Scribble

Dr. Sanjay Gupta

00:00:04

Welcome to Paging Dr. Gupta. This is the show where I get to hear from you and hopefully provide you with some answers to your questions that are useful. On today's episode, we're going to address something that you've surely read or heard about by now.

President Donald Trump

00:00:18

First, effective immediately, the FDA will be notifying physicians at the use of acetah... well let's see how we say that... aceta...minophen, acetaminophen, is that ok? which is basically commonly known as Tylenol.

Dr. Sanjay Gupta

00:00:37

That, of course, was President Trump, and he was talking about a new warning by the U.S. Food and Drug Administration over the use of Acetaminophen, Tylenol, by pregnant women.

Dr. Sanjay Gupta

00:00:50

Now, what to do? What is the link? How strong is it? And what should people do moving forward? Let's get into a couple of your questions on the topic right after this break.

Dr. Sanjay Gupta

00:01:06

There's a lot of questions I came in this week, but I wanted to start off with some basics. Acetaminophen, also called paracetamol, primarily in Europe, is sold under the brand name Tylenol. You probably have some of it in your medicine cabinet right now.

00:01:22

'Now, it's important to note that acetaminophen is considered the only safe over-the-counter option for pain or fever for a pregnant woman. When it comes to things like aspirin or ibuprofen or non-steroidal anti-inflammatories, they carry known risks to the baby.

00:01:38

That is why many professional physician groups and public health organizations have long supported the use of Tylenol at the lowest dose possible for the shortest amount of time to be used during pregnancy.

00:01:51

And importantly, untreated fever during pregnancy can harm a growing fetus.

00:01:56

'Now, to be clear, the FDA warning does not tell women to stop taking acetaminophen, but rather says they should quote minimizing the use of acetaminophen during pregnancy for routine, low-grade fevers. Again, that has been the recommendations for some time now.

00:02:14

'The FDA also said there is no evidence of a causal relationship, meaning a cause-and-effect relationship between acetaminophen and autism.

00:02:24

Just want to tell you, we've been reporting on this potential association between Tylenol and autism for some time. Studies have been coming out for some 20 years now. And the way things often work is that you get a signal of something going on: 'Hey, we see increased rates of autism in women who say they took Tylenol during their pregnancy. Let's start to investigate that more.'

00:02:49

Those initial studies are typically not very good because you're essentially asking a woman who subsequently, years later, may have a child diagnosed with autism to try and remember did they take Tylenol when they were pregnant? If so, when did they take Tylenol? How much Tylenol did they take?

00:03:06

It can be hard to remember. That's the point I'm making here. These studies are really hard to do.

00:03:12

There are other studies that have been done that actually looked at cord blood, measured cord blood to try and figure out acetaminophen exposure at different times during pregnancy. And again, associations were seen there.

00:03:26

But associations are just that. When you have something that's as ubiquitous as Tylenol, you can associate it to just about anything.

00:03:35

As one of the study researchers said, in the hot weather, violent crime goes up. In hot weather, ice cream sales go up. Both those things are happening during hot weather. But they really probably have nothing to do with each other, even though they could be considered associated. That's the key word. Association here. Not cause and effect.

00:03:58

I will say there was an interesting study done out of Sweden published last year. They followed more than 2 million children born between 1995 and 2019. About 185,000 of them were born to mothers who used acetaminophen during pregnancy. They were then able to compare autism rates of these children with their siblings and with children who were not exposed, essentially creating a sort of genetic control group.

00:04:23

In that study, they found no associated increased risk of autism or other neurodevelopmental disorders in response to the use of acetaminophen. So look, there's all these various studies out there. We've heard from the president. We've hear from the FDA commissioner about this potential association. You've heard what the recommendations are. Again, really not different than what doctors have been recommending for some time.

00:04:50

'And before I get into your questions, I think it is important to note that anytime you think about taking a medication, whether it be a prescription medication or even an over-the-counter medication, you should be thoughtful about it. Do I really need to take this medication? Are there other options? And the same can be said when it comes to Tylenol, especially during pregnancy.

00:05:13

'Pregnant women are at risk of infections because your body is essentially immune-compromised for a period of time to help allow you to carry the baby. That is part of the reason women are at higher risk for infections, which can lead to fevers, which may lead to increased use of Tylenol.

00:05:32

Okay, Kyra is back with us. What's the first question?

Producer Kyra

00:05:36

Hi, Sanjay. Okay, so we've been getting a lot of calls and messages about this topic and one that really stood out came from Devon in Vancouver. Now they're wondering if this whole conversation should have been more focused on pregnant women who are used to taking Tylenol pretty regularly. So what do you think about that, Sanjay?

