SMFM Reaffirms Acetaminophen as First-Line Medication for Treating Pain and Fever During Pregnancy

Acetaminophen remains the recommended first-line medication to treat pain and fever during pregnancy, according to an updated statement from the Society for Maternal-Fetal Medicine (SMFM). A comprehensive review of the available scientific evidence does not establish a causal relationship between acetaminophen taken during pregnancy and an increased risk of autism spectrum disorders and attention deficit and hyperactivity disorder (ADHD) in children, according to SMFM.  

SMFM’s statement is based on a thorough review of recent studies and earlier research on acetaminophen during pregnancy. The newest studies vary in their findings on the potential association between prenatal acetaminophen exposure and risk of childhood neurobehavioral issues and have significant limitations in their study design.  

“After another careful review of the existing research, we continue recommending acetaminophen as a safe treatment for our pregnant patients who need it for pain relief and to reduce fever,” said Judette M. Louis, MD, MPH, chair of the SMFM Publications Committee. 

Acetaminophen is a commonly used non-opioid analgesic during pregnancy. An estimated 65 percent of pregnant women use acetaminophen at some point during pregnancy, mostly to treat headache and fever. Acetaminophen is the active ingredient in many over-the-counter and prescription medications, including Tylenol®.  

“Both untreated fever and pain during pregnancy carry potential health risks, so you shouldn’t just ‘tough it out’,” said Louis. “Untreated fever, particularly in the first trimester, is known to be linked to birth defects and miscarriage. We also know that maternal fever during labor can be associated with poor neonatal outcomes.”  

Along with acetaminophen, SMFM recommends nonpharmacological interventions, including hydration and physical therapy, to help manage pain during pregnancy.  

Nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids are not recommended to treat fever and pain during pregnancy. NSAIDs increase the risk of fetal renal impairment, premature closure of the ductus arteriosus, oligohydramnios, and maternal bleeding. Opioid medications taken during pregnancy are associated with neonatal abstinence syndrome, addiction, and sedation, and are also not recommended as first-line treatments for pain during pregnancy. 

SMFM Statement: Acetaminophen use during pregnancy is available here.  

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About SMFM    
The Society for Maternal-Fetal Medicine (SMFM), founded in 1977, is the medical professional society for obstetricians who have additional training in high-risk, complicated pregnancies. SMFM represents more than 6,500 members who care for high-risk pregnant people and provides education, promotes research, and engages in advocacy to reduce disparities and optimize the health of high-risk pregnant people and their families. SMFM and its members are dedicated to optimizing maternal and fetal outcomes and assuring medically appropriate treatment options are available to all patients.    

Media Contact:  Greg Phillips, Director of Communications, press@smfm.org