What To Try First
Trying non-medicinal options is a good start, like rest, ice, or heat as appropriate, but sometimes, your best bet at pain relief is from pain relievers, also called analgesics. Tylenol , which is commonly used by expectant mothers, is considered to be generally safe in pregnancy for all three trimesters.
There are numerous other over-the-counter medications available, but many of these, including aspirin, Advil , and Aleve , are not always safe in pregnancy because of potential complications for you and your baby. Generally, aspirin should be avoided for most expectant women throughout pregnancy, and ibuprofen and naproxen are contraindicated after 20 weeks of gestation.Low dose aspirin may be prescribed during pregnancy to help reduce the chance of developing preeclampsia in women at increased risk of this pregnancy complication.
It is not considered safe to take ibuprofen or aspirin in pregnancy unless prescribed by your doctor or midwife.
The Epidemiological Evidence Of Neurodevelopmental Effects
Two notable studies overcame some of the important limitations of earlier studies. A 2021 study evaluated the association between levels of APAP metabolites in umbilical cord plasma and physician-diagnosed childhood ADHD, ASD and other developmental disabilities, using data from the Boston Birth Cohort. Cord plasma APAP metabolite concentrations in the first tertile compared with the second and third tertiles were associated with a more than twofold higher odds of an ADHD diagnosis and up to a threefold higher odds of an ASD diagnosis. Sensitivity analyses and subgroup analyses found consistent associations between APAP metabolite concentrations and ADHD and ASD across strata of potential confounders, including maternal indication, substance use, preterm birth, and child age and sex.
Present biomarker studies are not without limitations in the assessment of exposure. For example, present standard targeted methods are based on analysing free APAP and phase II conjugates after enzymatic deconjugation. This method captures only part of the metabolic pathway and leaves a fairly short window to assess APAP due to its short half-life ,,, which can lead to underestimation of actual exposure. Thus, a 2021 study suggested that biomarkers identified with standard methods used in biomonitoring are inadequate for human biomonitoring of a non-persistent chemical such as APAP and result in underestimation of actual exposure.
Is Acetaminophen Safe During Pregnancy
If you have a fever or if pain is disrupting your daily life during pregnancy, its OK to take acetaminophen occasionally, says Dr. Zanotti. We just dont want you taking acetaminophen every day or long-term.
Should you need pain relief while youre pregnant, discuss your options with your physician. For some conditions, limited amounts of acetaminophen might be your safest bet.
The Experimental Evidence Of Neurodevelopmental Effects
Experimental animal studies have suggested that perinatal APAP exposure, even at low therapeutic doses, increases the risk of brain and behavioural abnormalities in rodents,,,,,,,, supporting the epidemiological evidence . A 2019 study suggested that APAP enters the developing rat brain and cerebrospinal fluid in higher amounts than the adult brain. Long-term fetal exposure resulted in even higher transfer rates than short-term exposure, which might lead to accumulation of APAP in the fetal brain. Consistent with the epidemiological data, studies have demonstrated that the strongest effects of long-term use and exposure occur at a time equivalent to the beginning of the third trimester of pregnancy and the time around birth in humans,.
As with reproductive studies, inconsistencies between studies might relate to factors such as species, strain, age, dose, duration of exposure, and route and schedule of administration. However, a particular obstacle is the difficulty in translating human outcomes, such as ADHD and ASD, to behaviour in an animal model. Future studies should include evaluation of brain and behavioural effects in higher order species, from both prenatal and early life exposure, for specific indications and exposure windows.
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ACOG and obstetrician-gynecologists across the country have always identified acetaminophen as one of the only safe pain relievers for pregnant individuals during pregnancy, said Zahn. This consensus statement, and studies that have been conducted in the past, show no clear evidence that proves a direct relationship between the prudent use of acetaminophen during any trimester and fetal developmental issues, he added.
Acetaminophen can interfere with hormones and therefore potentially fetal development and the statement authors suggest that use of the drug may affect neurological, reproductive and urogenital systems, although the exact way in which the drug is proposed to do this is unclear.
