“This systematic review and meta-analysis provides some of the strongest evidence to date that paracetamol use during pregnancy is not associated with an increased risk of autism, ADHD, or intellectual disability in children. Importantly, the authors prioritised high-quality study designs, particularly sibling-comparison analyses, which are among the best available methods for accounting for shared genetic and family-level factors that can otherwise bias results. Their rigorous analyses showed no meaningful effect or association.

This is a significant finding 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, for example maternal fever, pain, or infection - factors that themselves can influence pregnancy and childbirth outcomes. By carefully addressing these sources of bias, the study clarifies that previously reported links are unlikely to be causal.

In an Australian context, the findings are reassuring. Paracetamol remains the recommended first-line option for managing pain and fever during pregnancy, and this evidence supports existing clinical guidance. Avoiding effective treatment for fever or significant pain during pregnancy can carry real risks for both the mother and the developing fetus. Overall, this study reinforces the importance of relying on high-quality evidence rather than speculation or politicised claims when making health decisions in pregnancy.”

"This is timely and important research because it shows once again that paracetamol use in pregnancy is not associated with an increased likelihood of autism, ADHD, or intellectual disability. Doctors and scientists have long held the view that paracetamol is safe, and that it can play an important role during pregnancy, including to reduce maternal feedback. The findings of the review support that position.

The researchers analysed data from 43 previous studies, involving more than 2 million children, to look for possible associations between paracetamol use in pregnancy and neurodevelopment diagnoses. This included re-analysing data from sibling studies, in which one child was exposed to paracetamol in pregnancy and the other child was not. No matter which way the researchers looked at the data, the answer came back the same – there was no association.

These findings should help doctors when providing advice about the use of paracetamol during pregnancy. However, the research must not be misinterpreted. There is a risk that some people may read the findings as suggesting there is a goal to reduce the likelihood of autism, ADHD, or intellectual disability in children. To do so would be abhorrent, and completely misaligned with contemporary thinking and community expectations."

"This is an extremely important study about paracetamol, a widely used and recommended analgesic medication for pregnant women.

Recent suggestions in the media that its use in pregnancy was associated with autism and other neurodevelopmental disorders in the offspring may well have no credible scientific basis.

This study examined evidence for and against by undertaking a rigorous systematic review investigating the relationship between paracetamol exposure in pregnancy and the occurrence of autism, intellectual disability and attention deficit hyperactivity disorder in the offspring. Restricting analyses to longitudinal studies with minimal bias and by also including sibling comparison studies, which automatically adjust for family, genetic and environmental factors, the authors found no evidence of increased risk.

They particularly expressed concern that “the politicisation of scientific uncertainty could create confusion among pregnant women and clinicians”.

Given the widespread use of this medication in Australia and the recommendations for its use in pregnancy by professional and regulatory bodies, it is vital that the public and the medical community are adequately informed.

Otherwise, there is a danger that the avoidance of use of this medication in scenarios where it would be medically recommended could result in other adverse outcomes for the mother, pregnancy and the unborn baby."

"Recent reports of paracetamol exposure during pregnancy causing ADHD and autism have been promoted by high-profile political figures in the United States particularly, and contributed to ongoing unnecessary stress placed on pregnant women.

It is very reassuring that this study, the first systematic review and meta-analysis prioritising sibling comparison - in an effort to minimise bias and exclude confounding factors such as parental genetics, home environment and socio-economic status - does not support an association between paracetamol use and these childhood conditions.

It has, rather, found there is absolutely no increased risk to the children of women who took paracetamol during the pregnancy, specifically looking at the outcomes of autism spectrum disorder, ADHD and intellectual disabilities.

The relief of pain is one of the core duties of any medical practitioner and pregnant women have a decreased number of options available to them. It is timely and reassuring for us to be able to offer pregnant women a well established and studied safe pain reliever to be used during pregnancy."

"Paracetamol has had a central role in obstetric practice for decades because it has consistently demonstrated the most favourable balance between maternal benefit and fetal safety for the management of pain and fever in pregnancy.

Recent public debate in the United States questioning its neurodevelopmental safety has generated understandable anxiety. This controversy has been driven more by selective interpretation of observational data than by robust causal evidence.

In this context, the comprehensive systematic review and meta-analysis by D’Antonio et al. provides a timely and methodologically rigorous reassurance.

By prioritising sibling-comparison designs and studies at low risk of bias, the authors appropriately address the central challenge of confounding by indication, familial genetics, and shared environmental factors that have plagued earlier analyses.

When these sources of bias are addressed, prenatal paracetamol exposure is not associated with an increased risk of autism spectrum disorder, attention-deficit hyperactivity disorder, or intellectual disability, with pooled estimates that are not only null but sufficiently precise to exclude clinically meaningful harm.

