Can You Take Tylenol While Pregnant?

When you’re pregnant, your body is...kind of going through it. Between the nausea, fatigue, and new aches and pains, you could certainly use some relief. But when you’re constantly hearing new rules about what to put in your body — like how soft cheeses and sushi are suddenly off limits — it’s natural to wonder if you can take Tylenol while you’re pregnant. It’s not recommended to take ibuprofen during pregnancy, according to the National Institutes of Health (NIH). Does that mean all over-the-counter pain meds are a no-go?

OB-GYNs have long relied on acetaminophen as the safest pain relief option for pregnant people. But in recent years, you may have seen headlines about new studies which asserted that taking too much acetaminophen while pregnant could increase your infant’s likelihood of developing autism or attention deficit hyperactivity disorder (ADHD).

So, is Tylenol or other brands of acetaminophen safe to take during pregnancy? Romper spoke with two OB-GYNs about the medication, how much you can take if you’re expecting, and why those scary sounding studies shouldn’t stress you out too much.

Can you take Tylenol while pregnant?

In short: yes. You should discuss any medications you want or need to take while pregnant with your OB-GYN to be safe, since everyone’s health history and pregnancies are different. But in general, Tylenol is considered the safest option for pain relief in pregnancy, doctors say.

“Tylenol is generally recommended to be safe in pregnancy for treatment of common things like headaches, fever, or general aches and pains,” says Dr. Richalle Sullivan, M.D., M.A., OB-GYN at Duke Health.

“I always talk to my patients about weighing their benefits versus the risk of a medicine. So to make a blanket statement of is something safe, it's really hard to give a 100% direct yes or no,” says Dr. Sarah Ziebarth, M.D., OB-GYN at Methodist Le Bonheur Healthcare. “What we know right now is that for certain indications, Tylenol is still our safest option. We have used it for decades. It has not been linked or proven to cause any developmental or congenital anomalies or birth defects or anything like that, that we can identify at this time.”

What about Tylenol PM during pregnancy

While OB-GYNs are OK with you taking regular Tylenol pregnant, they’re much more cautious about Tylenol’s other offerings, like Tylenol PM, because it combines multiple medications into one capsule.

“Each medication, it would be worthwhile to run it by your doctor individually, because there are so many different formulations on the market now in different combinations of medicines,” says Ziebarth. “In general, the ACOG makes a recommendation to avoid combination products for over-the-counter cold and flu medicines because we want to make sure that you’re not doubling up on certain medicines in the same class, or taking Tylenol plus another medicine which may contain Tylenol and not knowing you’re going over that dose.”

For example, Ziebarth says Tylenol PM is a combination of the ingredients in Tylenol and Benadryl. “We tell patients, yes you can take Tylenol and yes you can take Benadryl, but if you take Benadryl, don’t take Tylenol PM at the same time.”

Is Tylenol Cold & Flu safe during pregnancy?

When it comes to cold and flu medications from any brand, call your OB’s office before you take those, too. Pregnant people should not take Tylenol’s Cold & Flu products, Sullivan says.

“Ideally, we don’t want to use any kind of cold medication that has any kind of vasoconstrictor, so that’s going to be something like pseudoephedrine. That can cause vasoconstriction or tightening of the blood vessels in the nose, which is good for the cold symptoms to minimize congestion and mucus. However, that also has a detrimental effect on the blood vessels in the placenta. So as long as it doesn’t have this pseudoephedrine it’s usually fine in regards to cold medications. The Tylenol Cold & Flu Severe, because it has phenylephrine, it does cause that vasoconstriction, that’s usually not going to be recommended in pregnancy.”

What about those studies that say acetaminophen isn’t safe?

As recently as 2021, there have been studies published that claim taking acetaminophen while pregnant increased the likelihood an infant would develop autism or ADHD. Well, Sullivan and Ziebarth say the general consensus among experts is that they were pretty inconclusive. In fact, the American College of Obstetrics and Gynecology published a statement in 2021 stating the research showed “no clear evidence that proves a direct relationship between the prudent use of acetaminophen during any trimester and fetal developmental issues.”

“Those studies did not have great data collection,” says Sullivan. “They didn't use great methods to quantify how much Tylenol patients were taking. And then the way they assessed how their children were doing in the long term was based on maternal recall of their kid’s symptoms, basically, and not by using scientific data or by having physicians actually diagnose their children with these developmental disorders. So it really was not great data or evidence to conclude that Tylenol was not safe to use in pregnancy.”