“Neurodevelopmental disorders, in particular, are multifactorial and very difficult to associate with a singular cause. The brain does not stop developing until at least 15 months of age, which leaves room for children to be exposed to a number of factors that could potentially lead to these issues, said Zahn.
The study authors hope to conduct more research on the topic and say that there may be many mechanisms underpinning their conclusions which can be difficult to untangle, but in the meantime urge greater caution about acetaminophen use during pregnancy.
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Whats A Pregnant Person To Do
The good news is, theres no clear evidence between acetaminophen and fetal development, and many experts say it can still be used when necessary . This is important to know, because, as Tali Bogler, family doctor and low-risk obstetrics provider, Chair of Family Medicine Obstetrics at St. Michaels Hospital in Toronto, and co-founder of PandemicPregnancyGuide on Instagram points out, some pregnant people will endure pain because theyre scared to take medication if they think its unsafe.
Keeping acetaminophen as an option for pain and fever in pregnancy is important because Bogler says there arent many other safe choices to treat them.
Nonsteroidal anti-inflammatory drugs , like Advil, are sometimes required, note the SOGC, in the case of a serious illness that requires an anti-inflammatory medication, but they advise theyre to be used with caution. Some reports have suggested use in the second half of pregnancy might affect the kidney of the developing baby, they say. NSAIDs in later pregnancy may also cause closure of a small blood vessel that normally closes after birth, the ductus arteriosus. Closure of this vessel before being born could lead to complications with the babys heart and lungs that may have serious consequences. Because of these concerns, the SOGC suggests using NSAIDs should be discussed with your healthcare provider.
Tylenol Use During Pregnancy
There have been a lot of headlines in the newspapers and television news segments discussing the link between Tylenol use in pregnancy and attention deficit hyperactivity disorder in children. Just as another recent association study released earlier this year involving induction of labor and autism, this study has led to many questions from our patients. As we suggested with the last association study, association does not mean causality. So lets look at the data before we withhold Tylenol from pregnant women with fevers or teething babies.
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Natural Ways To Relieve Pain During Pregnancy
As much as the health professionals in the studies above advise against taking acetaminophen for pain during pregnancy, pregnant women still need other safe medications and remedies that ease the pain.
Some of the discomforts that pregnant women struggle with from the first trimester to the third that may warrant them needing pain relievers are
- Backaches and pains.
- Moderate pain in the uterus.
- Headaches and migraine.
- Reducing high fever.
Besides using Tylenol to treat pain as maternal-fetal medicine for the reasons highlighted above, there are other medications you must also avoid.
The first group is non-steroidal anti-inflammatory medicines , widely used to treat pain and swelling. Ibuprofen , aspirin, and naproxen are examples of over-the-counter NSAIDs. These could potentially result in miscarriage when taken before 20 weeks. And after 20 weeks, it may cause kidney issues.
So to anyone asking themselves, can you take Aleve while pregnant? The answer is no!
The other group to avoid during pregnancy are opioid painkillers like Codeine, Hydrocodone , and Meperidine . These raise the risks of miscarriages, premature birth, and neonatal abstinence syndrome when a child is born dependent on a substance.
Instead of using Tylenol or any of the above while pregnant, here are natural ways that doctors may suggest and are safe during pregnancy to relieve pain:
Apap Is An Endocrine Disruptor
Chemicals that disrupt the endocrine system are concerning because they can interfere with the activity of endogenous hormones that are essential for healthy neurological, urogenital and reproductive development,,. APAP is known to readily cross the placenta and bloodbrain barrier,. During pregnancy, changes occur in APAP metabolism, which might make pregnant women and their fetus more vulnerable to toxic effects. For instance, the molar dose fraction of APAP that is converted to the oxidative metabolite N-acetyl-p-benzoquinone imine might be increased during pregnancy,.
