Acetaminophen prescriptions for pregnant women declined in emergency rooms across the country after a White House briefing in September during which President Trump claimed that the painkiller could cause autism, researchers reported on Thursday.
The new peer-reviewed analysis, published as a research letter in the British medical journal The Lancet, looked at nearly 90,000 emergency room visits by pregnant women over an 11-week period after the White House briefing.
The study found that prescriptions for acetaminophen — the active ingredient in Tylenol — dropped by 10 percent before eventually seeming to recover.
By comparison, the researchers observed no change in acetaminophen prescriptions for more than 850,000 women who were not pregnant and arrived at emergency rooms during the same period.
Medical groups, including the American College of Obstetricians and Gynecologists, have defended acetaminophen in the recommended doses as the safest option to treat fever in pregnant women. Untreated fevers themselves are linked to an increased risk of neurological disorders in babies.
During the unusual White House briefing, the president — flanked by health agency leaders — urged pregnant women to avoid the painkiller, claiming that it could cause autism in children. “Don’t take Tylenol. Don’t take it. Fight like hell not to take it,” Mr. Trump said.
That claim is not supported by the data. While scientists have conducted research on a potential connection between acetaminophen and autism for years, the studies have so far yielded inconclusive results. The largest studies, using data from Scandinavian countries that have tried to account for genetic factors, have shown no link.
Andrew Nixon, a spokesman for the Department of Health and Human Services, said that the administration’s message was “another example of its commitment to telling the truth about public health.”
The new research showed that the decrease resulted in 22.5 fewer acetaminophen orders per 1,000 emergency room visits by pregnant women. The researchers did not find an increase in prescriptions for riskier pain-relieving alternatives, such as opioids.
Prescriptions of acetaminophen to pregnant women returned to the levels from earlier that summer by the end of the study period in December.
But the number of prescriptions might have still been lower than it would have otherwise, since acetaminophen use typically goes up during the cold and flu season, said Dr. Jeremy Faust, an emergency physician at Brigham and Women’s Hospital and a co-author of the new study.
More data was needed to better understand the full scope of the changes, he added. (Dr. Faust writes a widely read newsletter that has been critical of the Trump administration and federal health officials.)
Even if the dip in prescriptions was temporary, the study showed the substantial impact of public announcements in the short term, said Dr. Aaron Kesselheim, a professor of medicine at Harvard Medical School who was not involved with the study.
“Even if it’s the case that people move on and the news cycle spins onward and people forget, those short term spikes and dips represent many, many people,” Dr. Kesselheim said.
He also cautioned that the snapshot was incomplete because many people take acetaminophen at home, a use that is much harder to measure.
Prescriptions account for only a small fraction of the acetaminophen taken in the United States. Most of the time, people buy the drug over the counter and take it without a doctor’s supervision.
It’s not clear how much the declines in prescribing that occurred immediately after the news briefing were driven by women refusing acetaminophen or their doctors choosing not to order it.
“Ten percent is not a huge change, but you wouldn’t want any patients who are at risk for pre-eclampsia or febrile illness to go without treatment,” said Dr. Nathaniel DeNicola, an adviser to the American College of Obstetricians and Gynecologists on environmental issues.
The new study matched his own experience as an obstetrician encountering a wave of anxious patients in the immediate weeks after the White House briefing. The concerns quickly died down, he said.
“Patients were very willing to receive their doctor’s advice. And our advice never really changed: We use Tylenol as-needed, in the lowest amount and for the shortest duration,” Dr. DeNicola said.
Dr. DeNicola also noted that the new study showed that acetaminophen was prescribed judiciously to pregnant women in the first place. Fewer than a quarter of pregnant women presenting to the emergency room were prescribed the painkiller even before the White House announcement.
The new study also analyzed outpatient prescription data for leucovorin, a B vitamin-based drug long used to treat symptoms of chemotherapy. Dr. Marty Makary, commissioner of the Food and Drug Administration, announced at the news briefing that the agency had approved leucovorin as a treatment for autism.
The move flipped the script for the drug approval process. Typically a pharmaceutical company carefully studies a drug and then submits that data as part of a formal application for drug approval.
For leucovorin, the agency said it reviewed the relevant research and made the decision to recommend the drug on its own.
The Lancet study also analyzed prescription data from more than 8 million doctors’ visits for children aged 5 to 17 years old, showing that outpatient prescriptions for leucovorin increased by 71 percent during the 11-week study period.
Though the absolute numbers are still small, representing an increase of roughly 17 prescriptions per 100,000 children, the immediate impact of the announcement was undeniable, said Dr. Audrey Brumback, a pediatric neurologist at the University of Texas at Austin.
“I had a few weeks there where every single patient was asking about it,” Dr. Brumback said. “Now it’s like one to two patients per week.”
Small studies, including one that was recently retracted, have suggested that the drug can improve communication skills in children with a condition called cerebral folate deficiency, in which low levels of folate in spinal fluid can lead to deficiencies in motor and language development.
But that condition is rare. When trying to help families with their questions about leucovorin, Dr. Brumback has instead offered to do genetic testing to better understand what might have contributed to their altered brain development.
But the F.D.A. decision in September has put pressure on physicians to prescribe the drug.
“The announcement put leucovorin on families’ radar, so they started asking for it,” Dr. Brumback said. As long as families are requesting it, “clinicians will continue to prescribe it.”
Azeen Ghorayshi is a Times science reporter.
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