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Taking paracetamol while pregnant is safe and there’s no evidence it raises the risk of autism, ADHD and developmental issues in children, say experts behind a major new review.

Pregnant women “should feel reassured” by the findings, they say, which contradict controversial claims from US President Donald Trump last year that paracetamol “is no good” and pregnant women should “fight like hell” not to take it.

His views were criticised at the time by medical organisations worldwide. Experts say this latest review, in a Lancet journal, is rigorous and should end the debate over its safety.

But US health officials maintain that “many experts” have expressed concern over its use during pregnancy.

The US President shocked many doctors worldwide when he and his administration claimed paracetamol or a branded version called Tylenol – which is seen as the go-to painkiller for pregnant women – could be linked to autism in children, if taken during pregnancy.

Those claims led to confusion among women and concern among health experts, and prompted this new research.

Published in The Lancet Obstetrics, Gynaecology & Women’s Health, it looked at 43 of the most robust studies into paracetamol use during pregnancy, involving hundreds of thousands of women, particularly those comparing pregnancies where the mother had taken the drug to pregnancies where she hadn’t.

The researchers say using these high-quality studies of siblings means they can dismiss other factors such as different genes and family environments, which makes their review “gold-standard”.

The research also looked at studies with a low risk of bias and those that followed children for more than five years to check for any link.

“When we did this analysis, we found no links, there was no association, there’s no evidence that paracetamol increases the risk of autism,” lead study author and consultant obstetrician Professor Asma Khalil, told the BBC.

“The message is clear – paracetamol remains a safe option during pregnancy when taken as guided,” she added.

This reinforces guidance from major medical organisations in the UK, US and Europe on the safety of the common painkiller.

Any previously-reported links between the drug and an increased risk of autism are likely to be explained by other factors, rather than a direct effect of the paracetamol itself, the review says.

“This is important as paracetamol is the first-line medication we recommend for pregnant women in pain or with a fever,” said Prof Khalil, professor of maternal fetal medicine at City St George’s, University of London.

Health advice warns that women can run the risk of harming their baby if they don’t take paracetamol to bring down a high temperature or relieve pain when pregnant. This can increase the risk of miscarriage, premature birth or developmental problems in babies.

Medical experts not involved in the research have welcomed the study’s findings, saying it will help reduce worry among women.

Prof Grainne McAlonnan, from King’s College London, said expectant mothers “do not need the stress of questioning whether medicine most commonly used for a headache could have far reaching effects on their child’s health”.

“I hope the findings of this study bring the matter to a close,” she said.

Prof Ian Douglas, from the London School of Hygiene and Tropical Medicine, said the review was “well-conducted” because it excluded studies of lower quality, where no account was taken of important differences between mothers who use or don’t use paracetamol during pregnancy, such as underlying illnesses.

According to Prof Jan Haavik, molecular neuroscientist and clinical psychiatrist at the University of Bergen, the study provides “strong evidence” that use of paracetamol during pregnancy does not increase the risk of autism, ADHD or intellectual disability and “should effectively put this question to rest”.

It is widely believed by scientists working in this field that autism is the result of a complex mix of factors, including genetic and environmental ones.

A spokesman from the US Department of Health and Human Services said “many experts” had expressed concern over the use of acetaminophen – the US name for paracetamol – during pregnancy.

For example, a review in August 2025 led by Dr Andrew Baccarelli, dean of the Harvard T.H. Chan School of Public Health, found that using acetaminophen during pregnancy may increase children’s autism and ADHD risk, and urged caution over “especially heavy or prolonged use”.

Months earlier, Health Secretary Robert F Kennedy Jr had pledged to find out the cause of a steep rise in reported autism cases.

In a controversial speech in the Oval Office in September, the US president said doctors would be advised not to prescribe the pain reliever to pregnant women.

The US Food and Drug Administration (FDA) then issued a letter to clinicians urging them to be cautious about the use of acetaminophen in pregnancy, while also saying it was still the only drug approved for treating fevers during pregnancy.

On its website, the FDA says “a causal relationship” between the drug and neurological conditions “has not been established”.

Health officials in the UK have stressed that paracetamol remains the safest painkiller available to pregnant women.

From Mariia’s 16th-floor flat, the calm waters of the Black Sea stretch out into the horizon beneath the fading twilight.

“Up here you can see and hear when the drones come,” she says, standing by a wall-length, floor-to-ceiling window. When they hit buildings and homes in the city of Odesa down below “we see all the fires too”.

Her daughter Eva, who is nine, has learned the shapes and sounds of the objects that zoom through the sky on a daily basis. She proudly shows off a list of social media channels she checks when the air raid alerts go off.

“She knows whether what’s coming is a risk or a threat, and that calms her down,” her father Sergii says.

There is scarcely a place in Ukraine that has not been targeted since Russia launched its full-scale invasion nearly four years ago.

But in recent weeks Odesa – Ukraine’s third largest city – has come under sustained attack. Through strikes on port and energy infrastructure, Russia is trying to cripple the region’s economy and dent the population’s morale.

Moscow, however, does not just hit facilities. Its drones, mostly as big as a motorcycle, regularly crash into high-rise buildings like Masha’s, exploding on impact and blowing glass and debris inward. The consequences are often deadly.

“A few months ago Eva said she was afraid the drone would come too fast and we wouldn’t have time to hide,” Mariia says. “But I explained that if it came towards us, it would get louder and louder and then we’d know we have to run.”

Mariia, Sergii and Eva are originally from Kherson, a region 200km (125m) to the east of Odesa which is now in large part occupied by Russia.