ACOG and the Society of Maternal Fetal Medicine both concluded the studies weren’t well done, and kept their guidelines for using Tylenol during pregnancy the same, Ziebarth says.

“They just recommend using the lowest dose for the shortest amount of time possible and to use it for a medical indication, which is what we have been telling our patients the entire time. You know, we want to avoid a medicine if we’re able to, but oftentimes the benefits outweighed the risk,” she says.

When to take acetaminophen during pregnancy

All the same things you use Tylenol for when you’re not pregnant — headaches, pain elsewhere in the body, or fever reduction — are all appropriate uses of the medication while you’re pregnant too, experts say.

“Certainly for pain relief, headaches, it’s common to use in pregnancy,” says Sullivan. “If there’s any concerns for fevers having to do with an infection, you can use Tylenol. [To treat] backache or back pain, that’s a common use for Tylenol in pregnancy.”

Tylenol can help expectant parents dealing with pain continue working and caring for older children, Ziebarth says, and ensure they’re able keep up with daily life.

Tylenol can also be used to diagnose preeclampsia.

If you’re dealing with chronic headaches and have high blood pressure readings, your doctor may ask you to take Tylenol to help them determine if you have preeclampsia.

“If a woman has complaints of a headache in the later half of pregnancy as well as elevated blood pressures, it really raises concern for preeclampsia. One of the ways to make that diagnosis is, by definition, [she] has to [have] a headache that is not resolved with Tylenol. So we will give them a dose of Tylenol and then see if their headache resolves because that will help us differentiate from a tension headache, which Tylenol should improve, versus a preeclampsia headache, which is caused by increased fluid in the brain, which would not resolve a Tylenol. It’s the safest way for us to assess for that and that would actually really change the course of the pregnancy if we’re trying to decide if they need to be delivered early.”

How much Tylenol can you take while pregnant?

When you’re expecting, it’s hard to know whether you can take the standard dose listed on a medication’s label, or if you should opt for a different amount.

Four thousand milligrams is the standard adult dosage, Ziebarth says, but she recommends her patients limit their intake to 3,000 milligrams each day just to be safe. Again, it’s all about risk versus benefit, and OB-GYNs generally advise using as little medication as possible to do the job.

“It’s the same sort risk-benefit there,” she says. “If you have fever that’s not controlled with 3,000 milligrams per day, to do a dose up to 4,000 milligrams per day, it’s not going to be extremely detrimental and might preventing fever, which would be worth the added risk. What we are looking at is potential for liver toxicity and liver damage in a pregnant person. Again, it’s more of a cautious thing that we do as OB-GYNs to try to limit the dose to the lowest acceptable dose needed to treat the symptom.”

How much maximum strength Tylenol can you take while pregnant?

If you have the max strength tablets on hand, you’re able to take those too, Sullivan says. “The daily maximum dose is going to be 4,000 milligrams of Tylenol during a 24-hour period,” Sullivan says. “Usually I tell patients to take, if they’re having pain or headaches or something, two 500 milligram tablets. So that’s going to be two of the extra strength tablets, 1000 milligrams, and they can take that every six hours.”

Both of these specialists agree — as do OB-GYNs across the country, along with ACOG — that Tylenol is safe during pregnancy when used as needed, in the recommended dosage.

“Certainly if you need to, take it,” says Sullivan. “We don’t really have a lot of great options for pain medications to use during pregnancy. And so patients should not feel hesitant to use Tylenol if they truly are having pain or fever and need some kind of medication to help with those symptoms. As long as you’re not going over that 4,000 milligram limit on a daily basis or over a 24-hour period, then it’s fine to use Tylenol as needed.”

Studies referenced:

Bauer, A. Z., Swan, S. H., Kriebel, D., Liew, Z., Taylor, H. S., Bornehag, C.-G., Andrade, A. M., Olsen, J., Jensen, R. H., Mitchell, R. T., Skakkebaek, N. E., Jégou, B., & Kristensen, D. M. (2021). Paracetamol use during pregnancy — a call for precautionary action. Nature Reviews Endocrinology, 17(12), 757–766. https://doi.org/10.1038/s41574-021-00553-7

Sources:

Dr. Richalle Sullivan, M.D., M.A., OB-GYN at Duke Health

Dr. Sarah Ziebarth, M.D., OB-GYN at Methodist Le Bonheur Healthcare