During this week’s White House press conference in which President Trump has appointed over -the -counter drugs as a possible cause of the increase in autism rates,, He did not let the words, urge pregnant women “Fighting like hell” so as not to take it.
But apart from these remarks in the room of Roosevelt – during which Trump himself recognized “I am not so cautious with what I say” – the discussion on common fever and the role of analgesics during pregnancy is much more nuanced.
What research on the use of tylenol during pregnancy really says
Doctors, researchers on the very studies cited in support of Trump’s position and even other members of the president’s administration are largely united on a few key facts: untreated fevers during pregnancy have real risks for the fetus, acetaminophen (the active ingredient of Tylenol) remains the safest drug to treat them and any advice on the question should consult their doctor.
“Everything we should ask for the medical profession [is] To actually weigh the risks and advantages for women, with women, and be careful about the chronic use of pain drugs, ”said Dr Bate RitzUCLA epidemiology teacher who co-author paper published last month that the White house quoted as proof of the link between Tylenol and autism.
Ritz said he was misinterpreted.
The conclusion of the article, which examined existing studies on the subject, was that the association between the use of acetaminophen during pregnancy and subsequent diagnoses of neurodevelopmental disorders in children was strong enough to deserve the consideration of doctors when determining the way of treating fever or pain during pregnancy. The group has not determined a causal relationship between the drug and autism, or suggested to completely jump the medication, she said.
“Looking at all these studies, yes, there is a risk,” said Ritz. “It is not very big, but it is there, but risk increases are more visible in regular users of Tylenol. She is not a woman who has a fever and takes three tylenols.”
“There is always a weighing of risks and advantages, and fever in women is not good either. … Not having to take pain medication when you suffer from intense pain or chronic pain is also very cruel,” she said. “We should all have an interest in helping here, making the right decisions without blaming the victim and putting everything on individual women.”
His co-author, the epidemiologist of the University of Massachusetts, Ann Bauer, made similar declarations.
“What we recommend is judicious use – the lowest effective dose [for] The shortest duration under medical orientation and supervision, adapted to the individual ”, Bauer said to the media Politico.
The confusing recommendations of the administration
In the end, this is also what the administration also recommends.
THE letter The fact that Dr. Marty Makary, an American director of food and drugs, sent doctors this week clearly indicated that a “causal relationship” between autism and acetaminophen “has not been established and that there are contrary studies in scientific literature”.
He continued to recommend that clinicians plan to limit their use of acetaminophen for low routine fevers during pregnancy, while noting that medical advice “should also be balanced with the fact that acetaminophen is the most sure over -the -counter alternative in pregnancy among all analgesics and antipyretics.” (An pain reliever is an analgesic; an antipyretic reduces fever.)
Untreated fevers during pregnancy are associated with higher levels of congenital malformations, especially those of the heart, brain and spinal cord; premature birth; low birth weight; neurodevelopmental disorders, including autism; And fetal death, said Dr. E. Nicole Teal, deputy professor of maternal-fetal medicine at UC San Diego.
“The FDA letter, although much more nuanced than the president’s comments on the issue, always gives too much weight to the results of poorly designed studies,” she said.
She said she would continue to prescribe acetaminophen to pregnant patients who need to treat fever or intense pain, as it has the least known risk during pregnancy.
Are there other pain reduction drugs and fever that can be used during pregnancy?
Non-steroidal anti-inflammatory drugs such as ibuprofen (often sold like Advil) or Naproxene (often sold as aleve) are linked to problems with the development of blood and renal vessels, as well as oligohydramnios, a condition in which there is not enough amino liquid to support a healthy pregnancy. Aspirin raises the risk of bleeding complications, and narcotics – which can relieve pain but not fever – pose risks of dependence for the mother and infants, said Teal.
She referred to a statement From the American College of Obstetricians and Gynecologists noting that two decades of research on the issue had not found a causal relationship between acetaminophen and autism.
“Acetaminophen is one of the few options available for pregnant patients to treat pain and fever, which can be harmful to pregnant people when they are left untreated,” said Dr. Steven J. Fleischman, Dr. Steven J. American Fleischman of Obstetricians and Gynecologists and Gynecologists statement.
The group too note reviewed in 2015 And 2017 FDA and society for maternal-fetal medicine, respectively, found no risk associated with the appropriate use of the drug during pregnancy.
How to navigate government communications around the use of Tylenol
Nevertheless, the mixed messaging of the Trump administration on Tylenol seems likely to continue.
The Ministry of Health and Social Services republished this week A 2017 tweet From the Tylenol brand account which said: “We actually recommend none of our products during pregnancy.”
A Kenvue spokesperson, the company that owns Tylenol, said the position had been put out of context and incomplete.
“In accordance with regulations, our label clearly indicates” if it is pregnant or breastfed “, ask for a health professional before use” “, said Melissa Witt in an email.” We do not make recommendations on taking medication during pregnancy, because it is the work of a health care provider. “
Vice-president JD Vance offered similar advice this week.
“My advice to pregnant women would be very simple, which follows your doctor. No?” Vance said in a interview With the release diary after Trump’s press conference. “Talk to your doctor about these things.”
