A review found no link between prenatal acetaminophen exposure and offspring neurodevelopmental disorders.
Offspring neurodevelopmental disorder (NDD) risk is not increased by acetaminophen use during pregnancy, according to a recent study published in the Journal of the American Academy of Child & Adolescent Psychiatry.1
This data supports recommendations for prenatal acetaminophen use by the CDC, American College of Obstetricians and Gynecologists, and The Society of Obstetricians and Gynecologists of Canada. Investigators concluded there is not a causal link between acetaminophen use and the observed increase in attention-deficit/hyperactivity disorder (ADHD).
“An integrative approach, summarizing the present state of knowledge and quantifying specific methodological areas of biases, as our study does, is needed in order to have a significant impact on future studies performed,” said Anick Bérard, PhD, professor at the University of Montreal.
The systematic review was conducted to evaluate the link between acetaminophen use during pregnancy and NDDs.2 Articles published through August 26, 2025, were obtained through searches of the Medline, PubMed, PsycINFO, Embase, all EBM Reviews, Web of Science, and EBSCO CINAHL Complete databases.
Any study assessing the link between prenatal acetaminophen use and offspring NDD risk was eligible for inclusion. Two independent reviewers performed title and abstract screening followed by full-text screening, with a subgroup of other team members consulted to resolve discrepancies.
Children without in utero acetaminophen exposure were included as a reference group. Physician-based diagnoses of NDDs were performed using International Classification of Diseases, Ninth Revision and Tenth Revision codes, with measurements from psychometric instrument scales also included.
A diverse patient population was reported across the selected studies, alongside variations in follow-up duration. The definition of acetaminophen use was exposure during pregnancy in all of the included studies.
The link between acetaminophen use during pregnancy and offspring ADHD was assessed in 6 studies with heterogeneity of 67%. Overall, a 17% increase in ADHD risk was reported following acetaminophen exposure when determined by physician diagnosis or psychometric test, with an odds ratio (OR) of 1.17.
When defining ADHD by physician diagnosis alone, the OR was 1.16, vs 1.15 for psychometric tests alone, highlighting no change in findings. Additional ORs included:
Overall, statistical significance was only reported when using patient-chart data. Investigators noted that maternal recall has been proven more accurate vs patient-chart data for over-the-counter medicine. An OR of 0.97 was reported for ADHD following in utero acetaminophen exposure in studies using sibling designs, indicating no increase in risk.
Autism spectrum disorder (ASD) risk was also not increased by prenatal acetaminophen use. When basing ASD on physician-based diagnoses, an OR of 1.10 was reported. While a statistically significant OR of 1.20 was reported for ASD based on a psychometric test, this association was only evaluated in 1 study.
No other NDDs were impacted by acetaminophen use during pregnancy. Additionally, language developmental disorder and psychomotor developmental disorder risks were not influenced by the duration of use during pregnancy. Overall, only a minor increase in ADHD risk was observed from acetaminophen exposure, which did not remain in sibling analyses.
“Future studies should be meticulously designed to account for exposure and outcome misclassifications, timing, dosage and duration as well as indication for use, and confounding; discordant-exposure sibling designs should be prioritized,” wrote investigators.
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