Last year, President Trump added one more piece of advice for pregnant women to expect, when they’re expecting. “Don’t take Tylenol,” he said in a press conference. Flanked by Health and Human Services Secretary Robert F. Kennedy Jr. and Centers for Medicare and Medicaid head Dr. Mehmet Oz, Trump pointed to the routine pain reliever as the source of rising cases of autism.
“Don’t take it. Fight like hell not to take it,” he said.
Trump claimed that “there’s no downside in not taking it” and recommended that pregnant women only take it if the fever is so high that they can’t “tough it out.”
But a study from Allegheny Health Network published this year in the Birth Defects Research journal found that maternal fevers can be dangerous for developing babies. Dr. Peeraya Sawangkum, a maternal-fetal medicine physician at AHN, published a study that may link fever, especially in the first trimester, to a higher risk of birth defects and other complications.
“We do know that the treatment of fever in pregnancy, which has known adverse effects in pregnancy, outweighs any theoretical risk that Tylenol may pose,” said Sawangkum. She said that there is no clearly established link that Tylenol is associated with autism. Instead, she postulated the increase could come from the fact that health practitioners are getting better at diagnosing autism spectrum disorder.
The potential for fever during pregnancy to harm a fetus is well documented; what’s new from this study, according to Sawangkum, is the role temperature and duration of a fever plays in risks.
“So you can have a short amount of high fever for a short amount of time and have some of the similar effects as a low-grade fever for a longer amount of time,” she explained.
Sawangkum’s literature review compiled and reviewed data from a multitude of studies published worldwide over the last several decades. Her findings showed that a fever in the pregnant mother is associated with an increased risk of miscarriage, neural tube defects, craniofacial anomalies, congenital heart defects, fetal growth restriction and neurodevelopmental disorders in children. It also linked maternal fever and pregnancy loss.
The review did not determine “the exact mechanism” by which maternal fever causes birth defects, but she said an underlying theory is that inflammation caused by fever could disrupt normal embryonic development.
Until last year’s FDA announcement, acetaminophen, most commonly known as Tylenol, was the recommended first-line medication to treat pain and fever during pregnancy.
In March, however, The Lancet published a study that found Tylenol usage in emergency departments decreased by 10% in the first month following the announcement.
The study’s data doesn’t identify who sought to decrease the usage — providers or patients. But it found no decrease in acetaminophen’s usage in non-pregnant women.
Last month, the Society for Fetal Medicine reaffirmed acetaminophen as the first-line treatment for fever and pain in pregnancy. They wrote, “a comprehensive review of the available scientific evidence does not establish a causal relationship between acetaminophen taken during pregnancy and an increased risk of autism spectrum disorders and attention deficit and hyperactivity disorder (ADHD) in children.”
Sawangkum added that there are also ways to prevent fever in pregnancy. The first, she said, is staying up to date on vaccines, especially during flu season.
“Pregnancy is an immunocompromised state, so pregnant people are more susceptible to viral infections that are going around,” she said. “The symptoms that pregnant people face may be more pronounced than when you’re not pregnant.”
Second — those who are pregnant or planning to become pregnant should take a folic acid supplement, like those included in prenatal vitamins.
Sawangkum said taking folic acid around the time of conception can reduce the risk of birth defects, most notably neural tube defects, like spina bifida or brain anomalies. And smaller studies suggest folic acid can also mitigate some of the risk of fever in pregnancy.
Patients should ask their doctor about the supplements best for them.
She said, “we need to have a healthy mom to have a healthy baby.”