In vivo, in vitro and ex vivo studies have shown that APAP directly perturbs hormone-dependent processes, including inhibition of androgen production and increased oestrogen production, disruption of steroidogenesis, depletion of sulfated sex hormones, perturbation of immune function, induction of oxidative stress and indirect activation of the endocannabinoid system,,,,,,. Independently of APAP, these processes have been implicated as mechanisms related to the development of neurodevelopmental,,,,,,,,,, and reproductive disorders. In addition to potential effects on neuronal and reproductive development, a combination of clinical studies together with experimental work in animal models and cell lines has also suggested that APAP exposure during pregnancy might decrease fetal haematopoietic stem cell numbers alter steroidogenesis in the placenta and induce placental damage,,,,.
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Can I Take Tylenol Pm While Pregnant
Most of the over-the-counter medications that you usually take are perfectly safe even during pregnancy but because there are some exceptions, you should always talk to your doctor before you take a medication while pregnant, whether it is over-the-counter, prescription or even an herbal remedy. You should also remember that vague symptoms that are normally fine to ignore may indicate serious complications during pregnancy. Before you take any over-the-counter medications, talk to your doctor and go over your current medications as safe medications may cause complications when interacting with other medicines. One of the concerns of pregnant women is that Can I take Tylenol PM during pregnancy?.
Professional Medical Societies Response
The American College of Obstetricians and Gynecologists says its guidance on acetaminophen use during pregnancy remains the same: Using acetaminophen is safe during pregnancy after talking with your provider because there is no clear evidence of a direct relationship between acetaminophen and irregular fetal development.
ACOGs to the consensus statement also noted concern about the lack of options for safe pain relievers for pregnant patients.
The Society for Maternal-Fetal Medicine has not issued a direct response to the statement. But in 2017, its Publications Committee of articles relating to neurodevelopmental outcomes, especially ADHD, in children exposed in utero to acetaminophen. They agreed there was insufficient evidence of a causal relationship between these disorders and prenatal acetaminophen exposure.
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Pregnant Women Need Pain Management Solutions
Clinical trials on the pregnant population are notoriously lacking , and pain during pregnancy is especially understudied. However, we do know that severe pain during pregnancy, left untreated, could have dangerous consequences for the mother, including an increased risk of anxiety, depression and high blood pressure.
And if you happen to get a fever above 100.4Âº during pregnancy, reducing it is your best course of action, as prenatal fever is associated with an increased risk of neural tube defects and cardiovascular disorders in the fetus.
But other pain management options are limitedâor nonexistent. Nonsteroidal anti-inflammatory drugs such as ibuprofen come with an increased potential risk of miscarriage in the first half of pregnancy, as well as birth defects. Aspirin carries a risk of bleeding risks, and opioids come with serious risks of birth defects in the brain, spine or spinal cord.
More researchâand more optionsâare needed.
What Prompted The New Statement On Acetaminophen Use
Previously, the U.S. Food and Drug Administration had labeled acetaminophen as Category B, meaning no studies had demonstrated it caused birth defects in animals. Like many medications, no specific studies involving pregnant women were performed.
Recent research suggests that prenatal exposure to acetaminophen might alter fetal development and increase the risks of certain neurodevelopmental, reproductive, and urogenital disorders.
Acetaminophen can cross the placenta, meaning it can enter the fetal bloodstream through a patients blood when they take the medication. While this was considered harmless in the past, theres now concern that acetaminophen could act as an endocrine disruptor, potentially interfering with hormonal processes that influence the development of the babys nervous and reproductive system.
In some animal studies, acetaminophen exposure was associated with:
- Reduced androgens hormones that fuel the growth and development of male reproductive characteristics
- Irregular development of ovaries
Epidemiologic studies, which analyze patterns and causes of certain conditions in specific populations over a designated time period, also have indicated an association between prenatal acetaminophen exposure and reproductive or nervous system abnormalities.
Scientists observed the reproductive development of several children across the globe whose mothers had taken acetaminophen during pregnancy. Some studies suggested that:
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Paper Highlights Potential Risks Of Acetaminophen Use During Pregnancy
According to the authors of the statement, published September 23 in the journal Nature Reviews Endocrinology, research has emerged over the last several years that suggests it is possible for the drug to alter fetal development, which in some cases could result in neurological, urological, and reproductive disorders in the infant.
