Does Tylenol Cause Autism?

RFK Jr.’s big report on autism is scheduled to come out this month, and we’re hearing that it might point the finger at Tylenol as a possible cause. And the science on this gets confusing fast. Because some studies do suggest that taking acetaminophen while you’re pregnant could increase your kid’s chance of being autistic or having ADHD. But other research doesn’t find a clear connection — and scientists think there could be a whole other explanation here. So, what’s going on?? We sort it out, with help from epidemiologist Prof. Brian Lee. Find our transcript here: https://bit.ly/ScienceVsTylenolAutism In this episode, we cover: (00:00) The fears around acetaminophen and autism (02:18) Could acetaminophen be an endocrine disruptor? (06:25) Could acetaminophen affect brain development? (10:44) What if something else is going on? (20:26) Is there a link between acetaminophen and autism — or not?? This episode was produced by Meryl Horn, with help from Rose Rimler, Michelle Dang, and Ekedi Fausther-Keeys. We’re edited by Blythe Terrell. Mix and sound design by Bumi Hidaka. Our executive producer is Wendy Zukerman. Fact checking and consulting by Erica Akiko Howard. Music written by Peter Leonard, Bobby Lord, So Wiley, Emma Munger and Bumi Hidaka. Thanks to the researchers we spoke to for this episode and our other episode on autism. Science Vs is a Spotify Studios Original. Listen for free on Spotify or wherever you get your podcasts. Follow us and tap the bell for episode notifications. Learn more about your ad choices. Visit podcastchoices.com/adchoices

• 0:00Speaker 00

  Hi, I'm Meryl Horn, filling in for Wendy Zukerman, and you're listening to Science Versus.

• 0:07Speaker 00

  This is the show that pits facts against acetaminophen. Today on the show, does taking Tylenol when you're pregnant make it more likely that your kid will be autistic?

• 0:22Speaker 00

  This idea has been all over the news the past couple of weeks because of a big report that's coming from the US government. It's supposedly going to reveal the true causes of autism. And now what's going around is the claim that it's going to talk about Tylenol.

• 0:38Speaker 01

  HHS is set to release a report that will link autism to Tylenol use during pregnancy.

• 0:43Speaker 02

  The use of Tylenol by pregnant women may be linked to autism in children.

• 0:47Speaker 03

  The claim is shaking up medicine and raising questions from doctors.

• 0:51Speaker 00

  And the government hasn't confirmed that the report will talk about acetaminophen. But this idea, it isn't something that came out of nowhere or some totally fringe scientific theory. There are lots of legit studies on this, and some of them do seem to suggest that popping acetaminophen during pregnancy is linked not just to autism, but to ADHD and other stuff going on with the brain. Meanwhile, fears around taking Tylenol when you're pregnant have been spreading on social media for years. And these new reports have added fuel to the fire.

• 1:24Speaker 04

  I have been scared to death for days.

• 1:26Speaker 05

  Here's why you shouldn't take Tylenol if you're pregnant or you're thinking about getting pregnant.

• 1:31Speaker 04

  I took Tylenol throughout my whole pregnancy. I have a lot of [bleep] questions right now. And people better start [bleep] talking.

• 1:39Speaker 00

  And yeah, this does raise some big effing questions. Because tons of people take meds with acetaminophen in them when they're pregnant. Studies find that more than half of pregnant people in the US take these drugs.

• 1:53Speaker 00

  So what's going on here? Can taking Tylenol when you're pregnant up the chance that your kid will be autistic? When it comes to Tylenol, a lot of people are like...

• 2:03Speaker 04

  I have a lot of [bleep] questions right now.

• 2:05Speaker 00

  But then there's science.

• 2:09Speaker 00

  Science Versus will be right back after the break.

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• 3:59Speaker 00

  Welcome back. This is Meryl, and today we're diving into this question of whether there's a link between acetaminophen and autism. With me is senior producer Rose Rimler. Hey, Rose. Hi, Meryl. So yeah, you may remember that we worked on this whole autism episode a few months ago, right? Yeah. And we covered less like what causes autism, why it looks like it's gotten more common in the past few decades. And while I was working on that, I talked to a scientist who looked at Tylenol or acetaminophen. So it was kind of perfect because when I saw all of this was hitting the news, I was like, oh, now I can call that guy back up.