This finding is critically important, as earlier signals of risk are far more plausibly explained by the underlying maternal conditions prompting paracetamol use, such as infection, fever, inflammation, or pain, all of which are themselves associated with adverse pregnancy and neurodevelopmental outcomes.

The harms of untreated maternal fever and significant pain are well established, including increased risks of miscarriage, congenital anomalies, preterm birth, and adverse neurodevelopment.

Against this backdrop, precautionary calls to avoid paracetamol represent a misapplication of the precautionary principle, divorced from proportionality and clinical reality. Avoidance is not a neutral act; it risks exposing women and fetuses to known and preventable harms while offering no demonstrable benefit.

From a practical obstetric perspective, the implications are clear and clinical advice remains unchanged. Paracetamol should remain the first-line analgesic and antipyretic in pregnancy, used at the lowest effective dose for the shortest necessary duration, as is appropriate for any medication in pregnancy.

The strength of the current evidence base, synthesised in this review, supports continued reassurance to pregnant women and provides clinicians with a solid foundation to counsel confidently amid public confusion.

In obstetric care, our ethical responsibility is not to pursue hypothetical safety at all costs, but to balance evidence, risk, and benefit in a way that minimises real harm.

On the best available evidence, paracetamol remains a safe, effective, and indispensable medication in pregnancy."

“This study provides some of the clearest and most reassuring evidence we have so far about paracetamol use in pregnancy. The researchers looked carefully at the highest-quality data available, including studies that compared siblings within the same family. That approach is important because it helps separate the effects of a medication from family background, genetics, and shared environment.

They conclude that there is no meaningful increase in the risk of autism, ADHD, or intellectual disability in children whose mothers used paracetamol during pregnancy.

This matters because paracetamol is often the safest and sometimes the only option to treat pain or fever during pregnancy. Fever itself can be harmful to both the mother and the developing baby, so avoiding treatment out of fear can actually do more harm than good.

What this paper shows is that earlier alarm was likely driven by confusion between cause and coincidence. People who need paracetamol during pregnancy may already be dealing with illness, infection, or inflammation. Those factors, not the medication, are far more likely to influence child development.

Using paracetamol as directed during pregnancy remains safe. This study helps bring the conversation back to evidence, balance, and common sense - and that reassurance is incredibly important for families making everyday health decisions.”

"This article confirms previous findings that demonstrate the safety of paracetamol use as directed during pregnancy, aligning with directives from major health bodies across the world, including Australia.

In September 2025, the US government suggested that paracetamol might contribute to autism, based on one study with limited data and poorly reported results, which caused global confusion amongst the general population.

This study corrected methodological issues of the previous study by substantially expanding the scope of research, literature reviews and analyses of specific findings, including studies with low risk of bias, longer-term follow-ups, and neurodevelopmental conditions in addition to autism/adhd.

This new study not only demonstrates the safety of paracetamol use as directed, in line with major medical organisations around the world, but also highlights the elevated risks of avoiding paracetamol use in pregnancy as a first-line drug for fever and pain management."

"As an Australian obstetrician, I want to reassure pregnant women and their families that paracetamol remains safe to use in pregnancy when taken as directed.

This major international study published in The Lancet Obstetrics, Gynaecology & Women’s Health has reviewed the highest-quality evidence available, including sibling-comparison studies and large population data. The findings are reassuring: there is no evidence that appropriate paracetamol use during pregnancy increases the risk of autism, ADHD, or intellectual disability in children.

Last year when social media was abuzz with the suggestion that paracetamol was harmful, I cited the large Scandinavian studies involving millions of pregnancies, which carefully accounted for genetic and family factors. The findings in The Lancet article are consistent with this study.

Simply put, when rigorous methods are applied, and accounting for all bias, the previously suggested harms do not hold up.

What is well established, however, is that untreated pain and especially high maternal temperatures can be harmful in pregnancy. Fever has been associated with miscarriage, preterm birth, and congenital anomalies. For this reason, avoiding paracetamol out of fear is not evidence-based and may place both mother and baby at risk.

Paracetamol remains the first-line treatment for pain and fever in pregnancy, as recommended by Australian and international medical bodies. Used appropriately, it is safe, effective, and important.

Pregnant women should feel reassured - paracetamol, when used appropriately, is safe in pregnancy.

The strongest evidence we have shows no harm to children from paracetamol use in pregnancy.

Avoiding paracetamol is not justified - untreated fever in pregnancy is far more concerning.

Paracetamol remains the safest and recommended option for pain and fever during pregnancy.

This study confirms what we as obstetricians have said for years: fear should not override evidence."