Dear Members and Family of HDMG,

HDMG wanted to share current information about the safety of Tylenol in non-Pregnant people and recommendations for those that are pregnant.

Is Tylenol or Acetaminophen Safe to use if I am not Pregnant?

Tylenol, whose active ingredient is acetaminophen, is generally considered safe and effective when used as directed. However, taking too much can cause severe and potentially fatal liver damage. This can happen by taking too high a dose at once, taking multiple medications containing acetaminophen, or taking it with excessive alcohol.

Maximum daily dosage:

•The maximum safe dose of acetaminophen varies depending on the person's age and health.

•For healthy adults, the maximum daily dose is typically 4,000 mg.

•For extra-strength products, the manufacturer may recommend a lower daily maximum, suchas 3,000 mg in 24 hours.

•Some experts recommend a lower daily limit, such as 3,250 mg, for individuals taking themedication frequently or for more than a week.

•For children, the dose is based on their weight or age and should not exceed five doses in a 24-hour period.

Risks and who should be cautious:

•Certain individuals are at a higher risk of liver damage from acetaminophen and shouldconsult a doctor before use.

•Liver conditions: People with pre-existing liver disease, including hepatitis, may have a higherrisk of side effects.

•Alcohol consumption: Regular consumption of three or more alcoholic beverages per day canincrease the risk of liver damage.

•Older adults: Individuals over 65 may be at a higher risk of liver injury.

•Children: Parents and caregivers must follow dosing instructions carefully, using the correctmeasuring device for liquid formulations. Over-the-counter products should not be given tochildren under 2 without a doctor's approval.

•Fasting or poor nutrition: These can decrease the liver's ability to process acetaminophen,increasing toxicity risk.

•Other medications: Always check labels for other medications that may also containacetaminophen to avoid unintentional overdose. Acetaminophen is found in over 600prescription and over-the-counter drugs.

Is Tylenol or Acetaminophen Safe to use during Pregnancy?

Use of Acetaminophen in Pregnancy:

The Condition: Acetaminophen Exposure in Utero

•What it is: Acetaminophen (Tylenol) is an over-the-counter analgesic and fever reducingmedication widely used during pregnancy. Concerns have arisen regarding possibleneurodevelopmental risks associated with chronic prenatal exposure and potential overusefor low-grade fevers in pregnant women.

•Who it affects: Chronic acetaminophen use in pregnant women, especially late in pregnancy,may cause long-term neurological effects in their children.

Clinical Considerations: Chronic Use of Acetaminophen During Pregnancy

•What it does: Acetaminophen is the only over-the-counter medication considered safe fortreating fever during pregnancy. Maternal fever itself carries risks, including neural tubedefects and preterm birth.

•Current evidence and recommendations: Evidence does not definitively establish causality,but the consistent associations raise concern. An international consensus statement (2021)recommends pregnant women minimize use, consult providers before long-term use, andapply the lowest effective dose for the shortest duration. In a statement from the AmericanCollege of Obstetricians and Gynecologists (9/22/25) states “When considering the use ofmedication in pregnancy, it’s important to consider all potential risks along with any benefits.The data from numerous studies have shown that acetaminophen plays an important—andsafe—role in the well-being of pregnant women.”

•Safety profile: When used short-term and at appropriate dosages, acetaminophen remainswidely regarded as safe. However, unresolved questions remain regarding chronic or late-pregnancy exposure.

Context

•Balancing risks: Experts emphasize a balanced approach, acknowledging potential risks ofacetaminophen exposure while recognizing the dangers of untreated maternal fever and pain.

Recommendations for Fever during Pregnancy

When to Seek Medical Help

•Contact your Health Care provider immediately if you have a fever, a high temperature, orother signs of illness.

•A fever above 102.2°F (39°C) can increase the risk of birth defects or other complications.

•Fever is a sign of potential infection, which can harm both you and the baby.

Safe Medications

•Acetaminophen is currently considered the safest medication to reduce fever and pain duringpregnancy, we recommend contacting your health care provider.

•Use the lowest effective dose for the shortest amount of time, as advised by your provider.

•Avoid aspirin, ibuprofen (Advil®, Motrin®), and other NSAIDs unless specificallyrecommended by your healthcare provider, as they can cause serious problems.

•NSAIDs are generally contraindicated in pregnancy, particularly after 20 weeks, because theycan cause serious health problems for the unborn baby, including kidney problems, which canlead to dangerously low levels of amniotic fluid (oligohydramnios), and potentially lead toproblems with the baby's heart, such as the premature closure of the ductus arteriosus. Whilesome studies suggest a link between NSAID use and miscarriage in early pregnancy, the mostsignificant risks are associated with later-term use

Self-Care

•Rest and drink plenty of fluids, especially water, to stay hydrated.

•Use a cooling blanket if you have a very high fever.

•Wash your hands often and practice good hygiene to prevent infection.

Why it's Important

•Maternal fever, especially when untreated, can pose risks to the pregnant person and the fetus.

•Fever can be a sign of serious conditions like bacterial infections or influenza.

•Fever can also lead to dehydration and other heat-related issues for the mother.

•Evidence base: Large-scale cohort studies, including the Nurses’ Health Study II and the Boston Birth Cohort, reportassociations between in utero exposure and later diagnoses of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). Scientists have proposed biological mechanisms linking prenatal acetaminophenexposure to altered brain development.

•Conflicting findings: Family-based Scandinavian studies, comparing exposed and unexposed siblings, have not shownsignificant associations. Critics from Icahn School of Medicine at Mt. Sinai and Harvard argue that statistical adjustments in these analyses may mask true effects.

•ACOG affirms safety benefits acetaminophen pregnancy. ACOG. (n.d.). https://www.acog.org/news/news-releases/2025/09/acog-affirms-safety-benefits-acetaminophen-pregnancy#:~:text=Sep%2022%2C%202025-,ACOG%20Affirms%20Safety%20and%20Benefits%20of%20Acetaminophen%20during%20Pregnancy,causes%20neurodevelopmental%20disorders%20in%20children