Pregnancy pain is common, often dismissed, and rarely easy to manage. At the same time, recent headlines have stirred anxiety by suggesting that acetaminophen (Tylenol) use in pregnancy may be linked to autism. In this episode Dr. Julie Vignato from the UI College of Nursing helps us unpack what the science actually says, where misinformation creeps in, and how healthcare providers and public health communicators can share clearer messages.

The views and opinions expressed in this podcast are solely those of the student hosts, guests, and contributors, and do not necessarily reflect the views or opinions of the University of Iowa or the College of Public Health.

Lauren Lavin: Hello everybody and welcome back to Plugged into Public Health. My name is Lauren Lavin, and today’s episode is one of those conversations that feels both urgent and personal. We’re tackling a topic that has been making headlines and stirring up fear, the use of over-the-counter pain medications, especially acetaminophen or Tylenol during pregnancy.

You may have seen recent claims linking Tylenol to autism. These kinds of messages spread really quickly, especially with social media, but they often leave out the nuance, the evidence, and the voices of researchers who have dedicated their careers to this very issue. And that’s why this conversation matters so much right now.

Our guest is Dr. Julie Vignato, an assistant professor at the University of Iowa College of Nursing. She’s both a researcher and a mom, and she’s been at the forefront of studying pregnancy pain, what it looks like, how women cope, and how providers can better support them. She brings not only her expertise in epidemiology and pain research, but also a deep compassion for those who are navigating pain, guilt, and conflicting health advice. In this episode, we’ll cover what the evidence really says about acetaminophen, what we know about NSAIDs, like ibuprofen, why pain and pregnancy is too often dismissed, and how misinformation can compound maternal guilt.

We’ll also talk about where the science is headed and what all of us, whether parents, clinicians or communicators can do to share clear more supportive messages.

If it’s your first time with us, welcome. We’re a student run podcast that talks about major issues in public health and how they’re relevant to anyone, both in and outside the field of public health. Now let’s get plugged in to public health. Plugged In to Public Health is produced and edited by the students of the University of Iowa College of Public Health, and the views and opinions expressed in this podcast are solely those of the student hosts, guests, and contributors.

They do not necessarily reflect the views or opinions of the University of Iowa or the College of Public Health.

Lauren: Well thank you so much for being on the podcast today. Dr. Vignato, could you start by just introducing yourself, who you are, what you do at the University of Iowa? A little bit of background.

And maybe also your connection with pregnancy and pain and the research that you do surrounding that.

Julie Vignato: Sure. Thank you so much for asking me to be here and talk about this topic. So I’m an assistant professor at the University of Iowa’s College of Nursing.

But I’m also a mother that experienced moderate back pain in pregnancy. So when I started my dissertation in San Diego, I studied. The comorbidities or the relationship between depression and PTSD during pregnancy. And so I really look at ways to improve the mental and physical health of women during pregnancy.

When I came though to the University of Iowa as a postdoctoral fellow, I received the pain and associated symptoms fellowship because I realized that those women with mental health conditions had a lot of physical health conditions too. Mm-hmm. Like pain. So I started to build my program of research.

And led some of the first epidemiological studies exploring pain to start to build the field right about pain in pregnancy. So in one study, I discovered from a national sample that 55 to 78% of pregnant women have uncontrolled back pain, especially during their third trimester of pregnancy.

And when you think about how big the baby gets and how much weight that puts on the spine, it causes it to curve, and that’s something we call lordosis. And it’s really a main contributing factor to a lot of back and pelvic pain. And you think about it too, like, there’s not many medications we can give the mother.

Once we did the first study saying, yes indeed, this is a problem.A lot of women are experiencing this, the next step is to figure out, well, what type of pain are they experiencing? What’s going on in. Then the lives of these women, right? So the next step we did was qualitative research. And that just means that we did some interviews, right? And our findings illuminated this really distressing cycle.

