SMFM
Expert guidance reaffirms acetaminophen as first-line during pregnancy
Clinical takeaway: Clinicians can continue recommending acetaminophen as the first-line medication for treating pain and fever during pregnancy. Current evidence does not support a causal relationship between prenatal acetaminophen exposure and autism or ADHD, while untreated fever and pain remain associated with known maternal and fetal risks.
Concerns about possible links between prenatal acetaminophen exposure and childhood neurodevelopmental disorders have generated ongoing debate in recent years. Following a comprehensive review of available evidence, the Society for Maternal-Fetal Medicine (SMFM) has reaffirmed acetaminophen as the preferred pharmacologic treatment for pain and fever during pregnancy.
According to SMFM, current evidence does not establish a causal relationship between prenatal acetaminophen exposure and increased risk of autism spectrum disorder or attention deficit/hyperactivity disorder in children. The organization noted that many studies reporting associations are observational and subject to important limitations, including residual confounding. SMFM highlighted that sibling-comparison studies have generally not found an association, suggesting that familial and genetic factors may account for much of the observed risk.
The updated statement is particularly relevant because acetaminophen is used by an estimated 65% of pregnant patients, most commonly for headache and fever. Acetaminophen is also a common ingredient in many over-the-counter and prescription medications.
SMFM emphasized that untreated fever and pain during pregnancy carry established risks. Fever during the first trimester has been associated with birth defects and miscarriage, while maternal fever during labor may be linked to adverse neonatal outcomes. Maternal pain can also negatively affect overall well-being during pregnancy.
The organization continues to recommend nonpharmacologic approaches, including hydration, rest, and physical therapy, when appropriate. NSAIDs and opioids are not recommended as first-line treatments for pain or fever during pregnancy because of known maternal and fetal risks, including fetal renal impairment, premature ductus arteriosus closure, oligohydramnios, maternal bleeding, neonatal abstinence syndrome, and addiction.
As with any medication during pregnancy, SMFM recommends using the lowest effective dose for the shortest duration necessary. The statement also advises clinicians to remind patients that acetaminophen is contained in many combination products, including cold and flu medications, which can contribute to unintentional excess daily dosing.
“After another careful review of the existing research, we continue recommending acetaminophen as a safe treatment for our pregnant patients who need it for pain relief and to reduce fever,” said Judette M. Louis, MD, MPH, chair of the SMFM Publications Committee.
Source: Society for Maternal-Fetal Medicine. (2026, June 1). Society for Maternal-Fetal Medicine Statement: Acetaminophen use during pregnancy