By Dr. Mercola
Acetaminophen (brand name Tylenol) is one of the most widely used pain relievers, including among pregnant women.
Research published in the journal American Family Physician even called acetaminophen "the pain reliever of choice during pregnancy,"1 and U.S. Centers for Disease Control and Prevention data suggest 65 percent of pregnant women use the drug.2
Acetaminophen was most commonly used to treat pain, fever and flu symptoms among pregnant women in a recent study led by the Norwegian Institute of Public Health in Oslo.3
However, it's generally best to avoid any medications during pregnancy, including acetaminophen, unless they're absolutely necessary.
When used during pregnancy, even this "safe" over-the-counter (OTC) drug, researchers found, may be associated with an increased risk of asthma in children.
Prenatal Acetaminophen Exposure Linked to Asthma
Researchers analyzed data from the Norwegian Mother and Child Cohort Study, which includes 114,500 mother/child pairs. Both prenatal acetaminophen exposure and use of acetaminophen during infancy were associated with an increased risk of asthma at ages 3 and 7.
Children whose mothers had used acetaminophen during pregnancy were 13 percent more likely to develop asthma by age 3, and the more acetaminophen used by the mother, the greater the risk became.
The study also looked into whether the reasons behind acetaminophen use (pain, fever and flu) could be causing the asthma link, but the association remained even after accounting for these factors.
Women who reported using acetaminophen for more than one reason during pregnancy had children with the greatest risk of asthma at age 3.4
The researchers did not recommend that pregnant women or infants stop using acetaminophen, even though past research has also suggested an asthma connection.
For instance research published in Pharmacoepidemiology and Drug Safety in February 2016 also found acetaminophen use during pregnancy was associated with a modest increased risk for offspring asthma.5
Are Pain Relievers Safe During Pregnancy?
The findings raise questions about whether this widely used OTC medicine is actually as safe during pregnancy as women are being told.
Due to recent reports questioning the safety of prescription and OTC medicines when used during pregnancy, the U.S. Food and Drug Administration (FDA) recently looked into the issue.6 They looked into data regarding three widely used types of pain medications and potential associated side effects:
- Prescription nonsteroidal anti-inflammatory drugs (NSAIDs) and the risk of miscarriage
- Opioids and the potential risk of birth defects of the brain, spine or spinal cord
- Acetaminophen and the risk of attention deficit hyperactivity disorder (ADHD)
The FDA ruled that available data "prevented us from drawing reliable conclusions," and they decided to keep their recommendations on how pain medicines are used during pregnancy the same at this time. However, it's best to err on the side of caution when possible.
Acetaminophen Use During Pregnancy Linked to ADHD in Children
The potential link between prenatal acetaminophen exposure and ADHD came to light in 2014 after a study was published in JAMA Pediatrics.7
It included data from more than 64,000 mothers and children in the Danish National Birth Cohort. Over 50 percent of the women reported taking acetaminophen while pregnant, which was found to be linked to:
- A 30 percent increased risk for ADHD in the child during the first seven years of life
- A 37 percent increased risk of being diagnosed with hyperkinetic disorder (HKD), a severe form of ADHD
Behavioral effects appeared to be dose dependent. The more frequent the use of acetaminophen during pregnancy, the higher the offspring's chances of being diagnosed with ADHD-related problems.
Children of women who used the drug for 20 or more weeks during pregnancy had nearly double the risk of getting an HKD diagnosis. They also had a 50 percent greater chance of being prescribed an ADHD medication.
The researchers noted that "[r]esearch data suggest that acetaminophen is a hormone disruptor, and abnormal hormonal exposures in pregnancy may influence fetal brain development."8 As further reported by Forbes:9
"Acetaminophen can cross the placenta, making its way to the fetus and its delicate developing nervous system. The drug is a known endocrine (hormone) disrupter, and has previously been linked to undescended testes in male infants.10
Since the maternal hormone environment plays a critical role in the development of the fetus, the authors say that it's 'possible that acetaminophen may interrupt brain development by interfering with maternal hormones or via neurotoxicity such as the induction of oxidative stress that can cause neuronal death.'"
