A major review published in The Lancet Obstetrics, Gynaecology and Women’s Health has found no evidence that taking paracetamol during pregnancy raises the risk of autism, ADHD or intellectual disabilities in children, reinforcing long-standing medical guidance on its use.

The findings directly address earlier concerns and contrast with a 2025 US health advisory that suggested a possible link.

Large review finds no increased neurodevelopmental risk

Researchers from the University of Liverpool and European institutions reviewed evidence from 43 studies examining paracetamol use during pregnancy and child neurodevelopment.

The team focused on studies with the most rigorous methodologies, including sibling comparison analyses, which help control for shared genetic and environmental factors.

“Current evidence does not indicate a clinically important increase in the likelihood of autism spectrum disorder, ADHD, or intellectual disability in children of pregnant individuals who use paracetamol as directed, supporting existing recommendations on its safety,” the authors wrote.

They added: “When considering sibling comparison studies, paracetamol exposure during pregnancy was not associated with the risk of autism spectrum disorder.”

Earlier studies likely affected by bias

Paracetamol, an over-the-counter medicine commonly used to treat pain and fever, has previously been linked to a small increased risk of autism and ADHD in some observational studies.

However, the researchers said many of those studies were prone to bias and could not adequately separate the effects of the drug from the conditions it was taken for.

The review suggests earlier associations may reflect maternal factors such as pain, fever, infection or genetic predisposition, rather than a direct effect of paracetamol itself.

Findings counter 2025 US health advisory

In September 2025, the US administration issued health guidance citing “mounting evidence finding a connection between acetaminophen (paracetamol) use during pregnancy and autism”.

The authors of the new review said their findings align instead with studies using more robust analytical approaches, which do not support a causal link.

Experts say evidence now clearer

Rudrarup Bhattacharjee, a postdoctoral researcher at the University of Adelaide who was not involved in the study, said the findings are significant because “earlier concerns were largely driven by conventional observational studies that could not fully separate the effects of paracetamol from the underlying reasons it was taken for”.

“By carefully addressing these sources of bias, the study clarifies that previously reported links are unlikely to be causal,” he said.

In a commentary published alongside the review, researchers including those from the London School of Hygiene and Tropical Medicine said: “This study reinforces that the strongest epidemiological evidence does not support a link between paracetamol use during pregnancy and neurodevelopmental harm.”

They added that, when clinically indicated, paracetamol remains an important option for managing pain and fever during pregnancy, particularly where untreated infection and fever pose well-established risks to fetal health.