BMJ

Evidence remains weak for link between maternal acetaminophen use and autism, ADHD

November 11, 2025

Study details: This umbrella review synthesized 9 systematic reviews (40 observational studies; 4 meta-analyses) examining maternal paracetamol (acetaminophen) use during pregnancy and risk of autism spectrum disorder and ADHD in offspring. Reviews were assessed for quality using AMSTAR 2, and overlap among primary studies was high (23%).

Results: Most reviews reported possible to strong associations between prenatal paracetamol exposure and autism or ADHD. However, 7 reviews cautioned interpretation due to bias and confounding. Confidence in evidence was low (two reviews) to critically low (seven). Only one review included studies (n=2) reporting autism and ADHD in offspring that appropriately adjusted for familial factors and unmeasured confounding through sibling-controlled analyses. In both studies, the increased risk of autism in offspring and ADHD observed in the whole cohort analyses didn’t persist in sibling-controlled analyses for autism and ADHD.

Clinical impact: Current evidence doesn't clearly link maternal paracetamol use with autism or ADHD. Clinicians should continue to weigh benefits of treating pain or fever against theoretical risks, as untreated maternal illness may pose greater harm.

Source:

Sheikh J, et al. (2025, November 9). BMJ. Maternal paracetamol (acetaminophen) use during pregnancy and risk of autism spectrum disorder and attention deficit/hyperactivity disorder in offspring: umbrella review of systematic reviews. https://pubmed.ncbi.nlm.nih.gov/41207796/