Dr. Sanjay Gupta

00:05:58

Yeah, look, I think this is the important point, Devon. There is a nuance here. One thing I will point out is that because of the concerns about Tylenol and its potential association with autism over the last 20 years now, what we have seen is that Tylenol use during pregnancy has actually gone down over the past decade, even as autism rates have gone up. That's just something you should note. Tylenol use going down, autism rates going up. What does that mean?

00:06:28

But I think your point is the right point. In certain situations, obviously Tylenol can be beneficial. You do not want to have a fever when you are pregnant. There can be a lot of harm from that. And yet at the same time, we don't want to overdo the use of Tylenol.

00:06:45

'Let me layer a little bit more nuance to this. There was a study out of Norway that found that children who were exposed to acetaminophen during pregnancy for 29 or more days, so roughly a month, had an increased risk of ADHD diagnosis, a two-fold increase in risk. Again, this is an association study.

00:07:03

'But what they also found was that women who took Tylenol for one to seven days during pregnancy actually saw a lowered risk of such problem in their babies. So treating fevers appropriately seems to have been protective, whereas taking perhaps too much Tylenol, taking it for more than a month, may have been problematic. So short-term use was better for the baby than leaving a fever untreated.

00:07:31

But when you get to a month or so of Tylenol use, that may potentially be problematic. Again, an association. But why are you taking the Tylenol? Why do you have a fever? What is the underlying infection if that's what's driving the fever? Making sure you address this in totality.

00:07:50

After the break, we're going to look at the risks specifically that fevers can present during pregnancy and what can be done to minimize them.

00:08:02

Okay, welcome back to Paging Dr. Gupta. Today, we are talking about the use of Tylenol during pregnancy and the risk of autism. Kyra, who do we have next?

Producer Kyra

00:08:13

Okay, and we also heard from Megan in New Mexico. And she brought up another really important angle and is curious about what risks of fever during pregnancy can pose both for the parent and the baby.

Dr. Sanjay Gupta

00:08:26

Okay, Kyra, thank you. And thank you, Megan, as well, because I think this gets to one of the biggest questions around the issue.

00:08:32

'Again, it is important to point out that acetaminophen is really the only safe option for pregnant women to treat a fever. There have been studies using aspirin and nonsteroidal anti-inflammatories, ibuprofen, and those all carry objective risks.

00:08:47

Acetaminophan is really a safe option, especially true if you have a temperature of 103 or higher in the first trimester. Why? Because a temperature that high can increase the risk of birth defects in the brain, the spine, and the spinal cord. Those are all organ systems that are developing around that time.

00:09:06

And if the body is not normothermic, of a normal temperature, that could affect the way those body systems actually develop. Cleft lip, cleft palate, they can also be affected by untreated fever. Congenital heart defects, early labor, and miscarriage.

00:09:20

People who had a fever just before or during early pregnancy were more than twice as likely to have a child with a neural tube defect than those who didn't have a fever. And there have even been some early studies that have found increased risk of autism from fever. The very thing that obviously this whole discussion is about in terms of what we're trying to prevent here. Keep in mind the average body temperature is around 98.6 degrees. And a lot of the studies on this topic have been done in women who are pregnant when their temperature reached 103 degrees.

00:09:53

Okay, Kyra, time for one more question.

Producer Kyra

00:09:56

Yeah, so last up we have Bill in Maine, who wants to know what steps someone could take to lower their chances of getting a fever while they're pregnant.

Dr. Sanjay Gupta

00:10:05

Alright, the steps you can take to minimize the risk of fever while pregnant are going to sound pretty basic. Keep your immune system up, wash hands, make sure you're getting enough sleep, be up to date on your vaccinations.

00:10:17

'Keep in mind again that women are essentially immune-compromised during the time they are pregnant. That helps allow them carry the baby successfully to pregnancy. Some of the most common reasons that women develop a fever while pregnant are ear infection, food poisoning, stomach virus, urinary tract infection, and of course respiratory viruses like COVID and the flu.

00:10:40

So making sure you get recommended vaccines and really taking care of yourself during this time to not expose yourself to potential pathogens seems to make a huge difference. If you do have a fever, talk to your doctor. They may likely suggest taking Tylenol, taking acetaminophen. Again: should not take aspirin or ibuprofen to lower your fever while pregnant.

00:11:03

'It is okay to take low-dose aspirin during pregnancy if your provider recommends it for something like preeclampsia.

00:11:09

But there's also other things you could potentially do like using cooling blankets if the fever is not that high.

00:11:16

Look, it's a confusing topic and I think it got a lot more confusing this past week. I hope we were able to clear up some of that confusion with today's episode.

00:11:25

'And thanks to everyone who sent in questions, we got, so many questions on this. We want to continue to hear from you. If there's something health related you've been wondering about, send it to us. We might answer it next week. Record a voice memo, email it to asksanjay at cnn.com or give us a call 470-396-0832 and leave a message.

00:11:46

Thanks for listening. I'll be back next Tuesday.

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