Is acetaminophen harmful in pregnancy?

The short answer to that question is: probably not but we cannot be absolutely certain.

Let me beg your indulgence in an explanation about why that is the only honest answer I can give you.

The “gold standard” in assessing the risks and benefits of any medication is the “controlled trial”. In such a trial, a large group of people are randomly assigned to drug A or drug B or to Drug A or placebo. This tends to ensure that differences in outcomes between the people taking one treatment or the other are due to the treatment and not to the characteristics of the people taking them. With a large enough group and truly random assignment, differences among the subjects are assumed to be evenly spread.

Historically, drug trials have excluded pregnant women because the trial sponsors worried that they would be sued for any bad birth outcomes. While this did protect the trial sponsors, it meant that most of the time, we were totally in the dark about the safety and efficacy of drugs when prescribed to pregnant women.

The fallback has been the “observational trial.” You look at a group who took a given drug and compared their outcomes to a group who did not.

The enormous problem with observational trials is that they are often comparing apples to oranges. People who take a medicine on their own are not the same as those who do not.

Let us take acetaminophen as an example. We know that about 60% of women take it during pregnancy. Most of the trials that report more neurodevelopmental disorders (autism, ADHD) in acetaminophen users compare women who used it with those who did not.

What is the commonest reason for acetaminophen use? It is fever. Thus, acetaminophen users are much more likely to have had febrile illnesses than those who did not use it. If there is an increased incidence of autism among users, the culprit might just as easily be the febrile illness, not the drug.

Until someone – and realistically it will have to be the NIH, as no commercial firm will pay for it – does a controlled trial comparing pregnancy outcomes among women who take acetaminophen with those who take a placebo, we will be offering advice either way with imperfect data.

The closest I can find to a good study is one out of Sweden that used successive pregnancies of women who had more than one child, comparing the siblings and looking at acetaminophen use. This study found no increase in autism, ADHD or learning problems caused by acetaminophen use. Again, though, this was an observational study.

Strengthening this conclusion is a similar study reported this year from Japan that also concluded there was no association of acetaminophen use and autism or ADHD.

Given this, what is the best advice you can take?

First, as is true for all medications, take medication only when you need it. A temperature of 99.6 does not need treatment. A temperature of 102 is harmful to the fetus and should be treated. If you have a backache that can be relieved with heat or a backrub, skip the pills. If you are very uncomfortable, acetaminophen is clearly safer than anti-inflammatories such as ibuprofen or naproxen, that are known to cause fetal malformation, or narcotics.

Second, try to take it for as short a time as possible. The limited data we have suggests that chronic use is worse than occasional use, and that makes physiological sense.


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Does the MAHA movement truly care about America's children?

The Trump administration recently released a long-promised report decrying the sorry state of the health of American children and saying how it planned to change this.

They correctly begin by noting that “Despite outspending peer nations by more than double per capita on healthcare, the United States ranks last in life expectancy among high-income countries – and suffers higher rates of obesity, heart disease, and diabetes.” Unfortunately, they then largely focus their prescriptions on the wrong solutions.

The four areas on which they propose to work to improve our children’s health are ultra-processed food; chemicals in our environment; the lack of exercise due to the digital age; and over-medication and excessive vaccination.

I support (and have written about) reducing the over-abundance of ultra-processed food, particularly the use of high fructose corn syrup in our diet, but to date the RFK Jr-run FDA has spent its energy on trivia such as red food coloring rather than going after big agriculture and big food.

Our food supply does contain too many pesticides, but hunger and malnutrition threaten more American children than do pesticides, and the gutting of the social safety net by the Trump administration will make this problem worse.

More exercise is good for us all, children and adults, so we should be expanding access to outdoor spaces, including national parks, not limiting them as has been done with cutbacks to the National park service.

What is most telling about this report is what it does NOT cover. The chemical that is the biggest threat to health is nicotine and the carcinogens in cigarettes, but there is not a word in this report about tackling the problem of youth vaping, which has been shown to lead to nicotine addiction and life-long smoking.

The insistence on reducing childhood vaccination, a cause that has made millions for Kennedy through his referrals of plaintiffs to class-action suits, is an enormous threat to children’s health. The disinformation spread by Kennedy and his allies has led to reduced rates of vaccination. Fewer children are being vaccinated, which means that diseases once thought eliminated, such as measles and whooping cough, are already making a resurgence. Thousands of American children, and millions world-wide, will die if the anti-vax movement holds sway.

Finally, no mention in the report is made of the leading cause of death in U.S. children and adolescents: death from motor vehicle accidents and firearms. Unlike every other western country, an American teenager is much likely to die by suicide or homicide with a gun than from illness. If RFK Jr and his followers truly cared about America’s children, gun control would be top of their priority list. Its absence says it all.


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How much protein do I need?

Protein has become America’s nutritional obsession, and protein bars have become a $2 billion/year business.

The World Health Organization and the American National Academy of Medicine recommend that we get 0.8 grams/kg body weight daily. For a 180 lb. person, that would translate to about 65 grams of protein daily. At least 85% of Americans already get that much.

For reference, 6 ounces of chicken give you 53 grams of protein while 6 ounces of salmon or lean hamburger give you 44. A 6 oz container of Greek yogurt supplies about 14 grams.

Vegans must be more careful, but an ounce of almonds supply 6 gm, 8 oz of soy milk give 7 and 6 oz of tofu contain 14 gm protein.

Does anyone need more protein? If you are working out vigorously trying to build muscle, upping your protein intake probably helps, but only up to double the recommended 0.8 gm/kg intake, with no added benefit no matter how much more protein you consume.

Older adults often lose muscle mass. The greatest way to avoid this is with resistance training (lifting weights). There is some evidence that modest increase of protein intake, to about 1.2 gm/kg/day may help, but the key is exercise, not diet.

What about protein bars?

They can be an easy way to get calories and protein if you cannot eat a normal meal. Think long hikes or gym workouts squeezed in at lunch hour. They are certainly easy to carry.

Be careful to read the ingredients. Manufacturers can slap a “high protein” label on anything, and the majority of “energy bars” are glorified candy bars, loaded with sugar and ultra-processed. Some of the better options are Clif Bars, RxBars and Rise protein bars, but even the better bars are not as good as a balanced meal with natural protein.

Excess protein can be harmful to the kidneys, so keep your protein intake to no more than 1.6 gm/kg/day (130 gm for a 180 lb. person – proportionally more or less depending on your weight).


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