Review on Prenatal Acetaminophen Use and Risk of Childhood ADHD and ASD

Acetaminophen is one of the most widely used over-the-counter medications, including during pregnancy. Concerns have been raised about whether maternal acetaminophen use increases the risk of attention-deficit and hyperactivity disorder (ADHD) or autism spectrum disorder (ASD) in children.

A clinical perspective reviewed 56 relevant publications, including commentaries and editorials, and found that several studies reporting positive associations between prenatal acetaminophen exposure and ADHD or ASD risk were limited by biases, including selection bias, inconsistent adjustment for confounders, and unmeasured familial influences. When sibling analyses were applied to control for shared genetic and environmental factors, associations weakened substantially. This indicates that residual confounding likely contributed to earlier findings of increased risk.

Based on current evidence, in utero acetaminophen exposure does not appear to confer a clinically meaningful increase in childhood ADHD or ASD risk. The review concludes that existing evidence does not support changes to current clinical guidelines for treating fever or pain in pregnancy. Future prospective research should better account for familial and psychosocial environmental factors influencing both acetaminophen use and neurodevelopment.

Reference:

Damkier P, Gram EB, Ceulemans M, Panchaud A, Cleary B, Chambers C, Weber-Schoendorfer C, Kennedy D, Hodson K, Grant KS, Diav-Citrin O. Acetaminophen in pregnancy and attention-deficit and hyperactivity disorder and autism spectrum disorder. Obstetrics & Gynecology. 2025 Feb 1;145(2):168-76.

https://journals.lww.com/greenjournal/abstract/2025/02000/acetaminophen_in_pregnancy_and_attention_deficit.8.aspx