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If pregnant does taking Tylenol or generic acetaminophen link to ADHD in baby?

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A new study found a link between women taking acetaminophen while pregnant and their children later being diagnosed with the disorder ADHD. Use of acetaminophen during pregnancy linked to ADHD in children, University of California - Los Angeles (UCLA) researchers say, according to recent studies. Acetaminophen, found in over-the-counter products such as Excedrin and Tylenol, provides many people with relief from headaches and sore muscles. You may wish to read the abstract of the latest study, "Prenatal Acetaminophen and ADHD or Hyperkinetic Behaviors," published online February 14, 2014 in JAMA Pediatrics.

Acetaminophen (paracetamol) is the most commonly used medication for pain and fever during pregnancy in many countries. Research data suggest that acetaminophen is a hormone disruptor, and abnormal hormonal exposures in pregnancy may influence fetal brain development, says the study's abstract. Of course, more studies are needed because the exposure and outcome are frequent, these results are of public health relevance.

Maternal acetaminophen use during pregnancy is associated with a higher risk for HKDs and ADHD-like behaviors in children

When used appropriately, it is considered mostly harmless. During recent decades, the drug, which has been marketed since the 1950s, has become the medication most commonly used by pregnant women for fevers and pain. Now, a long-term study by UCLA, in collaboration with the University of Aarhus in Denmark, has raised concerns about the use of acetaminophen during pregnancy.

In a report in the current online edition of JAMA Pediatrics, researchers from the UCLA Fielding School of Public Health show that taking acetaminophen during pregnancy is associated with a higher risk in children of attention-deficity/hyperactivity disorder and hyperkinetic disorder

The data raises the question of whether the drug should be considered safe for use by pregnant women. ADHD, one of the most common neurobehavioral disorders worldwide, is characterized by inattention, hyperactivity, increased impulsivity, and motivational and emotional dysregulation. Hyperkinetic disorder is a particularly severe form of ADHD.

"The causes of ADHD and hyperkinetic disorder are not well understood, but both environmental and genetic factors clearly contribute," explains Dr. Beate Ritz, professor and chair of the department of epidemiology at the Fielding School and one of the senior authors of the paper, according to the February 24, 2014 UCLA news release, Use of acetaminophen during pregnancy linked to ADHD in children, UCLA researchers say. "We know there has been a rapid increase in childhood neurodevelopmental disorders, including ADHD, over the past decades, and it's likely that the rise is not solely attributable to better diagnoses or parental awareness. It's likely there are environmental components as well."

"That gave us the motivation to search for environmental causes that are avoidable," says the University of Aarhus' Dr. Jørn Olsen, another senior author and former chair of the UCLA, according to the February 24, news release, "Use of acetaminophen during pregnancy linked to ADHD in children, UCLA researchers say."

Fielding School's epidemiology department. "Part of the neuropathology may already be present at birth, making exposures during pregnancy and/or infancy of particular interest. Because acetaminophen is the most commonly used medication for pain and fever during pregnancy, it was something we thought we should look at."

The UCLA researchers used the Danish National Birth Cohort, a nationwide study of pregnancies and children, to examine pregnancy complications and diseases in offspring as a function of factors operating in early life. The cohort focuses especially on the side effects of medications and infections.

The researchers studied 64,322 children and mothers who were enrolled in the Danish cohort from 1996 to 2002. Acetaminophen use during pregnancy was determined using computer-assisted telephone interviews that were conducted up to three times during pregnancy and again six months after childbirth.

The researchers next followed up with parents when their children reached the age of 7. They first asked parents about any behavioral problems in their children using the Strength and Difficulties Questionnaire, a standard behavioral screening questionnaire used by scientists. It assesses five domains, including emotional symptoms, conduct problems, hyperactivity, peer relationship and social behavior in children and adolescents between the ages of 4 and 16.

In addition, they obtained diagnoses of hyperkinetic disorder among the cohort's children (at an average age of 11) from the Danish National Hospital Registry or the Danish Psychiatric Central Registry. Last, they identified if ADHD medications, mainly Ritalin, were redeemed for the children using the Danish pharmaceutical prescription database.

More than half of all the mothers reported using acetaminophen while pregnant

The researchers found that children whose mothers used acetaminophen during pregnancy were at a 13 percent to 37 percent higher risk of later receiving a hospital diagnosis of hyperkinetic disorder, being treated with ADHD medications or having ADHD-like behaviors at age 7. The longer acetaminophen was taken — that is, into the second and third trimesters — the stronger the associations. The risks for hyperkinetic disorder/ADHD in children were elevated 50 percent or more when the mothers had used the common painkiller for more than 20 weeks in pregnancy.

"It's known from animal data that acetaminophen is a hormone disruptor, and abnormal hormonal exposures in pregnancy may influence fetal brain development," Ritz says, according to the news release. Acetaminophen can cross the placental barrier, Ritz noted, and it is plausible that acetaminophen may interrupt fetal brain development by interfering with maternal hormones or through neurotoxicity, such as the induction of oxidative stress, which can cause the death of neurons.

"We need further research to verify these findings, but if these results reflect causal associations, then acetaminophen should no longer be considered a 'safe' drug for use in pregnancy," Olsen explains in the news release.

The February 24, 2014 Los Angeles Times article by Melissa Healy, "Acetaminophen in pregnancy linked to ADHD in kids, study finds" notes that pregnant women have long been assured that acetaminophen can treat their aches, pains and fevers without bringing harm to the babies they carry. Now researchers say they have found a strong link between prenatal use of the medication and cases of attention-deficit hyperactivity disorder in children.

