President Trump told the American public on Monday that Tylenol use during pregnancy causes autism, a claim that contradicts established science. The next morning, I asked a community of women physician experts for their reflections on this announcement. I quickly received more than 100 responses.
Their reflections highlight a serious concern: when political leaders promote medical conclusions that deviate from those of frontline clinicians and governing health organizations, such as American College of Obstetricians and Gynecologists and Society for Maternal-Fetal Medicine, the public is left navigating uncertainty, skepticism and potential harm.
Here is a selection of expert opinions from board certified physicians, arranged by theme.
Misunderstanding the Increase in Diagnosis of Autism
One assumption is that the rise in autism diagnoses reflects an increase in incidence. However, there are likely other causes.
“The increase in autism diagnoses is in part due to the increased understanding we have of level one autism. Physician training is improving. Child and adolescent psychiatrists and pediatricians used to be the only physicians trained in diagnosing and treating autism,” said psychiatrist Dr. Nicole Pavlatos-Delavoye. She believes that as the healthcare system witnesses autistic patients age, adult psychiatry and other fields are more active in the diagnosis and care of this population.
Erosion of Physician-Patient Trust
Safe and effective care depends on trust within the physician-patient relationship. The entire medicine system relies on patients believing that their physician prioritizes compassionate, evidence-based care.
Dr. Jill Steinsiek, a family physician, echoed those concerns. “These issues are eroding the physician-patient relationship,” Steinsiek said. “A relationship that I think is important for healing, preventive healthcare, education and public health.”
“As an oncologist, I witness every day how patients struggle with skepticism around treatments, like chemotherapy, which can be life-saving but is often feared for its harshness,” said Dr. Maria Borrero, a medical oncologist. She fears that if patients begin to panic over a basic and familiar medication, like Tylenol, trust can weaken further.
The Spread of Misinformation, Disinformation and Malinformation
Misinformation is false information shared without intent to harm. Disinformation is false information shared with the intent to harm. Malinformation is true information shared out of context or exaggerated to cause harm.
“We are in an era where information is readily available to anyone, anywhere, but that doesn’t make it credible, reliable, accurate. I know there has been so much misinformation, but worse is disinformation and malinformation,” noted pediatrician/neonatologist Dr. Dena Hubbard. “It’s a very confusing time for patients, and a devastating time for physicians.”
“In a climate where fear and outrage drive attention, misleading narratives can be powerful tools to mobilize supporters, distract from failures or undermine trust in institutions,” said Dr. Shikha Jain, a medical oncologist. “It’s happening because misinformation spreads faster than facts, and correcting it rarely gets the same traction.”
Oversimplifying the Causes of Autism
A major objection to the recent claim that Tylenol causes autism is that autism is known to have multiple contributing factors. Scientists have long explored the increased risk of autism based on genetic variation.
“There is no single cause of autism. There is no evidence that Tylenol nor vaccines cause autism. There is evidence that fevers in pregnancy can be harmful to the fetus,” added Dr. Chandani DeZure, a neonatal and developmental medicine pediatrician.
“Correlation is not causation,” added neurologist Dr. Robin Conwit. “Genetics and other factors must be taken into consideration.”
The Role of Policymakers Versus Physicians
Becoming a physician involves rigorous education and training. Developing expertise requires immense dedication, and applying evidence judiciously in patient care is a complex skill.
“Pause, breathe and think with your rational brain — should I listen to my pediatrician who knows my baby/child/adolescent and has studied, learned, practiced medicine or reality TV, influencers, politicians?” advised neonatologist Dr. Dena Hubbard. “Who has my child’s best interest at heart? When you have your next health emergency, are you going to Washington D.C., White House, Congress for medical care? Or are you going to the ER?”
“If America is the best, then why are we not listening to our best?” added Dr. Erica Hailey, a neuroimmunologist. “Medicine should be practiced by physicians, scientists and others trained in data analysis and statistics, not lawyers and politicians,” she says. She states that funds are needed for research and clinical triads and that senior leadership in the NIH and CDC should be experts in research, “not fake emergencies and false promises.”
Undermining Scientific Evidence and Medical Expertise
The academic research publication process is rigorous and highly selective. Studies, particularly those on controversial topics, undergo careful peer review to evaluate methodology, data quality and interpretation prior to publication. Misinterpreting any published research, however, increases the risk of patient harm.
