Can You Take Tylenol While Pregnant?
March 25, 2021
As your pregnancy progresses, you may feel all sorts of unfamiliar aches and pains. Another not-so-fun fact: Expectant moms may be more susceptible to illnesses, since pregnancy actually suppresses your immune system. The list of what you can take when you’re feeling under the weather is decidedly shorter these days, since many medicines aren’t considered pregnancy-safe. Here’s the question so many moms-to-be are asking: Can you take Tylenol while pregnant?
Whether you’re trying to stave off aches and pains or get relief from a cold or headache, you want to feel better—but you don’t want to harm your baby. Always discuss taking any medication, including over-the-counter medicines (OTC) and supplements, with your doctor first. “If there’s a need for medical information, a reputable online source can give basic information, but a physician’s input concerning what medications, if any, one should take while pregnant is worth its weight in gold,” says Kecia Gaither, MD, a double board-certified physician in ob-gyn and maternal fetal medicine and director of perinatal services at NYC Health + Hospitals/Lincoln in the Bronx, New York.
So what’s the general consensus about taking Tylenol while pregnant? Here’s what you need to know about using acetaminophen during pregnancy.
Tylenol is a name brand for acetaminophen, an analgesic (aka pain-relieving) drug. Doctors generally agree that Tylenol is safe for pregnancy to treat mild fevers and discomforts in the short term—as long as you follow the dosage instructions found on the bottle. Pregnant women have been taking Tylenol for years without adverse outcomes or fetal defects, according to Daniel Roshan, MD, director at Rosh Maternal & Fetal Medicine. While there may not be a lot of research concretely proving that Tylenol during pregnancy is safe, the lack of data for adverse effects leads experts to largely believe it is.
However, too much acetaminophen can be hard on both your and baby’s liver, research shows. Recent studies have linked prenatal acetaminophen exposure to higher risks of ADHD and autism in childhood. It’s important to know that this research shows correlation, not causation—in other words, there may be other factors that contribute to the link researchers found.
Also, these studies tend to explore long-term use, not an occasional pill for a pounding headache. “I’m aware of studies linking long-term use of Tylenol during pregnancy (i.e., greater than a month) with an increased risk of autism,” says Gaither. “But this is, again, causal relationship, not definitive given the many variables that existed within the study.”
Taking Tylenol Extra Strength While Pregnant
In general, as a mom-to-be, it’s best to start with regular strength Tylenol, says Roshan. Extra strength equals extra acetaminophen (500 mg in each tablet, as opposed to 325 mg), so try the basic formulation first and see how it works.
If regular Tylenol doesn’t relieve minor discomforts, Extra Strength is also okay to use, according to Roshan—but he cautions that neither should be taken above the daily recommended intake of acetaminophen, which is 3,000 mg a day, unless directed by your doctor. “Women who have underlying liver conditions or a pregnancy induced condition affecting the liver should avoid acetaminophen altogether unless advised otherwise by their provider,” Roshan says.
Taking Tylenol PM While Pregnant
Tylenol PM is a combination of two drugs: Acetaminophen and diphenhydramine (an antihistamine found in Benadryl). Both drugs have generally been thought to be safe during pregnancy, Roshan says, but it’s important to make sure usage is occasional, not consistent. “It’s also important to remember that medications that cause drowsiness, like Benadryl, can also cause a decrease in fetal activity, as baby will be drowsy too,” he explains.
Having a tough time getting to sleep? Try focusing on good sleep hygiene—like skipping late-night snacks, turning down your room temp and unplugging before bed—and use Tylenol PM only when you’re not feeling well. “In general we don’t recommend any sleep aids in pregnancy. Pregnant women experiencing insomnia unrelieved by a good sleep hygiene routine should speak to their OB about appropriate interventions,” Roshan says. “Sleep medications should be avoided unless directed by their provider.”
Taking Tylenol Cold While Pregnant
Like Tylenol PM, Tylenol Cold and Tylenol Sinus consists of multiple drugs. In addition to acetaminophen, both contain a drug called phenylephrine, a decongestant found in many sinus and cold medications, that can affect blood flow to the placenta and should be avoided during pregnancy.
“This decongestant causes short-term, moderate constriction of blood vessels, leading to increased blood pressure. In pregnant women, this elevation in blood pressure can temporarily decrease the amount of blood flowing to the placenta,” Roshan explains. “While the risk to the baby long-term is low, it’s recommended to avoid any medications that can cause an increase in blood pressure during pregnancy, including phenylephrine.”
Headlines linking Tylenol with potential harmful effects in pregnancy can be scary to read, but it’s important to understand the way the studies were conducted, and to understand that researchers make it clear that correlation does not equal causation. In other words, even if study results show that the regular use of acetaminophen during pregnancy is linked to disorders such as autism, researchers cannot definitively say that Tylenol is the cause of autism.
The definitive causes of autism and other mood and behavioral disorders “have remained elusive, and at best are multifactorial,” explains Gaither. “Genetics, environmental factors, maternal medications during gestation, intrauterine infections and [other circumstances] all have been causally linked to autism.” In general, whether you’re considering taking Tylenol PM during pregnancy because you can’t sleep, or you need to feel human after a cold has taken you down, it’s smart to read labels and ask your doctor.
In a study review, the FDA found that the strongest link between prenatal acetaminophen exposure and diagnoses such as ADHD occurred in women who took acetaminophen for over 20 weeks of their pregnancy. “Anything that’s causing protracted pain that leads to a consistent need for pain medication, such as Tylenol, needs to be medically evaluated right away,” says Gaither.
Tylenol vs. NSAIDs
Not all painkillers are created equal. Pre-pregnancy, you may have reached for whatever pain meds were in the cabinet, regardless of whether it was Tylenol or Advil. But non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen (Advil) and naproxen (Aleve) function differently than acetaminophen and have been linked to prenatal risk. These include congenital heart defects if taken in the first trimester, and potential heart abnormalities and low amniotic fluid levels in the third trimester. While in the womb, blood circulation through baby’s heart is very different than it is after baby’s born. According to Roshan, taking NSAIDs during pregnancy can cause a premature closure of the path for blood to flow to baby’s heart. It can also damage baby’s kidneys, leading to a decrease in the amniotic fluid that surrounds and protects the fetus until delivery, he explains.
“It’s thought by some OBs that taking NSAIDs through 20 weeks of pregnancy when absolutely necessary can be safe,” Roshan says. “However, more research has begun to suggest that no NSAIDs should be used in pregnancy because there isn’t a gestational period where they are considered to be absolutely without risk.”
If your doctor says you can use Tylenol while pregnant, make sure the medicine you select is acetaminophen-based. According to Roshan, the safest version is the basic acetaminophen pain reliever, but moms-to-be should always read the label and consult with their doctor. “While Tylenol is generally considered safe for use in pregnancy, every patient and every pregnancy is different,” he says. “Pregnant women should always consult their providers for advice on safe medication usage for both over-the-counter and prescription medications.”
About the Experts:
Kecia Gather, MD, is a double board-certified physician in ob-gyn and maternal fetal medicine with over 20 years of experience and specializations in caring for women with diabetes, HIV and obesity in pregnancy. She is also the director of perinatal services at NYC Health + Hospitals/Lincoln in the Bronx, New York.
Daniel F. Roshan, MD, FACOG, FACS, is the director at ROSH Maternal-Fetal Medicine in Manhattan. He specializes in maternal-fetal medicine, high-risk pregnancies, recurrent pregnancy losses, preterm labor, managing chronic diseases during pregnancy and more. He’s also an active member of the American College of Obstetricians and Gynecologists (ACOG) and the American College of Surgeons (ACS).
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