• 4:33Speaker 05

  You had this in your back pocket just waiting to go.

• 4:35Speaker 00

  Yeah. It was all set to go. So yeah, this is Brian Lee, professor of epidemiology at Drexel University. Hello.

• 4:43Speaker 07

  Hey, Meryl.

• 4:44Speaker 00

  How are you?

• 4:45Speaker 07

  It's been a very hectic last few days.

• 4:49Speaker 05

  I bet.

• 4:50Speaker 00

  Yeah, he's getting kind of swarmed and I wanted him to help me understand like where this idea came from in the first place. This idea that acetaminophen could affect a fetus? Like if we were going to build the case against acetaminophen according to science, where would the story start? And apparently these concerns have been floating around for a while.

• 5:12Speaker 07

  Over a decade ago, the first sort of research came out about acetaminophen during pregnancy and neurodevelopmental disorders. And that idea isn't crazy because it's been previously linked with other sort of disorders. For example, specific birth defects, possible sex hormone issues. Yes.

• 5:36Speaker 00

  Huh. So this was surprising to me, like sex hormone issues?

• 5:41Speaker 05

  So Tylenol or acetaminophen, we already know it can affect a fetus.

• 5:46Speaker 00

  Well, there had been research on it for sure.

• 5:48Speaker 05

  Okay.

• 5:49Speaker 00

  Suggesting that there might be some risks here, which was, it was surprising to me because I have been pregnant and doctors will always tell you that Tylenol and other stuff with acetaminophen in it is the safe one to take. You're not supposed to take Ibuprofen because that's thought to mess up blood flow to the fetus and has been linked to congenital birth defects. Acetaminophen is thought to be like the safer of the two.

• 6:12Speaker 05

  I didn't know that. So like if, if you're pregnant and you feel fluie or you have some pain, you're supposed to take Tylenol, not one of the other ones.

• 6:20Speaker 00

  Yeah, that's, that's why it's so common. It's like the one that for so long has thought to be relatively safe.

• 6:25Speaker 05

  But then they, but even though they have these suspicions from these other conditions?

• 6:28Speaker 00

  Well, there, yeah, there had been these kind of like trickling out of like concerns, like Brian said, that it might be messing with sex hormones, kind of acting as an endocrine disruptor.

• 6:39Speaker 05

  That's so random.

• 6:41Speaker 00

  Yeah, no, at first I was like, what? But apparently, back 15 years ago, some researchers pointed out that some painkillers sort of look like a type of endocrine disruptor that I'm sure you've heard of, phthalates. Sure. They're an element in plastics that are thought to be an endocrine disruptor. Exactly, yeah. And so they tried testing whether painkillers, including acetaminophen, acted like phthalates when they put them on cells in a dish. And they found that, yeah, they kind of did. Oh, interesting. And we think phthalates might mess up hormones like testosterone in the body. And so researchers started looking into this.

• 7:24Speaker 00

  And some of them did find that people who took acetaminophen during pregnancy were more likely to have a son with undescended testicles when they were born. Huh, okay. Yeah, so some researchers were finding these things, not in every study, but there were these hints that something might be going on here. And that was the backdrop for this new wave of studies looking at the brain. Because we know that hormones can affect brain development. So if something's messing with the hormones, maybe it could also change how the brain is developing in the fetus. Okay, that makes sense. And then studies start coming, looking at whether pregnant people who took acetaminophen were more likely to have a kid with autism.

• 8:09Speaker 00

  So like, you know, some of them would get thousands of pregnant moms and ask them some questions.

• 8:15Speaker 04

  They collected data on whether a mom used acetaminophen. Did you take Tylenol? Yes, no, that kind of a thing. And then they followed the baby after it was born to see if the baby developed autism.

• 8:31Speaker 00

  Mm-hmm. That's useful for our purposes. Yeah, exactly. Like, they followed these kids and then checked whether they're autistic. And these studies, they were finding stuff, but it was a little weird. Like, one of these studies found that it upped the chance for autism, but only when the autism was accompanied by hyperactivity symptoms. Another study found that boys were more likely to be autistic with this exposure to acetaminophen in the womb, but not girls. Huh.

