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In issuing the acetaminophen warning on Monday regarding a potential link to autism, where did the White House team get its data? And how does it compare to other research on the topic of using the drug during pregnancy?
To date, there have been more than 50 studies looking at a potential association between prenatal acetaminophen use and autism.
The results vary from finding a positive association to revealing no link, and some found mixed results.
That’s challenging, especially for women of childbearing age.
Dr. John Walkup is a child psychiatrist at Lurie Children’s
“When you take 40 positive studies suggesting there is a link and nine negative studies and you put them together, the 40 is going to drown out the nine,” he said.
More studies have suggested an acetaminophen autism link than research that has refuted it. However, the most extensive study, and perhaps the most thorough to date, conducted in Sweden initially showed a link, but researchers looked deeper and found otherwise. They studied nearly 2.5 million children from 1995 to 2021. They delved into family data and reported acetaminophen use. The study was published in the Journal of the American Medical Association.
“It’s passed a lot of benchmarks in terms of overall quality and rigor through that review process,” Walkup said.
The end finding, no link between acetaminophen during pregnancy and autism, Attention Deficit Hyperactivity Disorder, or other intellectual disabilities. Researchers were clear. But they were not initially studying autism.
“They have to admit that because the study wasn’t developed to answer that question, that there may be some things in there that weren’t measured that are part of the explanation,” Walkup said.
A multi-factorial explanation for autism is a consensus.
“Most things are multi-determined,” Walkup said. “Every person who took Tylenol during pregnancy didn’t have a kid with autism. So there has to be some kind of complication, other factor, and that only makes sense.”
It has been proven to be in the genes.
“About 100 genes have been implicated in autism,” Walkup said.
Latha Valluripalli Soorya, Ph.D., is the Director of the Autism Assessment, Research, Treatment, and Services Center, or AARTS, at Rush.
“So if you think within genetics, the technology is better to us to really, get really deeper into the genome, the understanding of the interactions between genes, environment,” Valluripalli said. “When we say environment, it’s like the environment, like the things that are we’re exposed to day-to-day, but also what was we’re all talking about now, the prenatal environment, or the social, cultural environment.”
There are known drugs proven to be linked to autism, and the FDA recommends pregnant women not take valproate, known as Depakote, used to treat seizures and bipolar disorder.
“There are also lots of drugs that have mixed findings, and I would say acetaminophen is in the category of mixed findings,” Valluripalli said.
Regarding the increasing numbers, the threshold for diagnosis has been adjusted to include more children.
“When I was in training, only the most severely impaired kids got an autism diagnosis,” Walkup said. “What we do know is over the past 10-15 years, we’ve loosened the boundaries of what autism is understood to be from a symptoms picture and so that’s why we call it a spectrum disorder now.”
Doctors say pregnant women should think about all the ways to stay healthy: eating well, exercising, not smoking or drinking. And if they have a fever, which can cause birth defects, it may be better to take something, including Tylenol.
“Nothing should absolutely change as of today, other than people are going to talk about this at the doctor’s office,” Walkup said.
“Please know there’s not an answer,” Valluripalli added. “And so, if you are a family member who has an autistic individual in your life, and you took Tylenol at some point in your pregnancy, please know that there’s not an answer.”
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