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Topic: Why Is Good Medical Advice for Pregnant Women So Hard to Find?

A recent warning about the pain reliever acetaminophen is a reminder that health risks in pregnancy remain maddeningly, dangerously understudied.

If you have spent the pandemic calculating the potential costs and benefits of every action you might take — whether to travel, to work, to see family, to seek medical care — while fearing that a misjudgment will result in catastrophe, you have some idea of what it can feel like to be pregnant in the 21st century. Women have been warned that everything from fish to frozen yogurt, alcohol, coffee, X-rays and airplane flights can harm an unborn child. In most such cases, the reproductive risks “tend to be fairly small, if they exist at all,” says Anne Drapkin Lyerly, a professor at the University of North Carolina’s Center for Bioethics. But just the possibility of a negative outcome, however unlikely, can obscure what might be the greater benefits of the action or substance in question.

The challenge in weighing risks while pregnant is especially difficult when it comes to medications — “There’s a lot of uncertainty and fear,” Lyerly says. But women cannot forgo treatment for conditions like diabetes, depression or high blood pressure the way they can give up unpasteurized cheese.

Last month, Nature Reviews Endocrinology published a statement raising concerns about fetal exposure to an over-the-counter medication that 65 to 70 percent of pregnant women in the United States report having taken: acetaminophen, a pain reliever and fever reducer commonly sold as Tylenol. Left untreated, fever during pregnancy has been linked to an increased risk of a child having neural-tube defects and cardiovascular disorders later in life. In adults, severe and ongoing pain can lead to depression, anxiety and high blood pressure, all of which can also negatively impact fetal development. There are compelling reasons to treat these conditions.

But while nonpregnant adults have multiple options for combating fever and pain, for pregnant women, acetaminophen — also an ingredient in hundreds of other cold, flu, allergy and sleep medications — is considered the safest choice. The Food and Drug Administration has so far found no conclusive evidence of risk during pregnancy when used as directed. And the agency warns against a common alternative: nonsteroidal anti-inflammatory drugs, which include aspirin, ibuprofen and naproxen (sold as Aleve). In rare cases when used in the second half of a pregnancy, they can lead to fetal kidney problems and low amniotic fluid levels.

Despite the clear need for acetaminophen to be available during pregnancy, the 13 authors of the Nature Reviews statement (which was signed by an additional 78 scientists) argue that raising awareness about its potential negative effects could have public health benefits. They considered evidence from observational and experimental studies and found an association between fetal exposure to the drug and neurodevelopmental disorders (including autism and A.D.H.D.) and reproductive and urogenital disorders (including early puberty and decreased fertility). In randomized controlled trials in animals, acetaminophen appeared to cause similar outcomes. The drug can disrupt the endocrine system, potentially affecting the activity of hormones that help regulate fetal development.

Topic Discussed: Why Is Good Medical Advice for Pregnant Women So Hard to Find?

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