The group based their recommendations on a review of 29 studies that included the use of acetaminophen, 26 of which found evidence of birth defects.
In addition to reaffirming that Tylenol and any drugs that contain acetaminophen should only be used when medically necessary, the authors suggest that there may be evidence why there should be caution. These drugs may cause potential abnormal development in children who have been exposed prenatally, says Neale.
Because of that potential risk, the authors recommend that pregnant women should be counseled before or early in pregnancy with the following guidance:
- Avoid taking acetaminophen unless medically indicated.
- If you are uncertain whether use is indicated or you are considering taking acetaminophen long-term, consult with your doctor or pharmacist first.
- Take the lowest effective dose for the shortest possible time.
Acetaminophen And Language Delay
A new study published just yesterday adds another dimension to the potential hazards that acetaminophen may cause.
Shanna Swan, Ph.D. who is a professor of environmental and public health at the Icahn School of Medicine at Mount Sinai in New York City, NY and team studied early language development in children whose mothers took acetaminophen during the very early stages of pregnancy.
Writing in the journal European Psychiatry, Prof. Swan used data from the Swedish Environmental Longitudinal, Mother and Child, Asthma and Allergy study.
This included self-reported data on acetaminophen use in early pregnancy meaning between the point of conception and enrolment in the study, which typically occurred at 813 weeks of pregnancy.
The data also included a measurement of acetaminophen levels in the urine of all participants at enrolment. The results found that 59 percent of the 754 women in the study took acetaminophen during early pregnancy.
Language delay in children meaning the use of fewer than 50 words by the age of 30 months was assessed by specialist nurses and a follow-up questionnaire. The authors also explain in the paper that it is an early marker of impaired cognitive development.
In all, 10 percent of the children experienced language delay. This was greater in boys than in girls.
Acetaminophen use was not linked to language delay in boys in this study.
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Why Are We Just Learning This Now
There were major shortcomings in earlier research including the fact that all but two of the earlier studies relied entirely on data from questionnaires filled out, after the fact, by the participating mothers. The recollection of those women is no doubt far less than perfect, and their credibility is not assured.
The second major flaw in the studies protocols is the lack of any way to ascertain the dosage taken, the frequency that the dosage was taken, and for how long the medication was used during each pregnancy.
Is Acetaminophen Safe For Pregnancy Maybe Not
By Dr. Aliabadi Education Team on 01/13/22
Its an unfortunate fact of pregnancy that moms-to-be are guaranteed a plethora of pain and discomfort during their pregnancies. There will be headaches, fever, inflammation, muscle aches, and other varieties of pain, all ranging from mild to severe pain. Its not surprising that many pregnant women frequently take over-the-counter medications, such as ibuprofen and acetaminophen , on a fairly regular basis during gestation.
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When Should I Tell People I Am Pregnant
Most miscarriages occur during the first 12 weeks of pregnancy, so you may want to wait until this critical period is over before telling others of your pregnancy. However, it may be difficult to keep such a secret to yourself. If you have an ultrasound at 8 weeks of pregnancy and see a heartbeat, your chance of miscarriage is less than 2 percent, and you may feel safe sharing your news.
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Apap Use During Pregnancy Is Widespread
APAP is one of the most commonly used medications globally. In the USA, APAP is estimated to be used by up to 65% of pregnant women,. Worldwide, more than 50% of pregnant women are estimated to use APAP,,. APAP has long been considered an option by regulatory bodies such as the FDA and EMA for use in pregnancy for pain and fever when used as directed,, as NSAIDs are contraindicated for use in pregnant women in later pregnancy,. Pharmacotherapy during pregnancy involves a benefitrisk assessment, in which there is a tradeoff between the potential benefits to the mother and fetus and possible risks to the fetus. The FDA has formerly given APAP a B rating for use in pregnancy in all three trimesters, meaning that animal studies have failed to demonstrate any risks of congenital birth defects from fetal exposure and that no adequate and well-controlled studies have been performed in pregnant women. In addition, the EMA has found epidemiological data inconclusive and that experimental data do not meet their standards,.
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