• 9:04Speaker 05

  Okay, kind of confusing.

• 9:07Speaker 00

  Yeah, like, none of these studies was like a slam dunk on its own. But at the same time, dozens of other studies were also coming out looking at other stuff, especially ADHD, and finding that rates of ADHD were up in these kids exposed to acetaminophen in the womb.

• 9:27Speaker 05

  Oh, okay.

• 9:28Speaker 00

  And yeah, in some cases, it looked like the link was strongest for mothers who took acetaminophen pretty often, like in all three trimesters. So there's like a dose-response element as well. That's what it looked like. And in 2021, this all comes to a head. A paper comes out from a bunch of researchers who'd been studying this called a consensus statement. They issued a, quote, "call for precautionary action," unquote, and basically suggested that people should pump the brakes on these pills, minimize the amount of acetaminophen that they take during pregnancy. Here's Brian.

• 10:07Speaker 07

  And then to top it off, they published in a Nature journal, which is one of the most highly regarded scientific journals out there.

• 10:16Speaker 00

  And so this statement really made scientists pay attention.

• 10:20Speaker 07

  Up until that point, most people just kind of treated it like, oh, you know, like, a new study pops up every day, you aren't really sure what to believe or not. But when consensus statement came out, it gave it like a stamp of authority.

• 10:33Speaker 05

  Yeah, I would feel that way about a consensus statement in Nature.

• 10:36Speaker 00

  Yeah.

• 10:37Speaker 05

  Or a Nature offshoot, yeah.

• 10:38Speaker 00

  And some parents even started suing the companies that make meds with acetaminophen in them, saying that they should have warning labels on them about these risks. But as all of this was happening, a lot of scientists were like, wait a second.

• 10:53Speaker 07

  When you use a phrase like consensus statement, it implies a sort of, every single expert in the room believes X, Y, and Z. Like, nine out of 10 dentists recommend Colgate or something of that sort. So it implies a sort of authoritative weight to the evidence.

• 11:12Speaker 00

  And implying- That this was the consensus seemed to piss a lot of scientists off. Some of them wrote responses to that consensus statement, saying that it was way too soon to come out so hard against acetaminophen, saying that the evidence they cited was, quote, "weak in consistence and to a large extent, methodologically inadequate," unquote.

• 11:34Speaker 06

  So they're saying the studies are crap?

• 11:35Speaker 00

  Well, basically, yeah. That's the sciency way of saying, what? This? That, you know, this is not enough. And so a lot of scientists were really skeptical of this and didn't buy this story. Scientists like Brian. Does taking Tylenol actually increase, when you're pregnant, increase the chance that your kid will have autism?

• 11:55Speaker 07

  The answer, uh, right now, points towards no.

• 12:01Speaker 00

  Oh, really?

• 12:02Speaker 07

  Yeah. So that's the short of it.

• 12:05Speaker 00

  Wow. Up next, the long of it. We'll hear the other side of the story and tell you whether or not you can have your damn Tylenol after the break.

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• 15:35Speaker 00

  Welcome back. This is Meryl. So far, we've gone through a lot of the evidence against acetaminophen, the ingredient in medicines like Tylenol. Lots of studies seem to find that taking it while you're pregnant does increase the chance that your kid will be autistic or have ADHD. Are you ready for the rest of the science, Rose Rimler? Uh, yes. Are you ready? Yes, I'm ready. All right, so here's where Brian Lee, our epidemiologist hero, comes in gallantly with a shiny new approach to looking at this question. His paper came out just last year.

• 16:16Speaker 06

  We had a study funded by NIH before everything went to hell. And we were like, hey, we could actually look at this.

• 16:24Speaker 00

  And so Brian teams up with some Swedish researchers because he's actually really into IKEA. I don't think that's why. Yeah, you got me. I think it's because the Scandinavians keep really good records, public health records. Yeah, it's because they have an amazing database.

• 16:44Speaker 06

  Sweden, having its lovely, universal healthcare system, means that you can track everyone. They don't just disappear in the system. They're there, they're tracked. Everyone has access to this, right?