Prenatal Acetaminophen Exposure May Be Linked to Fertility Problems, Cancer in Boys
Along with asthma and ADHD, prenatal acetaminophen exposure appears to cut levels of testosterone in the womb, at least according to a study in mice. The animals were given doses of acetaminophen equivalent to a human dose.
While treatment for just one day did not affect testosterone levels, treatment three times a day for seven days did, cutting testosterone levels in the mice nearly in half.11 The finding is concerning, since most common male reproductive disorders are linked to lower testosterone exposure in fetal life.
It's thought that acetaminophen's interference with the development of the male reproductive system could not only lead to genital birth defects but also to infertility and testicular cancer.12
Unlike the U.S. FDA, which has refused to warn pregnant women about potential risks, The Royal College of Midwives suggested pregnant women talk to their health care providers before taking acetaminophen.
The Royal College of Pediatrics and Child Health said that prolonged use of the drug should be avoided by pregnant women. Carmel Lloyd of the Royal College of Midwives told the Daily Mail:13
"Ideally, women should avoid taking medicines when they are pregnant, particularly during the first three months … Minor conditions such as colds or minor aches and pains often do not need treating with medicines."
While the mouse study suggested only male fertility may be affected, a separate study published in Scientific Reports revealed that acetaminophen (or NSAID) use in pregnancy could also potentially affect fertility of resulting daughters and granddaughters.14
Accidental Poisoning Is Another Major Mechanism of Harm
Acetaminophen was the medication involved in the most accidental poisonings according to calls to poison control centers across the U.S. related to infants younger than 6 months old.15
The drug accounted for 22,000 medication exposures and close to 5,000 general exposures.16 Acetaminophen is often recommended for infants instead of alternatives like ibuprofen.
In fact, acetaminophen is the most common pain reliever given to U.S. children, and it's estimated that more than 11 percent of U.S. children take the drug during any given week.17 In adults, taking just a bit too much can have significant health risks, particularly for your liver.
Acetaminophen poisoning is responsible for nearly half of all acute liver failure cases in the U.S.18 Among adults, taking just 25 percent more than the daily recommended dose — the equivalent of just two extra strength pills per day — can cause liver damage after just a couple of weeks of daily use.19
Children metabolize acetaminophen differently than adults, and the risks of liver failure from too much acetaminophen are thought to be lower among children than adults.20 However, liver injury has been reported among children given repeated doses.21
N-acetyl cysteine (NAC) is an antidote for acetaminophen toxicity and is well worth knowing about if you ever use acetaminophen or keep it in your house. NAC is administered as part of standard care in cases of acetaminophen overdose.
While I generally do not recommend using acetaminophen-containing drugs for minor aches and pains, they are sometimes necessary to temporarily suppress severe pain, such as post-surgical pain. For those instances, I recommend taking it along with NAC.
If you have children and keep acetaminophen in your home, I strongly recommend keeping a bottle of NAC as well in case of accidental overdose. NAC therapy should be initiated within eight hours of an acute overdose for best results. If you suspect an overdose has occurred, seek medical help right away. If this isn't an option, the World Health Organization (WHO) recommends the following protocol:22
"Oral administration is the preferred route for NAC therapy unless contraindications exist (e.g aspiration, persistent vomiting). The usual recommended loading dose is 140 mg/kg followed in 4 hours by a maintenance dose of 70 mg/kg orally given every 4 hours.
This dosing is commonly recommended to be continued for 72 hours; however more recent clinical experience supports tailoring the duration of therapy to the patient's clinical condition."