“The body of literature, including most recent well-controlled studies, does not support a causal link between acetaminophen use in pregnancy and autism in children,” added Dr. Amelia Sutton, a maternal fetal medicine and medical genetics OB-GYN.
“The April 2024 JAMA paper should really have put this issue to bed,” said Dr. Emily Koeck, a trauma/critical care surgeon. “Yes, it’s retrospective, but prospectively collected data and the study design is excellent. They looked at 2.5 million children over almost 30 years. Use of sibling controls entirely wiped out any association between acetaminophen and autism because autism is the result of a complex array of genetics.”
“It won’t change my prescribing practices for Tylenol since Tylenol is one of the only medications that women can actually take safely during pregnancy,” said Dr. Onyeka Otugo, an emergency medicine physician. “Pregnancy is a difficult time for a lot of women and their pain and fevers should be treated. Correlation does not equal causation.”
Casting Blame on Patients
Phrases like “tough it out” place undue responsibility on pregnant patients to endure pain or fever, inadvertently stigmatizing those who take Tylenol. This framing overlooks the complex physiological and pathological processes of pregnancy.
“These types of gut reactions to poor science are steeped in misogyny. Such as Trump’s statement, ‘just let women tough it out,’” added OB-GYN Dr. Ashely Renee.
“This morning I’ve gotten questions like — should I tell my daughter not to take Tylenol? I took Tylenol and my child developed autism. Is this my fault? The environment this administration is creating in healthcare and public health is toxic — continuing to feed the misinformation machine,” said Dr. Jenny Flaim, a radiologist.
“As a psychiatrist who sees pregnant and postpartum patients, many of whom struggle with postpartum anxiety, I can only imagine this misinformation, regarding one of the most widely used medications in pregnancy, will negatively impact mental health outcomes,” added Dr. Kimberly Elizabeth.
Overlooking the Risks of Untreated Fever
Fever caused by an infection should be addressed. There is ample evidence to the risks in both animal and human studies.
“We have strong data that fever in pregnancy is associated with a higher risk of autism. The 2018 Nature study is possibly the strongest evidence yet,” said OB-GYN Dr. Melissa Ackerman. So if we “don’t treat the fevers in pregnant moms, the autism rate may really increase.”
“Fever during pregnancy, especially in the first trimester, is associated with neural tube defects, oral clefts and congenital heart defects. It’s also associated with fetal growth restriction and giving birth to a ‘small for gestational age’ neonate,” added Dr. Amanda Horton, a maternal fetal medicine OB-GYN. “In labor, maternal fever can be associated with the development of hypoxic ischemic encephalopathy (HIE). Fever in pregnancy has also been linked to neurodevelopmental disorders.”
“When individuals without medical training offer recommendations that contradict evidence-based guidance of qualified healthcare professionals and scientists, it places patients at risk and undermines the trust essential to the doctor-patient relationship,” added OB-GYN Dr. Colleen W. Cardella.
Recognizing the Limits of Current Research
No research study is perfect or answers every possible question. It is important to understand not only the strengths of a study but also its limitations. Recognizing these limitations helps determine how findings can be applied in the real world and guides future research aimed at addressing unresolved gaps.
“I am the past president of the International Federation of Gynecology and Obstetrics (FIGO) and past president of ACOG,” said OB-GYN Dr. Jeanne Conry. “The research on some pesticides, air pollution, phthalates is more compelling than the research referenced today. Extensive Swedish study suggests associations are related to unmeasured familial confounding factors — meaning association not causation. Women are not just randomly “popping pills” they are treating fevers, autoimmune disorders, surgery.”
“It would be extraordinarily difficult to tease out an actual causative link when you take into account all of the prenatal and post birth exposures you would need to control for,” said Dr. Erin Habecker, an OB-GYN and perinatal psychiatrist. She adds that since many pregnant patients take Tylenol, there should be a strong causative signal if Tylenol was the major culprit.
“What we do know is that there are over 100 genes that have been identified to cause autism and studies showing strong family links,” said pediatrician Dr. Erin Duchan. She supports searching for other causes but warns that, “reinventing the wheel of things proven not to cause autism (vaccines, thimerosal, acetaminophen, etc.) is not the solution.”
While patient education is important to us, it is equally important to be cautious about misinformation, disinformation and malinformation. The safest approach, when seeking more information, is to talk with your physician about what care is right for you. As shown here, the medical community is largely aligned on the safe use of Tylenol during pregnancy.