Tylenol and pregnancy: A Q and A with Dr. Rebecca Titman

Why does the topic of Tylenol in pregnancy cause so much debate?
Medication use in pregnancy is complicated. Unlike those in other populations, we don't have randomized, controlled trials on pregnant patients. I've been working in the pain and pregnancy space for six years, and [questions about Tylenol] come up every few years. When we look at the studies we do have, there is a fair amount of data out there supporting that Tylenol is safe. A 2024 Swedish trial with 2.4 million children didn't find any associations. At the end of the day, I'm still very comfortable saying that, if you need it, take Tylenol during pregnancy. Fever and pain also matter and should be treated.

What do you think about the new studies driving these headlines?
The recommendations haven’t changed. The advice is to use acetaminophen for pain or fever only when needed, and to take the smallest amount that works, for the shortest time possible. Even the paper at the centre of this conversation recommends that. I find that pregnant patients generally want to avoid medication. That's why we lean on the rehabilitation strategies for pain management and use medication to help support them.

How should people evaluate information and decide whom to trust?
The big thing is to make sure you know where your information is coming from. In Canada, the Society of Obstetricians and Gynaecologists of Canada is the leader on pregnancy matters. Maternal-fetal medicine groups and other physician-led organizations also provide guidance. Whenever there's uncertainty, check with trusted professional sources. And definitely speak to your health-care provider if you're concerned. When I counsel patients on medication — such as Tylenol — I discuss the research. I also explain that what they might find online may not be relevant to their specific case. It can harm my relationship with a patient if they find conflicting information, so I usually discuss what they may see on social media.

What do people need to know about safe, effective pain management during pregnancy?
Pain during pregnancy is very common, and no one should feel they have to "just suffer through it." There are many ways people can adapt, modify and manage their pain, and medication is just one part. I use the "three Ps": Pharmacologic, physical and psychological. That combines medication, movement and posture, and things like stress and sleep management. In physiatry, movement is medicine. We look for gentle movements that patients can incorporate into their daily routines. This helps them stay active and manage their pain effectively.

Are people surprised that staying active plays such a significant role in pain management?
Absolutely. People tend to do better when they stay moving. It's different for everybody. Many of the things we would typically use for pain management outside of pregnancy remain safe to do. Gentle movement, swimming, walking, Pilates, yoga — these are all great things to continue during pregnancy. Using heat, ice and acupuncture can also be helpful. It's all about making minor adjustments to your day-to-day life.

What's your advice for anyone worried about pain during pregnancy?
There isn't any research that can clearly say who will experience pain and who will not. However, research does show that those who feel well-supported, maintain movement and keep an open dialogue with their health-care providers tend to feel and function better. Staying informed and talking openly with clinicians will always be the best route to effective, safe pain management.

Sinai Health is a recognized leader in women’s and infants’ health. We provide world-class care for everything from high-risk pregnancies to evidence-based menopause programs. To learn more about managing pain during pregnancy, contact the Pain in Pregnancy program and read Dr. Titman's previous Q&A.