Researchers meticulously examined the quality, reliability, and biases in previous studies that linked maternal paracetamol use with the risk of attention deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in children.
Paracetamol is one of the most widely used medications during pregnancy. Yet in September 2025, the U.S. President publicly warned against its use, suggesting a potential link to autism in children. In response, health authorities worldwide reassured the public, emphasizing that existing evidence does not support such claims and that paracetamol remains generally safe during pregnancy.
While numerous reviews have examined whether prenatal paracetamol exposure affects child neurodevelopment, the results have been inconsistent. Many studies failed to account for crucial factors, like maternal health conditions, genetic influences, or family environment, making it difficult to draw firm conclusions about cause and effect.
The BMJ team conducted a systematic evaluation, searching major databases like Medline, Embase, Cochrane, PsycINFO, and grey literature for reviews and meta-analyses on maternal paracetamol use and child ADHD or ASD risk. Only studies that analyzed cohort, case-control, cross-sectional, or randomized designs were included. Each review was carefully assessed for quality using the AMSTAR-2 framework.
Out of 663 identified records, nine systematic reviews covering 40 primary studies qualified for inclusion, including four meta-analyses. Most focused on maternal paracetamol use throughout pregnancy. The quality assessment revealed notable shortcomings: missing protocols, incomplete searches, inadequate bias assessment, and inconsistent statistical methods. Confidence in the results was rated low in two reviews and critically low in seven.
All reviews reported some association between prenatal paracetamol and neurodevelopmental issues, with slightly increased odds for ADHD (1.2–1.4 times) and weaker associations for ASD. Longer-term exposure, particularly in the third trimester, appeared slightly more linked. However, sibling-controlled analyses, which account for shared family and genetic factors, showed no real association. This strongly suggests that any observed links are more likely due to familial or other unmeasured factors rather than a direct effect of the medication.
Overall, the evidence does not support the idea that paracetamol use during pregnancy causes ADHD or autism. Apparent risks seen in some studies are likely the result of study design flaws or confounding factors, not a true pharmacologic effect.
In short, this comprehensive review reassures parents and healthcare providers: when used appropriately, paracetamol remains a safe option during pregnancy.
