With last week’s White House announcement about the link between acetaminophen (sold over the counter as Tylenol) and autism, state departments of health are going to have to craft state-level health guidance around consumption of the drug for pregnant mothers.
The Food and Drug Administration still maintains they have not found “clear evidence” that appropriate use of acetaminophen during pregnancy causes adverse pregnancy, birth, neurobehavioral, or developmental outcomes. The agency recommends consultation with a medical professional before taking it, basically devolving the decision down to the personal level. After administration officials held their press conference on the connection between autism and the drug, the Food and Drug Administration released a statement characterizing the link as “an ongoing area of scientific debate,” recommending doctors limit the use of acetaminophen during low-grade fevers and noting that aspirin and ibuprofen have well-documented adverse effects on fetal development.
States have already begun to take steps to craft their positions on acetaminophen use during pregnancy.
On September 23rd, the California Department of Developmental Services released a statement citing the Society for Developmental and Behavioral Pediatrics saying there is no strong evidence showing a causal relationship between the appropriate use of acetaminophen during pregnancy and harmful effects on fetal development.
In Florida, State Surgeon General Joseph Ladapo was previously most famous for opposing the COVID-19 vaccine and comparing vaccine mandates to “slavery.” Last week, he announced he would likely be adopting recommendations on the use of acetaminophen by pregnant women following the White House, saying they are “at a place that is more honest."
In Pennsylvania, one legislator has taken the announcement as a place for opening a dialogue. State Representative Abigail Salisbury, who chairs the Pennsylvania Autism Caucus and says she is on the autism spectrum, has asked house leaders to hold hearings with medical specialists and scientists to lay bare the current state of the research on autism.
The Illinois Department of Health wrote in a Facebook post last week that “there is no link between acetaminophen use during pregnancy and autism.” They note that untreated fevers can lead to pregnancy complications and that acetaminophen is a “safe fever reducer for use during pregnancy.”
In a Facebook post last week, the Michigan Department of Health and Human Services cited the American College of Obstetricians and Gynecologists’s position, saying they “support the use of acetaminophen in pregnancy when used in moderation.” The Department says acetaminophen is one of the few options available to pregnant patients to treat pain and fever, saying they both can be harmful to a woman and a “baby” during pregnancy when left untreated.
The New Jersey Department of Health and New Jersey Maternal and Infant Health Innovation Authority released a statement endorsing use of acetaminophen for pregnant women along with infant vaccination. They say they align their recommendations with professional organizations like the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the Society for Maternal-Fetal Medicine. Their official position is that “Pregnant patients should not avoid indicated treatment for fever or pain, including acetaminophen.” They justify this by saying that current evidence has not demonstrated a “causal link” between prenatal acetaminophen use and autism, ADHD, or intellectual disability. They also note that untreated fever and pain can cause health risks for mothers and infants and that decisions to treat should be made in consultation with a doctor.
The Washington State Department of Health communicated in a Facebook post that “years of research have shown that acetaminophen is a safe and reliable treatment for fever and mild pain, including when used during pregnancy.” In the same post, they affirmed the value of vaccines for protecting child and maternal health.
Robbie Goldstein, Commissioner of Public Health for the Massachusetts Department of Health, released one of the stronger statements on the state of the evidence of the use of acetaminophen during pregnancy. He called acetaminophen “one of the safest and most commonly used medicines to relieve pain and reduce fever in pregnancy” and went as far as to say that leaving fever or significant pain untreated is “far more dangerous” to a developing fetus than acetaminophen used as directed. He said the link between acetaminophen use and autism is “simply not supported by high-quality evidence.” He even went as far to say that public health statements should not be driven by “speculation or opinions from those without the training and knowledge to accurately assess the full scope of research and the associated clinical nuances,” implying opinions to the contrary were “harmful misinformation or disinformation.”
While I did not see any statements released by and state agencies in Wisconsin, I did see a statement made by the Facebook post by Public Health Madison & Dane County sharing the posting of the American College of Obstetricians and Gynecologists stating that two decades of research have found no causal link between acetaminophen use and pregnancy and that acetaminophen is a safe option for managing pain and fever during pregnancy–two conditions that can pose serious risks to patients and fetuses if untreated.
Similarly, I did not find any official statement by an agency of the state of Colorado, but Jefferson County, Colorado in suburban Denver posted a Facebook post sharing the American College of Obstetricians & Gynecologists’s statement that acetaminophen is safe for use during pregnancy, when taken as needed, in moderation, and in consultation with a specialist. They also shared infographics explaining that untreated fever and pain can harm mothers and fetuses, that there is no causal link between acetaminophen use and autism, and that acetaminophen use is one of the safest and most effective options for managing pain and fever in pregnancy.
In my quick review, I also did not find any prominent statements made by government officials in Arizona, Georgia, Indiana, Maryland, Missouri, North Carolina, Ohio, Tennessee, Texas, or Virginia.
Among these states, six had state agencies issuing strong statements in support of acetaminophen use for pregnant women when directed by a doctor, while only one state followed the White House’s lead in discouraging its use. Among the top 21 states in population, Florida was the only one I could find where a state official was following the White House’s lead to discourage acetaminophen use among pregnant women.
At least for now, it does not seem that the states are following the federal lead when it comes to radical shifts in public health guidance.