AILSA CHANG, HOST:
For years, acetaminophen, known in the U.S. by its popular brand name, Tylenol, has been considered completely safe for use during pregnancy, a time when doctors discourage patients from using many other medications. This week, the Trump administration announced that they would be changing the label to discourage its use by pregnant women, suggesting that there is a link between acetaminophen and autism. That announcement has led to confusion, alarm and many questions - so many questions, especially from expecting parents. So here to help us sort through some of that confusion is Dr. Noa Sterling. She's a board-certified OB-GYN who advises expectant parents through her app, Sterling Parents. Welcome.
NOA STERLING: Thank you for having me.
CHANG: Thank you for being with us. So I'm so curious - what kinds of questions have you been fielding this week since this announcement?
STERLING: A lot of people who have taken Tylenol in their pregnancy - still currently pregnant - freaking out, as you can imagine. And then a lot of people also who have children who have been diagnosed as Autism Spectrum Disorder and are wondering if their Tylenol use in pregnancy caused this.
CHANG: OK. Well, let's talk about what we actually know - the facts. Tylenol has been widely used for decades. What does the science actually say about its safety during pregnancy?
STERLING: Yeah. So the science tells us a number of things. No. 1, we know that the use of acetaminophen for fever in the first trimester is associated with a reduced risk of birth defects, so we know that it has that benefit. We also know that there are some studies that show an association between acetaminophen use in pregnancy and Autism Spectrum Disorder and ADHD. This is an association, not causation. And there's mixed data here. So there are some studies that show a positive relationship - that Tylenol use is associated positively with Autism Spectrum Disorder. And then there's some studies that show no impact, and some studies that show a negative impact.
CHANG: OK. What if you have a fever during your pregnancy? I mean, one big reason people take Tylenol is to bring down a fever. So can you just...
STERLING: Yes.
CHANG: ...Explain, why can a fever be potentially quite dangerous during pregnancy if left untreated?
STERLING: Exactly. So it - and it's specifically during a period we call embryogenesis. So that happens during the first trimester of pregnancy. And during that time period, elevated core body temperature is associated with birth defects. So we really do want patients when they have a fever - they have an elevated temperature above 100.4 - to take acetaminophen to bring that fever down. However, treating a fever later on in pregnancy is really for symptom control. It's not as necessary because fevers later on in pregnancy do not cause congenital anomalies.
CHANG: Well, in the meantime, given this latest announcement from the Trump administration, I'm just wondering what pregnant women should be doing. Because President Trump's advice to pregnant women is essentially, quote, "tough it out," and avoid Tylenol...
STERLING: Yeah.
CHANG: ...For any reason. Is that something you would recommend?
STERLING: No. And I really - I'm very upset by that terminology of tough it out because pregnancy is incredibly difficult, even for people who have healthy pregnancies. Pregnant women and individuals are already toughing out a lot. So we really have to look at the entire clinical picture. We know that it's important for acetaminophen to be used judiciously. Especially in the first trimester we want people to use it to bring down fever.
Now, later on in pregnancy, when fever is not as much of a concern, it still is the first line - the really only available medication that we have to treat pain. And the important thing is we really have to look at the entire clinical picture. An example is a lot of people will take acetaminophen in pregnancy because of back pain or hip pain that is preventing them from sleeping.
CHANG: Yeah.
STERLING: We know that disruption of sleep in pregnancy is associated with numerous complications, so we don't want to just say, no acetaminophen ever. What we want to do is have a shared decision-making with your health care provider so that you together can weigh the risks and benefits of taking acetaminophen in pregnancy.
CHANG: Dr. Noa Sterling is an OB-GYN in San Diego and founder of Sterling Parents, an app providing pregnancy and postpartum support. Thank you so much for joining us.
STERLING: Oh, thank you for having me and having this important discussion. Transcript provided by NPR, Copyright NPR.
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