Interestingly, the Los Angeles Times article points out that design of the study prevented a problem known as "recall bias." How you avert recall bias in research is first to gather details, for examples the facts on acetaminophen use long before signs of ADHD would become evident.

To avert recall bias, instead of researchers asking pregnant subjects to reveal the facts of how much or how often they took acetaminophen, the researchers interviewed the pregnant moms at the end of every trimester to gauge their use of the analgesic.

The reason for this technique is to let the team discern that the timing of a woman's acetaminophen use probably is very important to fetal brain development. The concept of how researchers avert "recall bias" also is explained in the February 24, 2014 Los Angeles Times article by Melissa Healy, "Acetaminophen in pregnancy linked to ADHD in kids, study finds."

The results of the new study, "Prenatal Acetaminophen and ADHD or Hyperkinetic Behaviors," were published online February 14, 2014 in JAMA Pediatrics and went viral in numerous mainstream newspapers. This new study adds to growing evidence that the active ingredient in Tylenol may influence brain development in utero, explains the Los Angeles Times article. For example, researchers don't provide clear answers for mothers-to-be or their doctors about whether acetaminophen is safe during pregnancy.

The consumer is left to do his/her own research by fact-checking the studies, the abstracts of the studies, and the wide variety of news articles as the results of studies go into mainstream news. That's why research needs to continue. In the meantime, if you're pregnant, please consider the studies about how various medicines can affect your unborn baby's organs. You also may wish to see, "Acetaminophen and Liver Injury: Q & A for Consumers." Or check out, "FDA: Acetaminophen doses over 325 mg might lead to liver damage."

In analyzing data on more than 64,000 Danish women and their children, researchers found that kids whose mothers took the painkiller at any point during pregnancy were 29% more likely to be diagnosed with ADHD than were kids whose mothers took none

The risk increased the most — by 63% — when acetaminophen was taken during the second and third trimesters, and by 28% when used in the third trimester alone. But when taken only in the first trimester, the added risk was 9%. That's why it's important when pregnant to avoid over-the-counter drugs that you don't know about how they'll change the developing brain of your unborn baby or what's an overdose, or how will the drug impact your liver or your unborn baby's liver and brain, and in what type of doses. See, "Acetaminophen and Liver Injury: Q & A for Consumers."

Other authors of the study included Zeyan Liew (first author) and Pei-Chen Lee of UCLA, and Cristina Rebordosa of the University of Arizona. Funding was provided by the Danish Medical Research Council (09-069178). Also, you can check out the site of the UCLA Fielding School of Public Health.

On the other hand, you may wish to check out the April 16, 2013 news release, "Anxious about life? Tylenol may do the trick."

Last year, there was another view. University of British Columbia researchers have found a new potential use for the over-the-counter pain drug Tylenol. You can check out the recent study or its abstract, "The common pain of surrealism and death: acetaminophen reduces compensatory affirmation following meaning threats." The study is published in the journal Psychological Science, June 2013.

Typically known to relieve physical pain, the study suggests the drug may also reduce the psychological effects of fear and anxiety over the human condition, or existential dread, the University of British Columbia's April 16, 2013 news release, "Anxious about life? Tylenol may do the trick." reported. The recent study is published in the Association for Psychological Science journal Psychological Science, June 2013.

The study advances understanding of how the human brain processes different kinds of pain

"Pain exists in many forms, including the distress that people feel when exposed to thoughts of existential uncertainty and death," says lead author Daniel Randles, University of British Columbia (UBC) Dept. of Psychology, according to the news release, Anxious about life? Tylenol may do the trick. "Our study suggests these anxieties may be processed as 'pain' by the brain – but Tylenol seems to inhibit the signal telling the brain that something is wrong."

The study builds on recent American research that found acetaminophen – the generic form of Tylenol – can successfully reduce the non-physical pain of being ostracized from friends. The UBC team sought to determine whether the drug had similar effects on other unpleasant experiences – in this case, existential dread.

In the study, participants took acetaminophen or a placebo while performing tasks designed to evoke this kind of anxiety – including writing about death or watching a surreal David Lynch video – and then assign fines to different types of crimes, including public rioting and prostitution

Compared to a placebo group, the researchers found the people taking acetaminophen were significantly more lenient in judging the acts of the criminals and rioters – and better able to cope with troubling ideas. The results suggest that participants' existential suffering was "treated" by the headache drug.

"That a drug used primarily to alleviate headaches may also numb people to the worry of thoughts of their deaths, or to the uneasiness of watching a surrealist film – is a surprising and very interesting finding," says Randles, according to the news release. Randles, a PhD candidate as of the 2013 date of the news release, authored the study with Professor Steve Heine and Nathan Santos.

Further research is required

While the findings suggest that acetaminophen can help to reduce anxiety, the researchers caution that further research – and clinical trials – must occur before acetaminophen should be considered a safe or effective treatment for anxiety. You can check out the study or its abstract, "The common pain of surrealism and death: acetaminophen reduces compensatory affirmation following meaning threats." Psychological Science, June 2013.

As for reducing anxiety, taking a walk or some other exercise and a change of diet that includes healthy foods also helps. There's not always a fast-pill cure for every sensation, and perhaps it's of interest to first see what nature can do over a longer time. Whatever the outcome, research continues in the tug between food as medicine, exercise, and the risk to reward values of any given medicines at different times.

On the other hand, an overdose of acetaminophen can lead to liver trouble, says other studies. You may wish to see, "Acetaminophen and Liver Injury: Q & A for Consumers." Or check out, "FDA: Acetaminophen doses over 325 mg might lead to liver damage." Some people use different varieties of any particular over-the-counter drug, generic or a brand name, for a long time without knowing what the research reveals about dosage or long-time use, or what could happen if pregnant or if nursing.



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