They left as soon as the invasion started in 2022 and mother and daughter briefly moved to Germany as refugees. But Sergii and Mariia could not bear the distance, so the family reunited in Ukraine and moved to Odesa.

Now, as attacks on the region intensify, Sergii wonders whether the family should prepare to leave again. “War is only about economics, and Odesa for the Russians is about infrastructure, so they will do their best to conquer it,” he says.

Tucked in south-western Ukraine, Odesa was an economic powerhouse before the war. But now that Russia occupies the majority of Ukraine’s coastline, the region has become even more vital. Its three ports are Ukraine’s largest and include the country’s only deep-water port. With land crossings disrupted, 90% of Ukraine exports last year were shipped by sea.

But in wartime the region’s importance is also its weakness.

Last month, Vladimir Putin threatened to cut off Ukraine’s access to the sea in retaliation for Ukrainian strikes on the “shadow fleet” tankers Russia uses to circumvent sanctions.

That threat has translated into concrete impact. For two years, Russia’s attempts to thwart Odesa’s economy have been near-relentless – but the last few weeks have been particularly difficult.

Aerial attacks on the ports have destroyed cargo and containers and damaged infrastructure; crew members on foreign merchant ships operating in the Gulf of Odesa have been injured or killed by drones; and 800 air-raid alerts in a year repeatedly halted port operations.

The result last year was a 45% decrease in exports of agricultural products, vital to Odesa’s economy.

The day after a drone strike this week set a Panamanian-flagged ship alight and severely injured one of its crew members, regional government head Oleh Kiper said that shipowners entering Odesa ports “clearly understand that they are entering a war zone” and that the ships were insured.

But if such attacks continue, in the long run foreign companies may be put off trading with the port.

As the strikes surge, air sirens go off frequently, but not everyone heeds them. Standing in front of a destroyed gym the morning after an overnight drone strike that injured seven people, Maryna Averina of the State Emergency Service concedes people have become “very careless about their own safety”.

A recent air raid alert lasted for most of the day. “Sitting in a shelter for 16 hours is simply unrealistic,” Averina says, as gym staff emerge from the destroyed building with whatever objects they have managed to salvage from the rubble and mangled metal inside.

While many Ukrainians are now sadly accustomed to the drone and missile strikes, they are increasingly frayed by the relentless attacks that cut off electricity and heating in the middle of a particularly biting winter.

In December, almost a million people in Odesa were left with no power. “We were among the first regions to experience what it means to go through the winter period without electricity and without heating,” says Oleh Kiper.

A month later, as temperatures hover around -1C, the supply remains severely disrupted.

Ada, 36, is strolling on the beach, unfazed by the wail of air alert sirens mingling with the squawking of seagulls. The drone attacks have ramped up but, she says, “the shelling isn’t as scary as this cold is”.

Nearby, a young mum named Yana agrees. Recently, she says, the situation across the board “has been really, really difficult”. At one point, a drone crashed into her flat, and another one hit the block soon afterwards.

Then came the power cuts. She and her family bought an expensive generator, but running it for seven hours costs around $10 – a significant expense in a country where the average monthly salary is around $500 (£375).

“We’ve all been living like this for four years now, unfortunately. We’re as helpless as flies, and everything is just being decided between the authorities,” she says, while struggling to keep her shrieking toddler out of the icy water.

“Maybe we’re being punished for something – the whole nation, not just a few, but everyone.”

Further down the beach, Kostya is fishing on a jetty stretching out into the sea. He says he is not worried about the Russians advancing to the city. “I don’t think they’ll make it here. [The Ukrainians] will break their legs first.”

But, he adds, things are painful, and scary. And like many Ukrainians he still seems to struggle to accept that war came to his country four years ago, waged by a neighbour he once knew so well.

In his youth, Kostya served in the army and swore an oath to the Soviet Union. “I never imagined that I would see something like this in my old age,” he says.

While Russian propagandists have long insisted that Ukraine’s independence since 1991 is a historical mistake, Odesa’s past role as the jewel in the crown of the Russian empire means it still holds particularly strong symbolic importance for Moscow.

Vladimir Putin has repeatedly referred to Odesa as a “Russian city” and frequently invoked the notion of “liberating Novorossiya”, a historical region of the Russian empire that encompassed parts of modern southern and eastern Ukraine, including Odesa.

“They wanted and they still want to seize Odesa, just like many other regions, but today everything possible and impossible is being done by our military to prevent this from happening,” insists the regional government leader.

Oleh Kiper has made it a personal mission to sever any perceived remaining ties that Odesa has with Russia. He is a staunch supporter of a 2023 Law on Decolonisation, which directed local authorities to rid their cities of any street names, monuments or inscriptions that could be linked to Russia’s imperial past.

Among the statues to be removed was a monument to the founder of Odesa, Russian Empress Catherine the Great, while streets named after Russian and Soviet figures were renamed. Pushkin Street became Italian Street, and Catherine Street is now European Street. Kiper also champions the usage of Ukrainian in a city where Russian is still very widely spoken.

Asked about the resistance he meets from Odesites who are proud of their heritage as a multicultural port to the world, he is defiant.

“The enemy is doing far more than we are to ensure that a Russian-speaking city becomes Ukrainian,” says Kiper. “It is forcing people to understand who the Russians are and whether we need them at all.”

The following day, as temperatures dropped to -6C, the city marked one month of partial blackouts, and air raid alerts were in force for four hours. The port of Chernomorsk, east of Odesa, was again hit by a ballistic missile, injuring a crew member on a civilian ship.

As is the case with the rest of Ukraine, if Russia cannot have Odesa, it seems determined to continue crippling it.

Additional reporting by Liubov Sholudko