy problems. However, the study did not consider why the women were taking acetaminophen, which could have affected the results.
Taking too much acetaminophen can cause liver damage, kidney damage, and anemia (less oxygen in the blood) in adults. It has also been reported to cause the same problems in the fetus.
Does taking acetaminophen in pregnancy affect future behavior or learning for the child?
There has been concern about a possible link between the use of acetaminophen in pregnancy and an increased chance of developmental delay, autism and attention deficit hyperactivity disorder (ADHD).
One study reported a possible link between the use of acetaminophen in pregnancy and mild developmental delay (including language delay) and hyperactivity. This link was stronger when acetaminophen was used for 28 days or more during pregnancy. However, this study had some important limitations. It did not measure how serious the illness was that led to acetaminophen use, making it unclear if the reported increased risk was related to acetaminophen use, the condition being treated, or a combination of factors. Also, the ADHD diagnoses were based on health records and not confirmed by researchers.
Another study showed a weak link between acetaminophen use between 18-32 weeks of pregnancy and hyperactivity and attention problems. This link was only seen in children under the age of 7 years. It is not clear if these findings are related to acetaminophen or to other factors.
There are also studies that have not found an increased chance of behavior or learning issues for the child. One study looked at the reported use of acetaminophen during pregnancy and then evaluated the exposed children at 4 years of age. This study did not find an increased chance of harmful effects on children’s I.Q., learning, or development. Another study looking at 185,909 children who were exposed to acetaminophen in pregnancy found no increased chance of autism, ADHD, or intellectual disability.
Breastfeeding while taking acetaminophen:
Acetaminophen is found in low levels in breast milk. When needed, it is given to infants at higher doses than they would get from breast milk. Negative effects in newborns exposed to acetaminophen through breast milk are rare. Be sure to talk to your healthcare provider about all your breastfeeding questions.
If a man takes acetaminophen, could it affect fertility or increase the chance of birth defects?
There are limited studies on the use of acetaminophen and men’s fertility (ability to get a woman pregnant). One study found that men with higher levels of acetaminophen in their urine took longer to get their partner pregnant, and another showed that men who took more than 4,000 mg per month also took longer to conceive a pregnancy. In general, exposures that fathers or sperm donors have are unlikely to increase the risks to a pregnancy. For more information, please see the MotherToBaby fact sheet Paternal Exposures at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/.
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