Despite recent claims linking acetaminophen use to autism, experts say the link is unproven.Illustration by The Globe and Mail/Getty Images
Ask a Doctor is a series of physician-authored columns offering insights and advice on common health topics. It is not a substitute for seeking medical care.
Recent headlines about acetaminophen, pregnancy and autism have left many expectant families feeling anxious. As a family doctor, I’ve noticed patients have more questions about which medications are safe to take during pregnancy after U.S. President Donald Trump suggested a link between autism and the use of Tylenol during pregnancy – a link experts say is unproven.
I understand why expectant families may feel concerned, as pregnancy is a time of immense change and the instinct to protect your growing baby is powerful. But while pregnancy is a time of caution, it shouldn’t be one of fear. Most medications can be used safely with the right guidance, and the goal is not to eliminate all risk but to balance it thoughtfully against the benefits. Doctors and patients should make decisions together that take into account the pregnant person’s health and the baby’s development.
Here is some of the information I often share with patients about pregnancy and medication.
Over-the-counter
Acetaminophen (Tylenol) is one of the most widely used medications to treat pain and fever in pregnancy. Decades of research, including large cohort studies reviewed by the American College of Obstetricians and Gynecologists and Health Canada, continue to support its safety when used as directed.
Untreated high fevers can themselves pose risks to fetal development, so avoiding acetaminophen altogether can sometimes do more harm than good.
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Non-steroidal anti-inflammatory drugs, or NSAIDs, such as ibuprofen (Advil/Motrin) and naproxen should be avoided in the third trimester because they can affect the heart and kidneys of the developing fetus. Short-term use earlier in pregnancy is sometimes appropriate under medical supervision.
Other common over-the-counter medications are generally considered safe when used appropriately. Antihistamines such as loratadine or diphenhydramine, used to treat allergy symptoms, are considered low-risk. Many antacids can be used for heartburn relief.
What about “natural” remedies such as herbal supplements? “Natural” doesn’t always mean safe. These products are often unregulated and poorly studied in pregnancy so always check with your health care provider before taking them.
Mental health
Mental health is a vital part of prenatal care, yet it’s an area where fear and misinformation often lead people to stop medications abruptly. Untreated depression and anxiety can increase the risk of preterm birth, low birth weight, and postpartum depression, according to the Society of Obstetricians and Gynaecologists of Canada.
Medications such as selective serotonin reuptake inhibitors or SSRIs, such as sertraline and citalopram, used to treat depression and anxiety, are among the most studied medications in pregnancy and are considered safe for most pregnant patients. I often remind patients that the small potential risks, such as mild and temporary newborn withdrawal symptoms, are usually far outweighed by the risks of untreated mental illness. When SSRIs are continued late into pregnancy, newborns may be monitored briefly for signs like jitteriness or difficulty feeding, which almost always resolve without intervention.
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The decision to continue or adjust a mental-health medication should always be made collaboratively with your clinician, considering both the parent’s wellbeing and the baby’s health.
Prescriptions that may need to change
Some prescription medications do require careful review during pregnancy. Certain blood-pressure drugs, such as angiotensin-converting enzyme inhibitors (ACE inhibitors) and angiotensin receptor blockers (or ARBs) are not considered safe during pregnancy owing to risks to fetal kidney development. Patients taking these medications should be switched to alternatives (such as labetalol or nifedipine). These changes are ideally made before conception, but even if pregnancy is already under way, adjustments can be made safely with medical guidance.
The same principle applies to anti-seizure medications, blood thinners, and diabetes treatments. Insulin needs often change as pregnancy progresses, and some oral diabetes medications may be swapped for options with better safety data.
This highlights why a check-in with your health care team before trying to conceive can be so valuable. If pregnancy is unplanned, never stop or change a medication without speaking to a clinician.
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Antibiotics
Bacterial infections during pregnancy need prompt treatment, and many antibiotics are considered both effective and safe, including penicillin, cephalosporins, and erythromycin.
There are some antibiotics that are safer at certain times in pregnancy than others. Your health care provider will choose the safest and most effective option based on the type and severity of infection and stage of pregnancy. Never self-prescribe or use leftover medications.
Retinoids
Retinoids used for severe acne, including oral isotretinoin (like Accutane), are highly teratogenic, meaning they can cause birth defects, and must be stopped well before conception. Patients taking isotretinoin are typically enrolled in pregnancy prevention programs. Even topical retinoids are usually discontinued during pregnancy out of caution.
If you’re using retinoids for acne or another skin condition and are planning to conceive, speak with your health care provider about alternative treatments.
Don’t forget folic acid
While much of the conversation around medication safety focuses on what to avoid, there are also things that are recommended – including folic acid, a B vitamin that plays a crucial role in the development of a baby’s brain and spinal cord. Adequate folic acid intake before and during early pregnancy dramatically reduces the risk of neural tube defects such as spina bifida and anencephaly.
Health Canada recommends that anyone who could become pregnant take a multivitamin with 0.4 mg of folic acid in it every day, ideally starting three months before conception and continuing through the first trimester. Those with certain health conditions, such as epilepsy or a previous pregnancy affected by a neural tube defect, may require higher doses.
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The bottom line? If you have questions about pregnancy and medication, speak to your health care provider. Pharmacies and provincial poison centres can also provide reliable information. And resources like First Exposure offer free, science-based advice to patients and health care professionals.
Dr. Sheila Wijayasinghe is a menopause-certified family physician practising at St. Michael’s Hospital in Toronto and the medical director of primary care outreach at Women’s College Hospital. She is also the resident health expert on CTV’s The Social and co-host of The Doc Talk Podcast.