SA medical societies say paracetamol is safe for use during pregnancy

Paracetamol remains the safest and most effective first-line treatment for pain and fever in pregnancy, as no alternative agent has a superior safety profile.

This is according to the South African Society of Obstetricians and Gynaecologists (SASOG), the Society of Obstetric Medicine South Africa (SOOMSA), and the South African Society for Ultrasound in Obstetrics and Gynaecology (SASUOG) which released a joint statement on the matter after statements and media reports suggested a link between paracetamol (acetaminophen) use during pregnancy and autism spectrum disorder (ASD).

US President Donald Trump earlier this week said that pregnant women should “tough it out” and avoid Tylenol (acetaminophen) over an unproven link to autism.

He said “taking Tylenol is not good” and to “fight like hell not to take it”.

But the three groups SASOG, SOOMSA and SASUOG, said they had carefully reviewed the available evidence, drawing on large cohort studies, systematic reviews, sibling-controlled analyses, and authoritative international assessments.

“In agreement with position statements from several international bodies, we confirm that there is no evidence that taking paracetamol in pregnancy at recommended therapeutic doses causes autism in children. While some early observational studies suggested a small association between prenatal paracetamol exposure and ASD, these analyses were particularly vulnerable to confounding by genetic, familial, and environmental factors, and in many cases relied on self-reported exposure data of limited reliability.

“By contrast, more robust study designs, especially sibling-control analyses, show no increased risk of ASD. A large Swedish population-based study, for example, demonstrated that when shared familial factors were accounted for, the association between paracetamol use and ASD disappeared,” their statement said.

They added that fever in pregnancy is not benign and has been associated with miscarriage, congenital malformations including neural tube defects and cardiac defects, preterm delivery and intrauterine fetal demise.

Similarly, they said severe or persistent pain, if not treated, can have a significant impact on maternal mental health, with clear consequences for both mother and fetus.

“Against this backdrop, paracetamol remains the safest and most effective first-line treatment for pain and fever in pregnancy, as no alternative agent has a superior safety profile. At standard therapeutic doses (500–1000 mg up to four times daily, to a maximum of 4 g in 24 hours), paracetamol is not associated with an increased risk of adverse pregnancy or child health outcomes.”

Cape Times