So pregnant mothers would have this pain and they just didn’t know what to do with it, so they couldn’t sleep, right? The pain interfered with their sleep. And it also interfered with their ability to work. And then they’d go to their providers, they’d go to other people they trusted, like their, their own mothers or their significant others.

And the women were just not listened to, is what we found in this study. They were minimized and, huh. They were told, well, you know, it’s okay. Go home and put your feet up. But what if you have to work? What if you have to change to around? You know? And a lot of women said too, that they were trying to save any maternity leave time they had for when the baby was born.

Lauren: Right. This, it makes it such a complex issue. There’s so many factors. You can’t just say, go home and rest. There’s probably no way.

Julie Vignato: Right, right. And you know, in our society too, like, women are strong, right? We know that we need to just tough things out and get through it.

And also, pain is looked at as an acute condition in pregnancy, not chronic. So chronic’s considered three months or more. So everybody thinks, well, once the baby’s born, everything will be better, right? Not necessarily. We know if you can’t sleep, you’re at a higher risk of getting depression. And women who are not listened to start to feel helpless and hopeless.

And those are also signs of depression. So could this pregnancy pain be a cause for depression potentially. And could this also potentially continue after the baby’s born? Some studies say yes, but we do need more research on that topic. So then we needed to see what are women using to treat their pain in pregnancy, right?

So we’re building the research, we’re trying to figure out the next step. And then that led to the study that you asked me about over the counter pain medication used during pregnancy.

Lauren: Which I’m so glad that we’re getting to this. This is such a timely topic, and I’m sure in my, my intro, I introed that.

But what does the current research actually say about the risks and benefits of over-the-counter pain medications like acetaminophen or ibuprofen in pregnancy?

Julie Vignato: Right, so the research clearly shows that acetaminophen also known as Tylenol, is safe during pregnancy as long as the dose does not exceed four grams per day.

That is very clear.

So Tylenol and Motrin work on mild pain, but we know that 50% of women in pregnancy, especially in the third trimester, have moderate to severe untreated pain. Okay, so just using mild pain relievers is not gonna help. Mm-hmm. For most women. Now, Tylenol works on the central nervous system, meaning that it’s most effective with headache, pain, and fevers.

Now, Motrin or ibuprofen works better on muscle pain. Okay. It’s more effective. So even just telling women for pain to take Tylenol throughout pregnancy may not be effective. Now you have to watch with Motrin or Ibuprofen. It’s an NSAID aspirin is one as well. There’s others like naproxen.

They are not recommended after 20 weeks of pregnancy because they can cause bleeding as well as birth defects. However, aspirin may be prescribed to high risk women by their medical provider if they’re at risk for a hypertensive disorder called preeclampsia because that has been shown to reduce the risk of, of.

Different types of issues that can happen. Ultimately it’s seizures. But you know, for some women they need to be on aspirin during pregnancy, but that is monitored by their providers. So that could be, you know, midwives, doctors, et cetera. So what I’m saying is that if you’re experiencing pain in pregnancy, the best thing to do is talk to your healthcare provider

Lauren: and they’ll be well informed about this and can give you a specific recommendation based on your pain and scenario,

Julie Vignato: Right, absolutely. Because, along with that, a lot of providers, you know, will also recommend for women to use massage, perhaps heat or cold. But we can still do better with that because a lot of these treatments are not covered by health insurance. They also need repeated treatments. So it could be hard for women to implement some of these.

Now we did have one Cochrane review that indicated that physical therapy, which combines a lot of these treatments and exercise right to strengthen muscles, was the most effective method in reducing pregnancy pain. However, again, not necessarily covered by insurance.

Lauren: Right. And was that even compared to over-the-counter pain relievers?

Julie Vignato: You know, that’s a great point. We need to do more studies.

Lauren: Okay. Yeah,

Julie Vignato: Yeah, absolutely. We need to do more studies.

