United States President Donald Trump has urged pregnant women to avoid paracetamol except in cases of extremely high fever, because of a possible link to autism.

Paracetamol – known as acetaminophen or by the brand name Tylenol in the US – is commonly used to relieve pain, such as back pain and headaches, and to reduce fever during pregnancy.

Australia’s Therapeutic Goods Administration today re-affirmed existing medical guidelines that it’s safe for pregnant women to take paracetamol at any stage of pregnancy.

Paracetamol is classified as a Category A drug. This means many pregnant women and women of childbearing age have long used it without increases in birth defects or harmful effects on the fetus.

It’s important to treat fevers in pregnancy. Untreated high fever in early pregnancy is linked to miscarriage, neural tube defects, cleft lip and palate, and heart defects. Infections in pregnancy have also been linked to greater risks of autism.

How has the research evolved in recent years?

In 2021 an international panel of experts looked at evidence from human and animal studies of paracetamol use in pregnancy. Their consensus statement warned that paracetamol use during pregnancy may alter fetal development, with negative effects on child health.

Last month a a group of researchers from Harvard University examined the association between paracetamol and neurodevelopmental disorders including autism and attention-deficit hyperactivity disorder (ADHD) in existing research.

They identified 46 studies and found 27 studies reported links between taking paracetamol in pregnancy and neurodevelopmental disorders in the offspring, nine showed no significant link, and four indicated it was associated with a lower risk.

The most notable study in their review, due to its sophisticated statistical analysis, covered almost 2.5 million children born in Sweden between 1995 and 2019, and was published in 2024.

The authors found there was a marginally increased risk of autism and ADHD associated with paracetamol use during pregnancy. However, when the researchers analysed matched-full sibling pairs, to account for genetic and environmental influences the siblings shared, the researchers found no evidence of an increased risk of autism, ADHD, or intellectual disability associated with paracetamol use.

Siblings of autistic children have a 20% chance of also being autistic. Environmental factors within a home can also affect the risk of autism. To account for these influences, the researchers compared the outcomes of siblings where one child was exposed to paracetamol in utero and the other wasn’t, or when the siblings had different levels of exposure.

The authors of the 2024 study concluded that associations found in other studies may be attributable to “confounding” factors: influences that can distort research findings.

A further review published in February examined the strengths and limitations of the published literature on the effect of paracetamol use in pregnancy on the child’s risk of developing ADHD and autism. The authors noted most studies were difficult to interpret because they had biases, including in selecting participants, and they didn’t for confounding factors.

When confounding factors among siblings were accounted for, they found any associations weakened substantially. This suggests shared genetic and environmental factors may have caused bias in the original observations.

Working out what causes or increases the risk of autism

A key piece to consider when assessing the risk of paracetamol and any link to neurodevelopmental disorders is how best to account for many other potentially relevant factors that may be important.

We still don’t know all the causes of autism, but several genetic and non-genetic factors have been implicated: the mother’s medication use, illnesses, body mass index, alcohol consumption, smoking status, pregnancy complications including pre-eclampsia and fetal growth restriction, the mother and father’s ages, whether the child is an older or younger sibling, the newborn’s Apgar scores to determine their state of health, breastfeeding, genetics, socioeconomic status, and societal characteristics.

It’s particularly hard to measure the last three characteristics, so they are often not appropriately taken into account in studies.

Other times, it may not be the use of paracetamol that is important but rather the mother’s underlying illness or reason paracetamol is being taken, such as the fever associated with an infection, that influences child development.

I’m pregnant, what does this mean for me?

There is no clear evidence that paracetamol has any harmful effects on an unborn baby.

But as with any medicine taken during pregnancy, paracetamol should be used at the lowest effective dose for the shortest possible time.

If you’re pregnant and develop a fever, it’s important to treat this fever, including with paracetamol.

If the recommended dose of paracetamol doesn’t control your symptoms or you’re in pain, contact your doctor, midwife or maternity hospital for further medical advice.

Remember, the advice for taking ibuprofen and other NSAIDS when you’re pregnant is different. Ibuprofen (sold under the brand name Nurofen) should not be taken during pregnancy.

Nicholas Wood, Professor, The Children’s Hospital at Westmead Clinical School, University of Sydney and Debra Kennedy, Conjoint Associate Professor, School of Women’s and Children’s Health, UNSW Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The cost of living crisis is affecting how we spend our money. For many people, this means tightening the budget on the weekly supermarket shop.

