Donald Trump has claimed the use of paracetamol in pregnancy is linked to an increased risk of autism – but what does the evidence say?

Americans consume more than 40% of all the world’s paracetamol, spending in excess of $4bn a year on products containing acetaminophen (as it is known in America – or by its leading brand name, Tylenol).

Autism rates in the US are also on the rise – going up from about one in 150 children in the year 2000, to around one in 30 today.

There have also been a number of well-publicised studies suggesting a correlation between mothers who took paracetamol during pregnancy and the birth of a child with autism or other neurodevelopmental disorders such as ADHD.

So surely something must be going on?

Well, not necessarily.

In studies that have suggested a link, the authors have been unable to show the drug itself led to autism instead of other factors.

These include: the genetics of the parents (autism’s genetic links are well established); the lifestyle or environment in which the mother lives; or most confounding of all, that the reason the mother was taking paracetamol – a viral infection perhaps – wasn’t a trigger rather than the drug itself.

A study showing a correlation is not the same as finding a cause.

Better understanding of autism has meant the criteria for diagnosing it have expanded over the last two decades to include far more people. Diagnoses may well be rising simply because we’re better at recognising it.

What’s more, there are numerous studies showing evidence of no link to paracetamol at all.

Chief among them is a huge study from last year that included 2.5 million children in Sweden.

In Sweden, a mother’s use of paracetamol during pregnancy is added to her medical records.

The researchers found a marginal increase in the risk of autism and paracetamol use by the mother. But crucially, when they included data for siblings born to the same mothers from pregnancies during which she took no paracetamol, the apparent link disappeared.

“Which provides a pretty strong evidence against the notion that paracetamol would cause harm,” said Dr Viktor Ahlqvist at the Karolinska Institute in Stockholm, who led the study.

Paracetamol still recommended in UK

The study showed not only that paracetamol wasn’t linked to autism, but that other studies, with poorer quality data were prone to seeing a pattern that wasn’t there.

This balance of evidence is why health authorities, including here in the UK, are confident in recommending paracetamol for use in pregnancy.

In fact, it’s now recommended as the safest choice, as other painkillers – even ibuprofen – have been shown to cause potential or actual harm to mother or babies.

While most doctors would advise women only to take medicines in pregnancy when necessary, avoiding paracetamol could do more harm than good.

“While you’re pregnant, experiencing uncontrolled fevers or some of the side effects from pain, such as high blood pressure, will be a lot more detrimental to a developing baby and a mother than paracetamol will be,” said Dr Monique Botha, who studies bias in autism research at the University of Durham.

Talking up a link between autism and paracetamol is also likely to anger people with autism or their parents, suspects Dr Botha.

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“Families with autistic children are often struggling with under-resourced care and someone standing up and declaring that they’ve potentially found the cause of autism – when it’s so misguided – isn’t going to change anything for them.”

Researchers worry too, that posing a link between a drug taken during pregnancy and autism adds unnecessary stigma to mothers of autistic children.

“We’ve seen this many, many times, going back to the scary stories of the 1960s, that the blame is usually on the mother and parents where a child has a condition,” said Dr Ahlqvist.

“With this current [US] administration, they’re again pointing the finger at mothers, when we have no substantial evidence to suggest that this is the case.”

So, if paracetamol doesn’t cause autism, what’s causing the Trump administration to talk about it?

With echoes of previous, and all too real, drug scandals like thalidomide, it’s the kind of story to generate controversy by association – however false.

And the Trump White House has form when it comes to finding issues to distract from genuine controversies surrounding the president.

The story also fits a key theme of US health secretary Robert F Kennedy Jr’s policy moves – like on childhood vaccines — that stem from his belief that children are being harmed by an overmedicated America.

But the whole point of science is that it doesn’t care what you believe, it’s about what the best quality evidence tells you.

So far, there’s been precious little of that behind the latest changes in US health policy.

Late night TV show presenter Jimmy Kimmel, who was taken off the air following a row over comments about Charlie Kirk, will return on Tuesday.

Kimmel, who was accused of being “offensive and insensitive” because of what he said on his show last Monday, will go back on air in his regular slot.

Disney said in a statement: “Last Wednesday, we made the decision to suspend production on the show to avoid further inflaming a tense situation at an emotional moment for our country.

“It is a decision we made because we felt some of the comments were ill-timed and thus insensitive.

“We have spent the last days having thoughtful conversations with Jimmy, and after those conversations, we reached the decision to return the show on Tuesday.”

Earlier today, hundreds of Hollywood stars signed an open letter to defend free speech following Kimmel’s suspension.

Robert De Niro, Ben Affleck, Jennifer Anniston, Selena Gomez, Lin-Manuel Miranda, Tom Hanks and Meryl Streep are among those who have penned the appeal.