Lauren: So part of the reason we’re having this conversation right now is because of some high profile comments recently that have linked Tylenol to autism. So can you talk about those common misconceptions, the effect of these misleading claims on this area of research?

Julie Vignato: Mm-hmm. Absolutely. And I’m, I’m glad you asked me that because I’m a mother of a child with autism as well, and I’m also a mother that experienced pregnancy pain. First and foremost, mothers really care about their children and it hurts us to see when we’re, we have children that struggle, right, and that are suffering, and we wanna do the best we can to help them.

Also, mothers feel guilt. It’s something that happens as soon as you get pregnant, right? The Barbie movie said it best in some ways, but you know, it’s like a mom, I have to work, but does that make me a bad mom because I have to work and somebody else take care of my child? Am I using the right diapers?

Should I be making my own baby food? I don’t have time to make my own baby food. Right, right. Should it be organic? Is baby food okay? Like we are like. Bombarded as mothers by all these different messages and they’re conflicting and regardless of what type of mother, you know, which way you go it just, it causes guilt and it causes stress and it makes women feel bad.

So we’ve gotta be clear with our messaging for sure. And I just wanna shout out to all mothers out there, this is not your fault. Now, autism that is caused by many factors related to genetics and an environment, not one single cause. And so we can’t just say it’s Tylenol that causes it, and we clearly have disproven that fact. Tylenol is safe.

Lauren: Where did they get this claim from and how, how did this get circulated in the last week or two? Right.

Julie Vignato: Another great question. I’m so glad you asked. Okay. So to understand this, you have to understand how research works, right? So initial studies did research on mice, and they might have been what was called cross sectionals.

So just that one quick little snapshot in time, we get some information. Now these studies may at like one snapshot of time, maybe consider a lower level of evidence, but they’re still good. Like we still need to do research on mice ’cause we’re not gonna do this research on human beings. Right. And this is just part of building the program of research, so to speak.

Like enlarging the field. We’re gathering some initial data and then that will build for our next study. So. In 2021, there was a call to action and a consensus statement from 91 scientists, and this is the Bauer 2021 article. And so all of these scientists said, “Look, our studies are good, but they’re not enough. We need more. We need to request studies that evaluate Tylenol at a higher dosage level. The amount and timing, right, that is given, and we need more rigorous studies in humans.” So these studies need to consider other factors like the influence of genetics and the environment right on taking Tylenol and this consensus statement then asked once all these studies are done, “FDA, can you please update your recommendations?”

And so a study came from that in 2024. It was published in jama and it’s from Sweden, I believe, about 2 million children evaluating the use of acetaminophen or Tylenol during pregnancy. And so this study occurred from 1995 to 2019, and then they did a 10 year follow up in 2021. What was unique about this study is that it used sibling control analysis to account for any co-founding factors or anything that could influence the results of genetics and environment.

What is also unique about sibling studies is that there might be other factors that influence the results that we don’t even know about. And sibling studies can help with that. So from this, clearly Tylenol does not cause autism. The other studies that were done, the lower level, the ones that are just building the program of research, you know, starting to introduce the field, did not account for factors such as genetics or the environment.

Lauren: Quick timeout. A sibling study compares brothers or sisters born to the same parents. Siblings share a lot of genetics in home environment, so when one pregnancy used acetaminophen and another didn’t, you can better isolate the medication effect from family level factors. That’s why this design is considered stronger for teasing apart correlation from causation. I just wanted to add that quick side note in just for our listeners who are not as familiar with research jargon and methodologies.

Lauren: Now we’re also gonna go back to your original article and what were some of the most important or surprising findings about how and why pregnant people used over the counter pain medication?

Julie Vignato: Yeah. So let me just describe the study a little bit to everyone.

Lauren: Yes, exactly. That background would be great.

Julie Vignato: So the study looked at Iowa PRAMS data. So PRAMs, I’m not gonna spell out what every word means here, but I’m gonna say this was a statewide survey that was done on pregnant women in the state of Iowa from 2019 to 2020.