• 16:57Speaker 00

  So, yeah, they got data from a ton of kids, almost two and a half million of them. Basically, every kid who was born there over a 24-year period. And they also had data from the moms, details about their medical care, like the medicines that they took during pregnancy. And so now Brian's team looked to see, were the kids exposed to acetaminophen in utero more likely to be autistic? And right off the bat, they found that, yes, they were. Oh. So they found that the kids who were exposed to acetaminophen had a 20 to 30% higher chance of being autistic. Oh, that's not what I was expecting you were about to tell me.

• 17:40Speaker 00

  Right, but actually, Brian's team was sort of relieved when they found this.

• 17:45Speaker 06

  This shows that we're not in crazy land. For example, that somehow our data are not.

• 17:50Speaker 07

  Flawed, we're not flawed. Everything is working as anticipated.

• 17:56Speaker 00

  And that's because the effects that Brian was seeing in his data was in the same ballpark as what other groups had found. But here is where Brian and his team took a different path. They wanted to see if other factors might be muddling up the data here, making it look like it's the acetaminophen to blame when really it's something else entirely. Yeah, okay, so Brian is trying to think of are there other factors that might come into play here? And trying to like, do some science to sort of suss those out, basically? Yeah, and so to try to do that sussing out, he starts checking like, okay, what if some of the other factors that we know are linked to autism could be contributing

• 18:37Speaker 00

  to that effect that he saw, that 20 to 30% increased chance? Because like we talked about in our earlier episode on autism, we know that the age of the mom can affect the chance of whether her kid will be autistic. Like, older moms are more likely to have autistic kids. Or if the mom has some other health condition or got sick during pregnancy, that might increase the chance for autism too. Hmm, and so those factors have been known for a while and are generally pretty well accepted. Yeah, yeah, exactly. And so Brian's team took another look at the data. And when they started accounting for some of that stuff, like how old the moms were, the effect of acetaminophen got smaller.

• 19:19Speaker 00

  It went from increasing the chance of having an autistic kid by 20 or 30% down to 5%.

• 19:27Speaker 07

  When it's down to like a 5% increase in risk, you start to actually wonder whether or not it's real or not.

• 19:33Speaker 00

  Could it be like moms who are older are more likely to take Tylenol? Because they're like, have more aches and pains or something like that? And we know that's separately associated with autism, that kind of a thing?

• 19:43Speaker 07

  Yeah, exactly.

• 19:44Speaker 00

  Oh.

• 19:46Speaker 07

  Or a mom being sicker, right? Like, you don't just take Tylenol for funsies.

• 19:51Speaker 00

  Yeah.

• 19:53Speaker 00

  So the other studies weren't adjusting for stuff like age of the parent.

• 20:00Speaker 00

  You know, other health conditions, stuff like that? Yeah, basically, they weren't all doing the same type of adjustments. Okay. Um, so that's, that's one thing. And then there's another massive factor that contributes to whether someone's autistic. Their genes. Oh, yeah. Yeah, they think that this is like the number one thing that determines whether someone's autistic. It's like 70 to 90% of it. So Brian's team wanted to know, could that be part of the story too? And that's sort of tricky to sort out. Like ideally, you'd look at identical twins, right? And expose one to acetaminophen in the womb and then see if there's like a difference in autism rates. I guess. I don't know how you would do that. Yeah, exactly. You can't do that.

• 20:43Speaker 00

  Um, but there is another way to get at this. They could look at siblings in their data.

• 20:50Speaker 07

  What if we did this within the same family unit? So basically, kids born to the same mom, but during one pregnancy, the mom used acetaminophen and the other pregnancy, uh, the mom didn't, right? So then you control at least partially for genetics.

• 21:08Speaker 00

  Yeah, that's great. So Brian's team looked in their giant Swedish database and gathered thousands of cases like this. They crunched the numbers and here's what they found.

• 21:19Speaker 07

  Everything flatlined in terms of, uh, risk. Every, you know, what was already, uh, very minimal increase in risk just flatlined to absolutely no difference in risk for a child who is exposed.

• 21:34Speaker 00

  No increased chance of autism.

• 21:36Speaker 07

  No increased risk for autism, for ADHD, for intellectual disability. It was just a pure flatline.

