Why do we know a little about medications during pregnancy

One evening in 2019, when I was a resident of pediatrics, I admitted two months old to the hospital for a note after a simple surgery. I explained to the child’s mother that I planned to order acetaminophen – which is uncommonly sold on the table in the name of Tilanol – every six hours, because the child had a clear source of pain. If the pain still prevents the child from eating, sleeping, or calming, the mother can ask for philosophers. I was leaving the room when the mother stopped me to ask about acetaminophen.

“Does it not cause autism?” She said.

I told her: “I am not aware of any research that connects Tilanol to autism.” “But I will search the matter and go back to you.” Meanwhile, we agreed to use both acetaminophen and opiates as needed, instead of managing them in a table.

When she sat on a computer in the hospital, I was surprised when I found that the mother’s question had a basis in the prevailing research. Small studies have been associated with exposure to iyaminophen in the womb with a child’s risk of autism. But this was not the same as saying that Tilanol caused autism. Perhaps whatever the drug that was treated – for example, fever, infections, or painful chronic conditions – it was distributed to autism, and acetaminophen did not.

For children under the age of three months, as for pregnant women, Taylinol is the safest medication for fever. (Ibuprofen and similar medicines, Non -steroidal anti -inflammatoryS, associated with kidney kidney injury.) She continued to request this to patients, if it is more cautious. Then, in 2024, A tougher study Of more than two million children born in Sweden, they did not find any connection between acetaminophen and nervous growth disorders. The epidemic scientist Catinen Gitelina also wrote, “The evidence tends strongly towards the link, not causation. (Taylinol is not a reason.

Last week, during a press conference, President Trump contradicts current research by urging women to “difficult” and avoid Tilanol during pregnancy. He said: “He fought like hell so that he does not take it.” On Friday, he wrote about the social truth, “Do not give Thailan to your little child for almost any reason.” Medical groups differed. The American College of Obstetricians and Gynecologists (ACOGShe advised women to continue using Tilanol when needed. The American Academy of Pediatrics said: “The misleading allegations that the drug is unsafe and is related to increased rates of autism in sending a dangerous and confusing message to parents, parents and pregnant mothers and is eating harm to individuals with autism.”

now Doctors submit reports Pregnant women hesitate to use the drug, Even when professionals recommend pain or fever. One of the reasons why Trump’s allegations are difficult to disperse is that it makes it look certain. In contrast, doctors can say that the most powerful research does not show a link between Taylinol and autism, and that medical professionals consider this the best choice for pain and fever during pregnancy. But we know that there is uncertainty in medical research, so we are talking carefully.

Doctors should be more specific. Pregnancy is not a rare condition – billions of people carry every year – that is, those who experience often are told that there is not enough research to ensure that the drug is safe. When a pregnant woman needs a medicine, whether for lupus or high blood pressure, she may feel that she is facing an impossible option: she suffers through a condition that she may harm herself or her child, or allows an experiment that is not controlled within the individual’s body. Isn’t there a better way?

The history of many human research rules dates back to the Nuremberg Law, a response to Nazi doctors who conducted brutal experiences in focus camps. To this day, the participants in the research must agree; Trials must be stopped if there is evidence of great harm. In the 1960s, the audience became aware that the Aleedumide, a nausea drug used on a large scale, may cause birth defects in an estimated eight thousand children outside the United States. The medicine has become a case of a state of growing biological ethics. In 1977, the Food and Drug Administration (FDA) was excluded not only pregnant women but also women “from the capabilities of childbearing” from clinical trials in the early stage, which focuses on safety and toxicity. The drug is tested instead for toxicity in pregnant animals – mice and rabbits – which often respond completely differently from humans.

According to Ruth Faden, founder of the Johns Hopkins Berman Institute for Biology Ethics, these efforts to protect women and infants had unintended consequences. In fact, she said, the general responses to the Aleedomide were “bad reading of history.” Aleedomide was not systematically tested on pregnant women. If so, it is possible that its risks will be discovered soon, and a fewer children have been affected.

In the nineties of the last century, the FDA expired from the “capabilities of childbearing”, and the National Institutes of Health established instructions to encourage women in general to participate in the research. In 2018, and The common ruleThe scientific practices of twenty federal agencies have been revised to facilitate researchers to include pregnant women. However, in 2024, a report issued by the National Academies of Science, Engineering and Medicine confirmed that “very little progress has been made in research involved in pregnant women and patients.” Often, Faden told me, still looked at pregnant women as fragile containers that need to be isolated from the world. “We need to protect women through research, not from research,” she said.

The studied safety protocols will be necessary to include pregnant women in moral research studies. Medicines that can harm their mechanism with a fetus – who prevents decisive nutrients such as folic acid, for example, or that prevent cells from dividing – will be excluded. As well as drugs that have disturbing effects in pregnant animals. As in any research study, participation should be voluntary, and the experience will be more likely to benefit from women rather than hurting them. If scientists begin to doubt that women or their children are harmful, the trial must be stopped or stopped completely.