More than 430 of the stars, including comedians, directors and writers, urged Americans to “fight to defend and preserve our constitutionally protected rights”.

The letter is addressed to the American Civil Liberties Union, and argues the decision was a “dark moment for freedom of speech in our nation”.

The letter adds: “Regardless of our political affiliation, or whether we engage in politics or not, we all love our country.

“We also share the belief that our voices should never be silenced by those in power – because if it happens to one of us, it happens to all of us.”

The list of signatures also includes Emmy-winner Noah Wyle, Oscar-nominated Florence Pugh, comedian David Cross, Tony-winner Kelli O’Hara and Molly Ringwald. Pedro Pascal, Billy Crystal, Nathan Lane, Kerry Washington and Kevin Bacon have also signed the letter.

The letter concludes: “This is the moment to defend free speech across our nation. We encourage all Americans to join us, along with the ACLU, in the fight to defend and preserve our constitutionally protected rights.”

Kimmel had used his show to accuse President Donald Trump and his allies of capitalising on the conservative influencer’s assassination.

He said: “We hit some new lows over the weekend with the MAGA gang desperately trying to characterise this kid who murdered Charlie Kirk as anything other than one of them and doing everything they can to score political points from it.”

Speaking about Trump, he added: “This is not how an adult grieves the murder of someone he calls a friend. This is how a four-year-old mourns a goldfish.”

“Many in MAGA land are working very hard to capitalise on the murder of Charlie Kirk,” he continued.

The Disney-owned ABC pulled the show following criticism from Brendan Carr, chairman of the Federal Communications Commission.

Mr Carr had threatened to “take action” against Disney and ABC.

In an interview with conservative podcaster Benny Johnson, he said: “We can do this the easy way or the hard way”.

Mr Carr then praised the move, saying “it is important for broadcasters to push back on Disney programming that they determine falls short of community values”.

But the decision sparked a global, furious backlash from the public and high-profile figures around the world.

Among them was former US President Barack Obama, who said on X: “After years of complaining about cancel culture, the current administration has taken it to a new and dangerous level by routinely threatening regulatory action against media companies unless they muzzle or fire reporters and commentators it doesn’t like.”

He added: “This is precisely the kind of government coercion that the First Amendment was designed to prevent – and media companies need to start standing up rather than capitulating to it.”

The decision came at a time Disney and Nexstar, the network operator, had FCC business ahead of them, with the former seeking regulatory approval for ESPN’s acquisition of the NFL Network and the latter need the Trump administrations approval to complete a $6.2billion purchase of broadcast rival, Tegna.

Trump, who was on a state visit of the UK at the time, said Kimmel had been cut for “bad ratings”.

He had said: “Well, Jimmy Kimmel was fired because he had bad ratings, more than anything else.

“And he said a horrible thing about a great gentleman known as Charlie Kirk.”

He added: “Jimmy Kimmel is not a talented person. He had very bad ratings, and they should have fired him a long time ago.

“So, you know, you could call that free speech or not. He was fired for lack of talent.”

“I forgive him.” They were three little words, and yet, they were huge.

In a stadium packed to capacity, Erika Kirk’s address to an assassin was delivered in tears and received with silence until the crowd grew into applause.

“The answer to hate is not hate,” she added. It is, perhaps, the message America needs to hear most and the one it has heard least.

As it happened: Trump delivers speech at Charlie Kirk’s memorial

The memorial to Charlie Kirk felt like a Republican state funeral in all but name.

This was MAGA in mourning, an occasion that laid bare the influence of Charlie Kirk and his politics.

They had travelled in their tens of thousands to the State Farm Stadium in Glendale, Arizona.

They saluted a conservative icon and the dress code crafted a patriotic spectacle in red, white and blue.

It was an act of remembrance on a stadium scale, huge in size and sentiment. It was also big on politics.

From the president down, the Trump administration’s top tier spoke of politics after 10 September, the day Charlie Kirk was killed.

This was a Republican movement in one place, with one microphone, after an assassination that accelerated the tectonic shift in US politics.

A week and a half since the assassination, political reaction has distilled into a war over freedom of speech and that was revisited by the president, even if he reserved most of his speech to pay homage to Charlie Kirk.

The White House decanted a full team from Washington DC to Arizona.

They came for reasons of sympathy and bereavement, of course. It was also an occasion laced with politics.

This was Washington’s travelling roadshow swinging by the support that Charlie built.

The same support was critical in helping Donald Trump back into power at the last election, and the challenge confronting the White House is in harnessing that vote in his absence and carrying it forward.

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Politically, it was a full-court press to style the horses amongst the youth vote and Christian nationalists.

Charlie Kirk brought them onside, and Team Trump wants to keep them there.