Patients often have many questions for Dr. Ashish Premkumar, an OB-GYN who specializes in high-risk pregnancies.
But before this week, he wouldn’t have expected the safety of Tylenol to be at the top of the list of concerns for his high-risk patients. Yet he’s been fielding questions about the common pain reliever all week, including from one of his patients who’s been on the medication recently to help deal with complications, he said.
“She asked if it was safe because she had heard what the president had said,” said Premkumar, a maternal-fetal medicine specialist at UChicago Medicine who is also an assistant professor of obstetrics and gynecology at the University of Chicago. “She was anxious about it.”
He told her it was safe to continue taking acetaminophen, the active ingredient in Tylenol, and she relaxed, he said. But such discussions put him in a “very strange position,” he said.
“I’m just this little doctor who did this training … but then I have the president of the United States essentially counterarguing what we’re trying to do,” Premkumar said.
Chicago-area OB-GYNs say they’ve been answering questions all week about the safety of Tylenol after President Donald Trump urged women Monday to limit their use of the medication during pregnancy, saying it can be associated with an increased risk of autism.
“Taking Tylenol is not good,” Trump said during a news conference. “For this reason, (we) are strongly recommending that women limit Tylenol use during pregnancy unless medically necessary.” He encouraged women to talk with their doctors “for more information about limiting the use of this medication while pregnant.”
During the announcement, Robert F. Kennedy, Jr., secretary of Health and Human Services, cited “clinical and laboratory studies that suggest a potential association between acetaminophen use during pregnancy and adverse neurodevelopmental outcomes, including later diagnosis for ADHD and autism.” Kennedy said the U.S. Food and Drug Administration would begin the process of a safety label change for the medication.
Following the announcement, leading medical associations fired back against the claims.
The American College of Obstetricians and Gynecologists said in a statement that current evidence does not support the idea that acetaminophen use during pregnancy causes neurodevelopmental disorders. The Society for Maternal-Fetal Medicine issued a similar statement saying acetaminophen remains, “an appropriate medication to treat pain and fever during pregnancy.”
Studies that showed an association between autism and acetaminophen use during pregnancy were methodologically flawed, the American College of Obstetricians and Gynecologists said.
Kenvue, the company behind Tylenol, said in a statement: “We believe independent, sound science clearly shows that taking acetaminophen does not cause autism. We strongly disagree with any suggestion otherwise and are deeply concerned about the health risks and confusion this poses for expecting mothers and parents.”
Not surprisingly, the results of this disagreement between medical experts and the Trump administration have been spilling into local doctors offices and hospitals across the Chicago area all week.
Dr. David Ouyang said some of his patients at Endeavor Health this week have told him they think the federal government’s claims about Tylenol are bogus, while other patients have been very concerned.
“We‘ve had some patients who came in incredibly anxious and worried,” said Ouyang, who is division director of maternal-fetal medicine at Endeavor.
He said one patient came expressing “a profound amount of guilt” for using Tylenol in a past pregnancy, even though her child is seemingly healthy.
“Definitely (we) are seeing … patients who have suddenly been burdened with this significant amount of guilt and doubt,” Ouyang said.
Dr. Michelle Winter, chair of obstetrics and gynecology at Duly Health and Care, said she had one mother this week, who has a child with autism, tearfully ask her, “Is this something that I did?”
“That’s always heartbreaking as a physician to see that,” Winter said. “I just kind of gave her the information that we had, and gave her reassurance that, no, this is not something we believe you caused to happen to your child.”
Winter said she started hearing more questions from patients toward the end of this week, once news of the announcement had a chance to sink in. Among the materials Duly doctors give to pregnant patients is a list of safe over-the-counter medications — a list that includes Tylenol. Some patients have asked Winter if it should be off the list now.
Winter said she’s told patients that it is still on the list. She’s explained that doctors already knew that there were some studies showing an association between acetaminophen use during pregnancy and autism, Winter tells patients, but she also explains that other studies don’t show an association, and no study has shown that it causes autism.
“We certainly don’t want to let our fevers go untreated, and I don’t want them turning to unsafe (during pregnancy) alternatives like ibuprofen or other NSAIDs (nonsteroidal anti-inflammatory drug),” Winter said. “As with any medication in pregnancy, whether it’s over-the-counter or prescription, I generally advise patients they should only be taking medications when necessary.”
Ouyang said he’s also telling patients that it’s still safe to use Tylenol to treat fevers and pain during pregnancy, especially because high fevers and pain during pregnancy can carry their own risks if not treated.
“There’s a lot of changes to your body during pregnancy,” Ouyang said. “If somebody has pain and discomfort to the point where other measures aren’t assisting them in being active or being able to manage that pain, that can be a problem. We generally don’t tell our patients to tough it out in situations like that.”
Premkumar said, among his patients, the announcement seems to have reinforced existing attitudes toward health care. Patients who tend to distrust the health care system seem concerned about the Tylenol announcement while those who have more trust in the system do not.
It’s important for patients to ask questions, Premkumar said, but he worries this latest announcement could lead to less trust between doctors and patients.
“It is really important that patients trust their OB-GYNs,” Premkumar said. “This kind of stuff where we say, ‘Oh it’s nothing. This is all bad data, or the president doesn’t know what he’s talking about,’ it still (produces) that lingering doubt. My doctors say this isn’t causing this but the president does.”
Endeavor Health pediatrician Dr. Annie Mlnarik said Tylenol has long been a go-to medication for many patients, including pregnant women and infants.
Now, she worries about mothers of children with autism.
“It just breaks my heart for the families who have children who are autistic, now the moms are potentially wondering, ‘Could I have been a part of causing this?’ even though they weren’t,” Mlnarik said. “Tylenol is such a safe medication, and it’s so well studied.”
The leader of the National Institutes of Health also announced Monday that the agency would spend an additional $50 million to fund more than a dozen autism research projects focusing on causes and therapies for autism. Federal health leaders also said the U.S. Food and Drug Administration would authorize the use of a medication called leucovorin for children with autism.
The administration cautioned that “it is important to note that leucovorin is not a cure for (autism spectrum disorder) and may only lead to improvements in speech-related deficits for a subset of children with (autism spectrum disorder).”
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