One victim may be fresh fruit and vegetables. Data from the Australian Bureau of Statistics (ABS) suggests Australians were consuming fewer fruit and vegetables in 2022–23 than the year before.

The cost of living is likely compounding a problem that exists already – on the whole, Australians don’t eat enough fruit and vegetables. Australian dietary guidelines recommend people aged nine and older should consume two serves of fruit and five serves of vegetables each day for optimal health. But in 2022 the ABS reported only 4% of Australians met the recommendations for both fruit and vegetable consumption.

Fruit and vegetables are crucial for a healthy, balanced diet, providing a range of vitamins and minerals as well as fibre.

If you can’t afford as much fresh produce at the moment, there are other ways to ensure you still get the benefits of these food groups. You might even be able to increase your intake of fruit and vegetables.

Frozen

Fresh produce is often touted as being the most nutritious (think of the old adage “fresh is best”). But this is not necessarily true.

Nutrients can decline in transit from the paddock to your kitchen, and while the produce is stored in your fridge. Frozen vegetables may actually be higher in some nutrients such as vitamin C and E as they are snap frozen very close to the time of harvest. Variations in transport and storage can affect this slightly.

Minerals such as calcium, iron and magnesium stay at similar levels in frozen produce compared to fresh.

Another advantage to frozen vegetables and fruit is the potential to reduce food waste, as you can use only what you need at the time.

As well as buying frozen fruit and vegetables from the supermarket, you can freeze produce yourself at home if you have an oversupply from the garden, or when produce may be cheaper.

A quick blanching prior to freezing can improve the safety and quality of the produce. This is when food is briefly submerged in boiling water or steamed for a short time.

Frozen vegetables won’t be suitable for salads but can be eaten roasted or steamed and used for soups, stews, casseroles, curries, pies and quiches. Frozen fruits can be added to breakfast dishes (with cereal or youghurt) or used in cooking for fruit pies and cakes, for example.

Canned

Canned vegetables and fruit similarly often offer a cheaper alternative to fresh produce. They’re also very convenient to have on hand. The canning process is the preservation technique, so there’s no need to add any additional preservatives, including salt.

Due to the cooking process, levels of heat-sensitive nutrients such as vitamin C will decline a little compared to fresh produce. When you’re using canned vegetables in a hot dish, you can add them later in the cooking process to reduce the amount of nutrient loss.

To minimise waste, you can freeze the portion you don’t need.

Fermented

Fermentation has recently come into fashion, but it’s actually one of the oldest food processing and preservation techniques.

Fermentation largely retains the vitamins and minerals in fresh vegetables. But fermentation may also enhance the food’s nutritional profile by creating new nutrients and allowing existing ones to be absorbed more easily.

Further, fermented foods contain probiotics, which are beneficial for our gut microbiome.

5 other tips to get your fresh fix

Although alternatives to fresh such as canned or frozen fruit and vegetables are good substitutes, if you’re looking to get more fresh produce into your diet on a tight budget, here are some things you can do.

1. Buy in season

Based on supply and demand principles, buying local seasonal vegetables and fruit will always be cheaper than those that are imported out of season from other countries.

2. Don’t shun the ugly fruit and vegetables

Most supermarkets now sell “ugly” fruit and vegetables, that are not physically perfect in some way. This does not affect the levels of nutrients in them at all, or their taste.

3. Reduce waste

On average, an Australian household throws out A$2,000–$2,500 worth of food every year. Fruit, vegetables and bagged salad are the three of the top five foods thrown out in our homes. So properly managing fresh produce could help you save money (and benefit the environment).

To minimise waste, plan your meals and shopping ahead of time. And if you don’t think you’re going to get to eat the fruit and vegetables you have before they go off, freeze them.

4. Swap and share

There are many websites and apps which offer the opportunity to swap or even pick up free fresh produce if people have more than they need. Some local councils are also encouraging swaps on their websites, so dig around and see what you can find in your local area.

5. Gardening

Regardless of how small your garden is you can always plant produce in pots. Herbs, rocket, cherry tomatoes, chillies and strawberries all grow well. In the long run, these will offset some of your cost on fresh produce.

Plus, when you have put the effort in to grow your own produce, you are less likely to waste it.

Evangeline Mantzioris, Program Director of Nutrition and Food Sciences, Accredited Practising Dietitian, University of South Australia

This article is republished from The Conversation under a Creative Commons license. Read the original article.