• 21:43Speaker 00

  Hmm. Yeah, so what this means is that within a family, whether or not the mom took acetaminophen, the chance that her kid was autistic was the same. So can you put this all together for me? Like what?

• 21:57Speaker 05

  What's going on here exactly?

• 21:58Speaker 00

  Okay, yes. So the more I learned about this, the more I realized that there could be a completely different explanation for why acetaminophen and autism might seem like they're linked. Because like, if you imagine, like, say you're a mom of an autistic kid, that means that you're also more likely to be on the autism spectrum yourself, right? You probably have some of these autism genes too. And being on the spectrum, having some autistic traits, that's actually been linked to having more pain when you're pregnant.

• 22:32Speaker 05

  What?

• 22:33Speaker 00

  It's also been linked to having migraines. Yeah.

• 22:36Speaker 05

  Oh.

• 22:37Speaker 00

  And so like, we have these reasons why people on the spectrum might be more likely to take acetaminophen. So maybe that's why it's looking like it's the medicine causing the autism. But we have a way of explaining all of this without blaming the acetaminophen at all.

• 22:53Speaker 05

  So, all right, so this is like a classic, sort of red herring, science story.

• 22:57Speaker 00

  Yeah.

• 22:58Speaker 05

  So like, it looked like it was this one thing, but it's actually that one thing is associated with this other thing, that it was sort of covering up.

• 23:06Speaker 00

  Mm-hmm. Yeah, that could really be what's going on here. I mean, it would be like, if you looked at your chance of playing outdoor pickleball, that might go up along with how likely you are to have had ice cream recently. But really, both of these things are just linked because it's warmer outside.

• 23:29Speaker 05

  Uh-huh. Yeah, exactly, that's what I mean.

• 23:33Speaker 00

  Yeah.

• 23:34Speaker 05

  It's like, they're not directly influencing the other, it's just like, they're both responding to the same third variable.

• 23:39Speaker 00

  Yes, there's a third variable, exactly.

• 23:42Speaker 05

  Okay, classic.

• 23:43Speaker 00

  That's what it seems like to me. But there is still like, a back and forth here, a bit of a nerd fight, like

• 23:51Speaker 05

  Uh-huh.

• 23:52Speaker 00

  Other researchers saying Brian's study isn't perfect either, and there are still reviews coming out that say there is a link between acetaminophen and stuff like autism.

• 24:02Speaker 05

  Mm-hmm.

• 24:02Speaker 00

  So I asked Brian about these studies. I guess like, normally I would trust a meta-analysis, looking at a bunch of studies over Like a couple of studies here and there saying something else. Like, why should I trust your study more than this meta-analysis?

• 24:19Speaker 07

  So, one of the fun things with the meta-analysis is that it's a garbage in, garbage out kind of a thing. You can feed it garbage, but your meta-analysis is not going to turn this garbage into something beautiful. You can repeat the wrong thing many times in completely different samples and get the same wrong results in every single sample.

• 24:45Speaker 00

  And yeah, it's not like he's saying that these are all terrible scientists, but more that these reviews are mostly looking at studies that didn't have that genetic stuff. Like, they couldn't look at siblings. They just didn't have that data. And so they couldn't do what Brian's team did. But Brian's study, it's not the only one that did do that kind of like sibling analysis. And so like, there was one that just came out a couple of weeks ago from Japan that did the same thing, and it backed up Brian's study.

• 25:20Speaker 05

  Okay, so given all that, what do you make of all this? Like, if you were pregnant right now, would you take Tylenol?

• 25:29Speaker 00

  Well, for the autism question, I do find studies like Brian's to be the most convincing. Like, I don't think there's a clear link here. And even to go back to those other concerns around Tylenol, like that idea that it might be a hormone disruptor.

• 25:45Speaker 05

  Oh, the undescended testicles.

• 25:47Speaker 00

  Exactly. What about the undescended testicles? And to go back to those, those studies on the undescended testicles are super mixed. So like, some studies will find a link there, other studies don't. And Actually, the most recent review that I could find on this said that most studies don't find more undescended testicles in babies exposed to acetaminophen in utero.

