Why Trump's 'tough it out' advice is a dangerous message for women

As if pregnant women didn't already have enough to worry about.

This week the Trump administration confidently claimed that the use of paracetamol during pregnancy was linked with the development of autism in infants.

"Don't take Tylenol," the US president said, using the drug's American brand name. "Tylenol is not good. I'll say it. Not good."

He also told pregnant women to "tough it out" when it comes to fever and pain (we'll get to that part later). 

None of this is good advice.

Let's not make a stressful time worse

I am a mother who has lived the confusion and chaos of pregnancy multiple times. I also work as a GP who sees many patients through the preconception, pregnancy and postpartum phases.

One thing I know for certain is that every parent I've ever met was attempting to do their best.

Pregnancy is a bewildering time. Social media is flooded with images of baby bumps in billowing dresses and videos of people painting nurseries, but for many it's full of uncertainty. People are overwhelmed with health advice — a lot of it from questionable or unqualified sources.

Patients ask me about what supplements to consider preconception, what foods to avoid because of listeria risk, how warm the bath or spa should be, how much physical activity is recommended, whether intercourse is safe, or air travel, or hair dye — and so much more.

At a first pregnancy consult, I talk to parents about what blood tests and ultrasounds are advised, plus the options and essentials in terms of screening. Then there's extensive discussion about pregnancy-safe foods, medications to ideally avoid (the ones which do have evidence of harm in pregnancy) and other counselling.

There's a lot of non-bogus things for people to worry about already. A lot.

Paracetamol should be an easy choice

In Australia, paracetamol is listed as a "pregnancy category A" medication. According to the Therapeutic Goods Administration "category A" medications have been taken by a large number of pregnant women without any proven increase in the frequency of malformation or other indirect or direct harms to the foetus.

Practically, a listing of this nature means that I can tell patients it is a safe medication to use during pregnancy. It's a good option for pregnant patients to use during febrile illnesses like influenza and COVID-19, for headaches and other muscle aches and pains (which can be more common during pregnancy).

This was one decision that was easy for vulnerable patients trying to do no harm to their baby — unlike having to choose the lowest-listeria-risk option in the food court!

But Donald Trump and his health secretary Robert F Kennedy Jr just made this easy decision feel like yet another difficult one, where anxious parents have to weigh up the risks and benefits.

To be clear: it shouldn't be.

Let's talk about the evidence

There are studies that have looked at the question of using paracetamol during pregnancy. Before we dive in, it's worth revisiting a critical concept for topics like this: correlation and causation are two very different things.

Here's an example I use with patients: in the Australian summer there are more iceblock sales, and more bushfires tend to occur. Quite obviously there's a confounding factor driving both — the warmer weather — which means it's an association and nothing more.

Nobody would say that iceblock sales cause the bushfires.

Now, let's take that principle and look at a recent study in the journal BMC Environmental Health.

The paper found that exposure to paracetamol in pregnancy was associated with a higher incidence of neurodevelopmental diagnoses in children, such as autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD).

The authors themselves said they couldn't show that paracetamol directly causes neurodevelopmental disorders. These conditions are extremely complex and genetic factors play a big role.

Suggesting paracetamol as the cause ignores a key consideration — that the very reason many women use medication during pregnancy is for a fever.

And fever, particularly in early pregnancy, can be harmful, increasing the risk of miscarriage and certain malformations like neural tube defects.

There's also some research suggesting that fever itself, from an infection during pregnancy, may influence a child's development. 

So is it the fever, the medication, genetic factors or something else?

Pointing the finger at paracetamol is not only unfounded, it also ignores more likely explanations.

Other studies have found no evidence to link paracetamol with a higher risk of neurodevelopmental diagnoses. A Swedish paper, published in the well-respected Journal of the American Medical Association in 2024, included over 2 million children born between 1995 and 2019.

Researchers compared siblings, where the mother had used paracetamol in one pregnancy and not the other, and concluded that paracetamol use was not associated with risk of autism, ADHD or intellectual disability in the child.

Doctors love sibling-matched trials like this one, because they control for as many variables as possible.

Like any area in medicine there is mixed evidence; some studies show an association, some show none, but the key thing is that there is certainly not enough evidence to suggest a clear causative link between paracetamol use by pregnant mums and neurodevelopmental diagnoses in their kids.

Stigma, shame and guilt

Putting misuse of evidence to one side, I have a more fundamental gripe with the Trump administration's mission to find the "root causes" of autism and eliminate it.

The way they speak about diagnoses such as autism and ADHD is extremely stigmatising.

To suggest there's a prevailing environmental cause for a condition with very strong genetic factors not only oversimplifies a complex issue, it also makes parents and caregivers who may already be experiencing huge amounts of guilt, shame and stigma feel worse — and ultimately responsible for their child's diagnosis.

Again, to be clear: they are not.

Trump and RFK Jr's language implies that a diagnosis of neurodivergence is the worst thing that could possibly happen to someone. I've had patients tell me how deeply hurtful it is to hear language that diminishes their existence or suggests they, or their children, are a burden.

Now the US President talks about "reaching the ultimate goal" of ending autism.

Military language is being used about a medical diagnosis.

It's time to stop blaming women

On the day of the announcements in the US, health professionals like me around the world shuddered. We put out content on social media platforms to try and offer reliable information to already anxious, vulnerable, pregnant patients.

Like many others, I already help expecting mothers seek clarity and reassurance with their lists of questions. That's before they start worrying about using paracetamol for a headache, or pelvic girdle pain, or any of the myriad ailments that come with carrying a baby.

Then to make matters worse, came Donald Trump's suggestion that women should "tough it out" and just put up with pain and fever if they could. 

At a time where we are only just starting to touch the sides of medical misogyny and properly amplify women's health, this is infuriating.

The average time for a woman to receive a diagnosis of endometriosis is seven years, because women are often dismissed by the health profession when it comes to issues such as pelvic pain, heavy vaginal bleeding or pain during intercourse.

The time for women "toughing it out" is over.

If you talk to parents, or you are a parent, you will know that there is far too much noise, guilt and confusion surrounding pregnancy. People already feel judged about how they conceived their child, how they birthed them or how they feed them.

And there are more than enough legitimate things to worry about.

Generating more without robust evidence is dangerous.

You can hear Dr Preeya Alexander and Dr Norman Swan discussing this story and all the latest health news on the Health Report, 9am on Saturday on ABC Radio National or the ABC listen app.