And after they accounted for all of the surveys and missing data 759 mothers contributed. So, 79 of the mothers in our study reported taking an over-the-counter pain reliever during their most pre recent pregnancy, and 17% reported taking a recommended over the counter pain reliever. So what was surprising is that mothers completed the English, not Spanish, version of the survey, reported taking higher rates of over the counter pain medication, and that was 77% versus 59% in the Spanish version. Those with higher rates of education and income also reported using similar high rates of over-the counter-pain relievers versus Hispanic mothers or those with lower income and education levels.

However, even though I say that, there were some limitations in our study. We do not know because we were using a survey. If this is related to the mothers being high risk and prescribed by their providers to take aspirin, nor do we know if Motrin was taken prior to 20 weeks gestational age. We also do not know if the more educated higher socioeconomic status women have better access to healthcare.

And have been educated on the use of Tylenol to take during pregnancy as a reason or perhaps they need more education, and, and that is our signal from this, from these results that really needs to be explored further. So as you can see through the studies I’ve done, we’re just starting to add to the field.

We’re starting to build the research. There were so many confounding factors potentially in this study. The next step would be to gather data across pregnancy. See what other diagnoses they have, their education levels, their access to healthcare, their genetics environment. Perhaps they’re even taking other medications we’re not aware of.

Lauren: What would you say is the big takeaway between the study that you did, that you just referenced, and then as well as the Sweden study with more than 2 million children? What do you hope that listeners take away based on this body of evidence that we have currently available?

Julie Vignato: That’s a great question.

In our current era where everybody has access to all sorts of knowledge, right? Knowledge is freely available that I would hope, well, like as the American Nurses Association’s code of ethics state, it is nurses’ responsibility to correct misinformation. But I would hope that as nurses or other healthcare providers, public health, for example, that we’re able to educate people not only on what is safe, but also how we got there.

So in this podcast I’ve been talking about building the program of research, right? Yes. Building the field. So where I’m at right now is I’m still gathering information and this will help me design a more rigorous. Study for more accurate results. The Sweden study was building that research, so now that we have some very clear evidence and accurate results,

Lauren: What advice would you give to pregnant people who are unsure about whether to use over-the-counter pain reliever?

Julie Vignato: In this moment, right? Well, every person is unique, right? You have a different environment, you have a different genetic makeup. You might have different risk factors and other like conditions. Your medical provider, your midwife, your nurse practitioner, your physician is trained to look at that and help you.

Figure out, you know, are they safe for you? When can you take them? You know, what is your best treatment plan? So I would encourage anybody who’s not sure to talk to their medical providers,

Lauren: so then. If we’re directing towards healthcare providers or, you know, we think about public health communicators, how can they work to improve the messaging so people feel informed without being scared?

Julie Vignato: You know, it is very important to have very clear messages and simple statements. However, I also feel like the public at large is very smart and has a tremendous access to all sorts of information. So when we’re giving a public health message, we also like this podcast. Yeah. This is a great idea.

Mm-hmm. Like, for those that wanna learn more, you know, go to reliable website. Right. Start looking. And this may be perhaps a way to think at things differently, a paradigm shift, so to speak, in our thinking. But why can’t those that have these questions go to the evidence directly? On PubMed, for example, right?

PubMed being a public library, you can look at these articles and there’s some basic things I tell my students, but I think the public can do it too, right? Yeah. So like is the public aware that there is a Cochran online library?

Lauren: I would say mostly, probably not. Maybe you should explain what that is as a primer, right?

Julie Vignato: So. Cochrane has a very strict method to be able to do reviews in a very systematic and rigorous way. And when a review that provides us some really high level information about the evidence towards anything is published, it is also published in simple, not scientific language.

Lauren: And I think that’s the key that, ’cause sometimes if people go to literature, it can get complicated. But Cochrane in particular, makes it accessible.

