Is it safe to take paracetamol in pregnancy?
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Paracetamol has become our go-to medicine when it comes to relieving pain and bringing down a temperature. But can you take it when you're pregnant? We look at the latest advice and ask the experts just how safe it is when you're expecting.
Paracetamol (also known by brand names Panadol, Hedex or Disprol) is one of the most common painkillers that can be taken for a number of complaints including headache, fever, back pain, sore throats etc.
It's usually recommended as the first painkiller to try because it's good at tackling mild to moderate pain and side effects are very rare.
Paracetamol is also considered as safe for pregnant women to take, by the NHS unlike ibuprofen, which when taken in pregnancy can increase your chance of a miscarriage.
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The NHS states that:
'Pregnant women are generally advised to avoid taking ibuprofen. Paracetamol is recommended as a safer choice when you're pregnant.'
But just how safe is it? We look into the latest research and expert advice that suggests it should be considered carefully before taking it in pregnancy.
Here's what you need to know ...
Can taking paracetamol harm my unborn baby?
Although studies have been carried out investigating a link between paracetamol and birth defects in babies, none could be found.
According to bumps (Best Use of Medicine in Pregnancy):
'There is therefore currently no scientific proof that paracetamol causes birth defects, undescended testes, or changes in hormone levels.'
However, while lots of studies show it to be perfectly safe, 2017 research conducted by the Norwegian Institute of Public Health and the University of Oslo found that using it regularly for more than a week ‘slightly raised the risk’ of your child going on to have ADHD.
However, taking paracetamol for up to seven days was considered 'responsible and harmless use' by the researchers. Lead researcher Eivind Ystrøm said:
'We found that it was safe to use paracetamol for a few days, for example, for a fever. It may even be beneficial because it reduces the period the foetus is exposed to high temperature.
'Pregnant women who need pain relief over extended periods of their pregnancy should consult their doctor. For example, if they have migraines and consider using paracetamol for longer periods.'
More recently (2019), a UK study looked into 19,000 children born in Bristol with behavioural issues such as attention problems and hyperactivity.
Conducted by Bristol University Medical School it found that 43% of mothers had taken the painkiller between the fourth and seventh months of pregnancy.
However, further research is required to prove a causal link as opposed to an association.
Professor Jean Golding, who led the study, said:
'Our findings add to a series of results concerning evidence of the possible adverse effects of taking paracetamol during pregnancy.
'It is important that our findings are tested in other studies – we were not in a position to show a causal link, rather an association between two outcomes.'
Some health experts therefore believe that you should try (where possible) to manage without it in pregnancy – or at least take it for as little time as possible.
So should you take it, or not?
Carmel Lloyd, Head of Education at the Royal College of Midwives (RCM), believes that, ideally, women should avoid taking anything for minor illnesses, such as colds or minor aches and pains, particularly during the first three months.
She says:
'If women feel they need to take medicines such as paracetamol when they are pregnant, they should talk to their midwife or doctor first. They can also get advice from their local pharmacy.'
Netmums' official GP and CEO of ZoomDoc, Dr Kenny Livingstone, recommends all pregnant patients should try to avoid paracetamol unless 100% necessary.
‘If paracetamol is required, it should be used for the shortest period possible and not on a regular basis.'
But while a mild cold may not be a reason to take a short course of paracetamol, according to these experts – a fever is.
Dr Martin Ward-Platt of the Royal College of Paediatrics and Child Health (RCPCH) explains why it's important to reduce a fever with paracetamol:
‘Fever during pregnancy can be harmful to the developing embryo, with links to a significant increase in the rates of spina bifida and heart malformations, so small doses of paracetamol are sometimes necessary,’ he said.
‘If you have a high fever during pregnancy, greater than 38 degrees, paracetamol can be taken, but again, ideally not for more than a few days.'
How much is safe to take?
If you choose to take paracetamol during pregnancy, or are advised to by your GP to reduce a fever, for instance, then the usual dose for adults is one or two 500mg tablets up to four times in 24 hours.
This applies to pregnant women, too.
However, the NHS does recommend erring on the side of caution with how much you take. It says:
'For safety, if you take paracetamol in pregnancy or while breastfeeding, take it for the shortest possible time.'
What's always essential with paracetamol is to:
- leave at least four hours between doses
- never exceed eight 500mg tablets in 24 hours.
If you have a liver or kidney problem or are taking other medication, check with your GP before taking paracetamol.
And of course, if you've had an allergic reaction to it before, don't risk taking it during pregnancy.
If you took it regularly for migraines, talk to your GP before using it long-term in pregnancy.
You only need to visit our forum to see that paracetamol in pregnancy is a hot topic. Here we answer some of your questions about it ...
My doctor said it's ok to take paracetamol 'occasionally' in the first trimester. What does this mean?
‘It means ideally trying to avoid taking it but if you have a high fever, taking paracetamol, at the lower dosage, a few times,' says Dr Livingstone.
'You should not be taking paracetamol regularly.’
How many paracetamol tablets can I take in one day?
‘The lowest possible that manage your pain or fever,' says Dr Livingstone.
'No more than two tablets, four times per day – but ideally – half this amount.'
I've just taken paracetamol in my first trimester – is that ok?
'The likelihood is that your child will be absolutely fine – I would not be concerned with taking it infrequently,' says Dr Livingstone.
I read that taking paracetamol in pregnancy causes asthma in babies – is that true?
‘There is no definitive proof and more studies are required to confirm this,' says Dr Livingstone.
Is paracetamol available on prescription?
Paracetamol was banned as a prescription medicine in 2018.
The ban also included other common over-the-counter medicines such as cough and cold products and laxatives and hopes to save the NHS as much as £100million.
So although when you're pregnant you're entitled to free prescriptions from the NHS, this will no longer include paracetamol.
So, just remember, there's no scientific evidence to suggest that taking paracetamol could harm your unborn baby, provided it's taken correctly and not for long periods of time.
For any concerns about feeling unwell or which medicines to take during pregnancy, always ask your GP and midwife – they know you and your medical history the best.
In the meantime, you can always chat to other mums who may be worried in our forum, below.
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