Using Tylenol During Pregnancy: Benefits and Risks

As a pregnant woman, experiencing lower backaches, dealing with post-morning sickness headaches, sticking to the dental checkup you scheduled 5 months ago even though it interferes with your new nap schedule…There are plenty of reasons you might reach for Tylenol when you’re expecting.

Around 65% of American pregnant women say they’ve taken this OTC painkiller while pregnant. And while Tylenol (also called acetaminophen or paracetamol) has historically been regarded as pregnancy-safe, new research has called its safety back into question—leaving many expecting moms wondering what they can confidently use.

As of this writing, the consensus around using Tylenol while pregnant remains unclear. But the conversations around it reinforce that when it comes to taking any drug while pregnant, it’s always best to consult with your doctor. Not only can they shed light on any associated risks, but they can also help recommend a dose that’s safe for your baby.

Below, we break down the Tylenol-while-pregnant debate and offer some alternatives for moms who want to err on the side of caution.

Can you take Tylenol while pregnant?

Consuming Tylenol while pregnant has long been a topic of debate amongst healthcare providers and researchers. In 2021, the medical journal Nature Reviews Endocrinology published a “call for precautionary action” regarding the use of acetaminophen (also known as paracetamol) by pregnant women.

Shortly thereafter, the American College of Obstetricians and Gynecologists released a statement countering Nature’s consensus. They asserted that the paper, as well as previous studies, demonstrated “no clear evidence that proves a direct relationship between the prudent use of acetaminophen during any trimester and fetal development issues.”

Among clinicians, acetaminophen is generally still considered one of the safer (even preferred) OTC painkillers to take during pregnancy when used as directed. Many physicians and OBGYNs continue to recommend the drug to their patients.

That said, like almost every other aspect of being a pregnant woman, the decision to take or not take Tylenol is entirely up to you. If you’re concerned about reports of acetaminophen’s potential hazards, understanding how OTC painkillers work can help illuminate why it may or may not be the right choice for your pregnancy.

A general rule of thumb is that Tylenol should be used once you’ve  exhausted other natural means to relieve pain or discomfort. Always take it at the lowest dose possible to achieve pain relief, with the shortest duration of overall use.

How does Tylenol work?

Herein lies the dilemma: there is currently no scientific consensus around precisely how acetaminophen functions in the body due to its complex metabolism. In contrast, another type of OTC painkiller known as NSAIDs (nonsteroidal anti-inflammatory drugs) are better understood metabolically—but they are not considered safe for use while pregnant.

Some common NSAIDs include:

• Aspirin
• Ibuprofen (e.g. Advil or Motrin)
• Naproxen sodium (e.g. Aleve)

NSAIDs work by blocking two enzymes (cyclooxygenase 1 and 2) involved in telling the brain to reduce the production of prostaglandin. That’s why NSAIDs aren’t considered safe for pregnant women to take—prostaglandin plays a critical role in reproductive activities, as well as other healing functions like promoting inflammation and blood flow.

The use of NSAIDs (e.g. Advil and Aspirin) in pregnant women has been linked to complications like:

• Higher risk of miscarriage, especially in the first trimester
• Kidney developmental issues
• Heart developmental issues
• Low amniotic fluid

While there is clinical consensus around taking NSAIDs while pregnant, acetaminophen’s metabolism remains obscure.

Tylenol is known to be an endocrine disruptor, which means it interacts with and may disrupt normal hormonal activity, both during and in the absence of pregnancy. Concerning pain management, it’s generally believed to interact with and inhibit pain receptors in the brain and spine, though the exact chemical processes aren’t well understood.

For this reason, some pregnant women may shy away from using it during pregnancy.

Benefits of Tylenol During Pregnancy

Tylenol doesn’t offer any benefits apart from alleviating two uncomfortable symptoms: mild to moderate pain and fever.

Provides Mild Pain Relief

Tylenol can be a very effective medication for the treatment of mild to moderate pain. You might reach for Tylenol if you have:

• Headaches and migraines
• Muscle aches
• Toothaches
• Backaches
• Sore throat
• Small bone breaks or fractures (like a stubbed toe)

Helps Reduce Fever

Adults and children may also use Tylenol to help bring down a mild fever. Like its role in tempering pain, it’s not known exactly how Tylenol reduces fever. Scientists and researchers suspect acetaminophen works on the hypothalamus part of the brain, which plays an important role in regulating temperature.

