Last September, President Donald Trump and Robert F. Kennedy Jr. claimed that women using acetaminophen, best known as the brand name drug Tylenol, during pregnancy could be raising their children’s risk of autism. Many outside scientists quickly denounced the claim as based on weak evidence. Research out this week, however, shows at least some doctors and pregnant women have since heeded Trump’s warning to stay away from the over-the-counter pain and fever medication.
Scientists studied the medical records of people across the U.S. who visited emergency departments or outpatient clinics last year. They found the use of acetaminophen among pregnant women in the ER dropped following the Trump announcement. Meanwhile, prescriptions of leucovorin for children, a drug now touted as an autism treatment by the White House with little supporting data, rose during the same time.
“Although causal claims cannot be made, the observed associations are consistent with influence of new FDA recommendations on clinical decisions,” the authors wrote in their paper, published Thursday in the Lancet.
The Tylenol scapegoat
RFK Jr. and other health officials have been somewhat restrained in blaming acetaminophen (widely called paracetamol outside of the U.S.) for autism, noting that more research is needed to show a causative link. Trump certainly hasn’t been, though. At the September press conference, he repeatedly told women to immediately stop using acetaminophen, even yelling at times. The administration has also stated it would soon take regulatory action, such as adding a warning label to acetaminophen products.
Some studies have suggested a possible link between maternal acetaminophen use and autism, but many others haven’t. Two recent reviews of the data, including one published this January, have failed to find compelling evidence for any cause-and-effect connection. Given Trump’s bully pulpit, though, and his enduring popularity among a segment of the country, it’s certainly possible that some people listened to his advice.
The study researchers examined data from Cosmos, a database representing over 200 million patient records collected from health care systems in the U.S. and other countries. They focused on U.S. patient data in the three months before and after the September autism announcement, looking at orders of acetaminophen for pregnant women in the ER. They also tracked outpatient prescriptions of leucovorin, a drug that Trump and health officials first endorsed as a treatment for autism at the September announcement.
Following Trump’s declaration, ER orders for acetaminophen among pregnant women dropped by about 10%, the researchers found. Acetaminophen orders didn’t decrease among non-pregnant women, nor did orders for opioids, supporting the idea that this diktat only affected the maternal use of acetaminophen. They also found that outpatient prescriptions of leucovorin increased by 71% relative to before the Trump announcement.
The ripple effects
Of course, acetaminophen is widely taken outside the ER, so it’s still unclear how its use in general might have changed nationwide. The researchers also note their study can’t tell us how much of this change is due to pregnant women turning down the drug as opposed to doctors deciding to not order it for their pregnant patients.
“[N]onetheless, they show the apparent power that public authority figures have to drive sudden changes in health-care practices,” they wrote.
There is perhaps some good news. ER orders for acetaminophen began to rise from late November into early December, the researchers found. It’s possible, then, the Trump effect waned over time, especially as more and more health organizations denounced the autism link. That said, the winter is also cold and flu season, so the increased orders may only reflect a seasonal trend.
Obviously, more study is needed to know how the Trump announcement may have changed maternal acetaminophen use in the U.S. But should it continue to dip, it could have serious long-term ramifications for the health of women and their children, the researchers say.
“There are multiple potential consequences from these changes, including higher incidence of untreated fevers (a risk factor for neurological disorders) and use of antipyretic or analgesic medications that are less safe in pregnancy than paracetamol, which is safe to use during pregnancy,” they wrote.
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