Kira Philipsen Prahm, MD, PhD, highlights no link between acetaminophen exposure and autism risk

In this interview, Kira Philipsen Prahm, MD, PhD, a medical doctor at Rigshospitalet, discusses how pediatricians should interpret evolving evidence on prenatal acetaminophen exposure and its potential association with autism, emphasizing the importance of study design and careful risk communication. Her research aimed to clarify previously reported associations by applying both traditional population-level analyses and more rigorous sibling-matched comparisons.

Prahm explains that earlier studies identifying a possible link between acetaminophen use in pregnancy and autism often relied on population-level data, which can be vulnerable to confounding. Differences between women who take acetaminophen and those who do not—such as underlying illnesses, pain, fever, or patterns of health care use—may account for observed associations rather than the medication itself.

In contrast, sibling-matched analyses compare outcomes between pregnancies within the same woman, effectively controlling for shared genetic and environmental factors. Because of this, such analyses are considered a stronger methodological approach. Notably, both Prahm’s study and many prior investigations found that any association observed in population-level analyses disappears when sibling comparisons are used, suggesting that earlier findings were likely because of residual confounding rather than a causal effect.

Despite extensive adjustments for maternal comorbidities and medication use, Prahm acknowledges that some residual confounding cannot be fully excluded. A key concern is confounding by indication, meaning the underlying reason for taking acetaminophen—such as infection or fever—could itself be associated with neurodevelopmental outcomes.

Additionally, the study lacked data on OTC acetaminophen use, which may have led to some exposure misclassification. However, prior validation studies suggest that this limitation likely introduces minimal bias, and additional analyses that accounted for changes in OTC availability did not alter the findings.

For clinicians counseling families, Prahm stresses the importance of contextualizing earlier research. Previous studies have reported only small, inconsistent associations that tend to diminish after controlling for confounders. Her study found no association across all analytic methods, with narrow confidence intervals indicating that even a potential effect would likely be very small. Overall, the weight of evidence does not support a meaningful link between prenatal acetaminophen exposure and autism risk.

Clinically, these findings reinforce acetaminophen’s role as a first-line treatment for pain and fever during pregnancy. Pediatricians should balance theoretical risks against the known harms of untreated maternal conditions, reassuring patients that current evidence supports the medication’s safety when used appropriately.

No relevant disclosures.

Reference

Prahm KP, Chen P, Rode L, et al. Acetaminophen exposure during pregnancy and the risk of autism in offspring. JAMA Pediatr. Published online April 13, 2026. doi:10.1001/jamapediatrics.2026.0646