Vitamin D-Rich Foods During Pregnancy Decrease Risk of Allergies in Children
A higher intake of vitamin-D-rich foods during pregnancy has been linked to a lower risk of allergies in children. The study found for each 100 IUs per day of food-based vitamin D intake during the first and second trimesters (equivalent to the amount of vitamin D in an 8-ounce serving of milk) was associated with about a 20 percent lower risk of developing allergies by school age.23
In this case, the use of supplemental vitamin D was not associated with the benefit, although it's unclear what type of supplemental vitamin D was studied. Other research suggests that vitamin D deficiency may be a primary underlying cause of asthma. Vitamin D will also help to upregulate your immune system, which may explain its potential role in allergies.
You can find some vitamin D in mushrooms, fish, eggs and dairy products, and there may be vitamin D in lesser-known food sources as well, like meat. However, when pregnant, you need a vitamin D level above 50 ng/ml to protect yourself and your baby from serious complications, such as premature delivery and preeclampsia.
You should have your levels tested and monitored during pregnancy and get appropriate sun exposure and take supplemental vitamin D3, if necessary, to reach optimal levels. I firmly believe optimizing your vitamin D during pregnancy is one of the most important things you can do for the health of your child. When a child is born deficient in vitamin D his or her health can be significantly affected in any number of ways.
Research confirms there is a lifelong impact of vitamin D deficiency in pregnancy ranging from not only childhood allergies and asthma but also colds and flu, dental cavities, diabetes, and even strokes and cardiovascular disease in later life.
Top Natural Acetaminophen Alternatives
Acetaminophen is so common that many people, including pregnant women, have become "blasé" about its use and its potential dangers.24 Before you reach for acetaminophen or any other pain-relieving drug, it makes sense to exhaust more natural options first — particularly for minor or tolerable pain. For instance, the Emotional Freedom Techniques (EFT) works very effectively for relieving pain and can be used safely for pregnant women and children.
No matter what your reason for taking acetaminophen, type it into the search box above and you'll likely find a natural alternative. Even if chronic pain is your problem, the following options provide excellent pain relief without any of the health hazards that acetaminophen and other pain relievers carry. If you're pregnant or breastfeeding, consult with your health care provider before taking any medications, herbs or supplements.
- Astaxanthin: One of the most effective oil-soluble antioxidants known. It has very potent anti-inflammatory properties and in many cases works far more effectively than many NSAIDs. Higher doses are typically required and one may need 8 mg or more per day to achieve this benefit.
- Ginger: This herb is anti-inflammatory and offers pain relief and stomach-settling properties. Fresh ginger works well steeped in boiling water as a tea or grated into vegetable juice.
- Curcumin: Curcumin is the primary therapeutic compound identified in the spice turmeric. In a study of osteoarthritis patients, those who added 200 mg of curcumin a day to their treatment plan had reduced pain and increased mobility.25 In fact, curcumin has been shown to have potent anti-inflammatory activity, as well as demonstrating the ability in four studies to reduce acetaminophen-associated adverse health effects.26
- Boswellia: Also known as boswellin or "Indian frankincense," this herb contains powerful anti-inflammatory properties, which have been prized for thousands of years. This is one of my personal favorites as I have seen it work well with many rheumatoid arthritis patients.
- Bromelain: This protein-digesting enzyme, found in pineapples, is a natural anti-inflammatory. It can be taken in supplement form, but eating fresh pineapple may also be helpful.
- Cetyl Myristoleate (CMO): This oil, found in fish and dairy butter, acts as a "joint lubricant" and an anti-inflammatory. I have used this for myself to relieve ganglion cysts and a mild annoying carpal tunnel syndrome that pops up when I type too much on non-ergonomic keyboards. I used a topical preparation for this.
- Evening Primrose, Black Currant and Borage Oils: These contain the fatty acid gamma linolenic acid (GLA), which is useful for treating arthritic pain.
- Cayenne Cream: Also called capsaicin cream, this spice comes from dried hot peppers. It alleviates pain by depleting the body's supply of substance P, a chemical component of nerve cells that transmits pain signals to your brain.
- Therapeutic modalities such as yoga, acupuncture, meditation, hot and cold packs, and even holding hands can also result in astonishing pain relief without any drugs.