Drawbacks of Tylenol During Pregnancy

Unfortunately, Harvard Medical School reports that tens of thousands of hospitalizations per year are attributed to acetaminophen. While it is a widely used OTC painkiller, be advised that it comes with these three drawbacks.

It Can Be Hard On Your Liver

For both pregnant and non-pregnant people, Tylenol can be very taxing for the liver to process. Tylenol passes through the gastrointestinal tract and into the bloodstream where it’s later filtered through your liver. There, a potentially toxic byproduct is produced (NAPQI), which can harm your liver if it’s sustained damage in the past.

For this reason, Tylenol may be hazardous for individuals who:

• Have liver disease
• Have a history of smoking
• Are over 40

Additionally, if you’re in recovery or have struggled with alcohol misuse disorder in the past, Tylenol may not be a safe option for you. People with a history of alcohol abuse may have sustained damage to their liver.

If you’re not sure how well your liver will tolerate Tylenol due to your medical history, it’s best to consult with your healthcare provider. They can help you identify a wise, safe option for dealing with pain or fever.

It’s Not The Best Choice for Chronic Pain

If you struggle with pain that’s not related to any symptoms of early pregnancy, it’s normal to want to reach for the quickest thing available in the medicine cabinet, put the pain to bed, and get on with your day. But using Tylenol regularly can be toxic to your body if it’s used too often, as in the case of:

• People who deal with persistent headaches or migraines
• Highly active people who experience muscle soreness
• People who have sustained a recent injury

The FDA cautions not to use Tylenol for more than 10 days in a row to treat pain unless your physician recommends otherwise. If you’re using it to lessen a fever, it should not be used for more than 3 days.

Additionally, it’s imperative to follow the recommended dosages—but if you can take less while still finding pain relief, take less. If you’re pregnant, it’s best to reach out to your healthcare provider before taking it to certify that you do not need to lower your dose.

It’s Still Being Investigated for Fetal and Maternal Safety

The consensus published in Nature Reviews Endocrinology alleged the following risks were associated with taking acetaminophen while pregnant:

• Increased risk of neurological defects
• Increased risk of early puberty in females
• Increased risk of low sperm count in males
• Elevated risk of hypospadias in males (a developmental disorder affecting the penis)
• Elevated risk of testicular issues in males
• Elevated risk of urogenital disorders

However, Harvard Medical School cautioned that the study was undertaken with “significant limitations” and provided little insight into:

• What constituted a potentially harmful dosage
• At what points in pregnancy the drug could cause the most harm

That said, if you’re considering taking Tylenol, it’s important to consult with your healthcare provider ahead of time, and it’s probably best to limit your use of the drug as much as possible.

Alternatives for Dealing With Pain or Fever During Pregnancy

Depending on what types of symptoms you’re dealing with, you may be able to find relief without Tylenol as pain reliever by turning to some of these remedies:

• Apply heat – Hot compresses, like a hot water bottle, or taking a warm bath can help to soothe back pain during pregnancy.
• Up your water intake – Staying well-hydrated and drinking cool fluids can help some people quell a fever. This can also help replenish fluids that may be lost when temperatures are elevated. Water, herbal, non-caffeinated teas, and sports drinks may all work well.
• Practice relaxation and mindfulness – Relaxation techniques like box breathing or meditation can help some people build a tolerance to mild or moderate pain. There are several guides available for prenatal yoga and meditation during pregnancy. Harvard Medical School has even advocated for the use of mindfulness in treating migraines—mindfulness works to reduce stress, which may in turn reduce the severity of pain.

And the age-old remedy for almost any time you’re feeling under the weather? Rest. So while you deserve a round of applause for making that dental check-up, there’s no harm in sticking to your daily nap schedule from now on. It may help ward off your next headache, and besides—you and your bundle-to-be deserve it.

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This post has been reviewed for accuracy by the following medical professional:

Dr. Heather Soper, Certified Nurse Midwife

Dr. Heather Soper brings over 15 years of experience in women's health and obstetrics to her role as the owner of The Genesis Resort for Birth. Complementing her clinical practice, she serves as an Assistant Professor of Nursing at James Madison University, where she educates nursing students with a focus on compassionate, patient-centered care. Her advanced training and dedication to midwifery are evident in her contribution to both academia and the wellness of expectant mothers.

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