• 26:11Speaker 05

  So even the, the thing that started this whole suspicion of acetaminophen during pregnancy off, that has actually a pawn for their investigation, not really borne out. Like, there, there might not actually be a link there either.

• 26:24Speaker 00

  No, yeah, exactly. And a bunch of big medical groups agree here. They say that we don't have evidence that taking acetaminophen during pregnancy causes autism or issues with the development of the fetus, like the FDA, regulators in Europe, a big group of OBGYNs. But like, yeah, just in case if I did take acetaminophen, I'd try not to take it for like weeks at a time. Because generally, some of the studies that do find risks, only find them if you take acetaminophen for like longer periods of time.

• 27:00Speaker 05

  It also depends, I guess, on what you're taking it for. I mean, I'm not a, I'm not a, this is not medical advice, but it does make me wonder, like, if you have a high fever.

• 27:11Speaker 00

  Yeah.

• 27:12Speaker 05

  That might be worse for the fetus than the like infantismal risk of some Tylenol on their brain development, right?

• 27:20Speaker 00

  Yes, actually, that's true too. So having a fever when you're pregnant, we know that ups the chance for lots of serious stuff, like birth defects for the kid, heart malformations, premature births.

• 27:32Speaker 05

  Uh huh.

• 27:33Speaker 00

  And fevers also happen to be linked to a kid being autistic later.

• 27:37Speaker 05

  Oh. Uh huh. Okay, that's very interesting and fairly satisfying, actually.

• 27:44Speaker 00

  Yeah.

• 27:45Speaker 05

  All right.

• 27:46Speaker 00

  And by the way, we did reach out to the company that owns Tylenol, and they sent us a big statement pointing to some of the science that we've talked about. And they said, quote, "We continue to believe that taking acetaminophen does not cause neurodevelopmental disorders, including autism," unquote.

• 28:03Speaker 00

  And for Brian's part, he really doesn't think the science supports the idea that taking a little Tylenol when you're pregnant makes the kids later become autistic or have ADHD.

• 28:12Speaker 07

  Like, taking off my epidemiologist hat and just, you know, as a person hat, like, blame is damaging. It's harmful. And it doesn't exactly help. People might be blaming themselves for, like, that one random Tylenol they took when, you know, they were pregnant 10 years ago. And, you know, if we can help, you know, take away some of that guilt that's there, I think that's, that's nice, because people shouldn't be feeling guilty about these things in the past.

• 28:41Speaker 00

  Yeah, feel guilty about something else. Go back to feeling guilty about eating lunch meat. Yeah. All right. Well, thanks, Rose. Thanks, Meryl. That's Science Versus.

• 28:54Speaker 00

  All right. Rose, do you want to ask me how many citations I have in this episode? Oh, yeah, Meryl. How many citations do you have in this episode? We have 59 citations. Woo! So if you want to see all the science that went into this episode, check out the transcripts. You can find links to that, which has all these beautiful citations in the show notes. And we did reach out to the US Department of Health and Human Services about this, and a spokesperson said, quote, "Until we release the final report, any claims about its contents are nothing more than speculation," unquote. And if you want to learn more about autism, check out our other episode on this, called Autism: The Real Reason It's Going Up. And if you want to tell us what you think of this episode

• 29:37Speaker 00

  or have episode ideas, reach out to us. Our Instagram is science underscore VS.

• 29:50Speaker 00

  This episode was produced by me, Meryl Horn, with help from Rose Rimler, Michelle Deng, and Akedi Foster Keys. We're edited by Blythe Sorrell. Mix and sound design by Bumi Hidaka. Our executive producer is Wendy Zukerman. Fact checking and consulting by Erica Ikiko Howard. Music written by Peter Leonard, Bobby Lord, So Wiley, Emma Munger, and Bumi Hidaka. Thanks to all the researchers that we spoke to for this episode and our other episode on autism. Science Versus is a Spotify Studios original. Listen for free on Spotify or wherever you get your podcasts. And if you do listen on Spotify, follow us and tap the bell for episode notifications.

• 30:31Speaker 04

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• 31:13Speaker 04

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• 31:54Speaker 04

  Call 1-800-545-5979, or visit zepbound.lily.com.

• 32:03Speaker 04

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