A comprehensive review of over 3 million participants finds limited evidence to support claims that prenatal paracetamol use causes autism or ADHD, reaffirming current medical guidance.
A new umbrella review has added weight to the argument that paracetamol use in pregnancy is not a cause of autism or attention-deficit/hyperactivity disorder in children. Writing in Developmental Medicine & Child Neurology, researchers said the apparent links reported in earlier studies weakened markedly when they limited their analysis to stronger evidence, with the estimates moving towards no effect.
The review drew on seven meta-analyses and more than 3 million participants. Across the broader set of findings, prenatal paracetamol exposure showed small positive associations with autism and ADHD. But once the authors restricted their analysis to higher-quality work, the signals largely disappeared. The paper’s authors said the available epidemiological evidence does not support a robust causal relationship, and that the most plausible explanation is a mixture of methodological problems, including residual confounding and misclassification of exposure.
That conclusion is consistent with guidance from the American College of Obstetricians and Gynecologists, which said in a 2025 practice advisory that acetaminophen remains the pain reliever and fever reducer of choice during pregnancy. The organisation said the weight of evidence does not support a causal link with neurodevelopmental disorders and advised pregnant patients to use it sparingly, at the lowest effective dose and for the shortest time needed, with medical advice where appropriate.
The new review also sits alongside earlier research that has fuelled debate but has not resolved it. A systematic review and meta-analysis published previously found a small increased risk of ADHD, although the association weakened in sensitivity analyses, suggesting that unmeasured confounding may have influenced the result. Another review found higher ADHD risk even after adjusting for some confounders, while a broader sweep of 46 studies reported that most showed some association between acetaminophen use in pregnancy and neurodevelopmental disorders, especially when use occurred in the second or third trimester. Taken together, the latest umbrella review suggests that the louder claims of harm have outrun the strength of the evidence.
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