Julie Vignato: Yes, exactly. And so you can look at the simpler language and then actually like see the evidence for yourself. Another thing. The public at large can do is even look at the studies and look for their conflict of interest statements. So if something is being published, but then perhaps they have a large stake in a company or some sort of invention that conflicts with that, you know, that might be something they would wanna question or investigate further.

Lauren: That’s a great point.

Julie Vignato: Also, even just looking at the abstract. Then looking to see like how big the sample was. So if they’re just doing interviews and you can have a small sample. So the number of people in this study, right? Maybe, oh, I don’t know, 13 if it’s a certain type of questions versus up to 30.

If it’s a small sample like that and they’re just doing interviews, you can’t apply those results to other populations or other communities, so is the sample large enough If they’re doing a survey study? That’s something else to consider. And then look at the limitation section. No study is perfect, we live in an imperfect world. There’s always gonna be a way to improve.

Lauren: Absolutely. We want it that way.

Julie Vignato: Yes. So look at the limitations. See how the next steps are to build this program of research, right, or to improve the field. I mean, even in that consensus statement from 2021 that I talked about earlier, there was a long list of recommendations to direct future study.

Lauren: So there’s been a lot of fear and guilt I think stirred up in the last week. Mm-hmm. And for people who are pregnant now and for mothers of maybe children with autism who use Tylenol during their pregnancy. So how should we be talking about that in a supportive way? What, what do you think the conversation should look like around that?

Julie Vignato: I think the first thing that all mothers should know is that this is not your fault. None of this. It goes back to mother guilt, right? Mm-hmm. That just comes with, comes with pregnancy. So the ANA, American Nurses Association Code of Ethics, encourages nurses or says we have an ethical responsibility to correct misinformation.

And so, by supporting mothers, encouraging them, answering their questions providing some additional clarification as well as perhaps other options you know, encouraging them to talk with their healthcare providers. Would be very helpful. But then also as nurses, we follow the ethical principle of respect for autonomy so that we respect it when the person makes their own decision.

Lauren: Absolutely. As we close this up, what gaps do you think still exist? What do you think that we, like, we know and people should take away leaving this, and where do you see the next steps in this field?

Julie Vignato: Mm-hmm. Yeah. So as a pain pregnancy researcher, the biggest gap I see is that still 55-to-78% of pregnant mothers have moderate to severe untreated pain during pregnancy. This interferes with sleep and their ability to do their normal activities such as take care of a toddler or work in our society. We believe that pregnancy pain is acute and will resolve after delivery. Yet preliminary research suggests this is not the case. Untreated pregnancy pain may lead to depression and lost work, greater healthcare costs.

And even the use of opioids which may be prescribed, that can lead to neonatal opioid withdrawal symptom or syndrome, excuse me. And that can cost the United States up to $369 million annually. So, the next step is to continue to build the field. This includes rigorous studies on multimodal pain treatments to eventually include perhaps even building the research to do different sites across the United States.

We need more research to inform current clinical guidelines. We have pain guidelines for the postpartum period, but not necessarily during pregnancy. And repeated individualized education is also needed. So I would stay, stay tuned as the research builds.

Lauren: Well, Julie Vignato, you have been an amazing guest and this was a really timely conversation, so I hope all of our listeners feel well informed. I also think I’m gonna include in the show notes links to maybe the Cochrane body of literature as well as your previous study and that Swedish study Sounds great so that people can go to the literature themselves that we’ve just been talking about, or maybe you pull it up while we’re talking about it so you can look at it yourself. But if they have any further questions, what would you suggest that our listeners do?

Julie Vignato: Reach out to their healthcare providers.

Lauren: Right. Great. Yes. Well, thank you so much for taking time to chat with me and educate our listeners.

Julie Vignato: And thank you so much for, for inviting me to be here today.

Lauren: That wraps up today’s episode of Plugged In to Public Health. We’ve heard from Julie Vignato that pregnancy pain is common, complex, and often undertreated, and that safe effective options do exist when used appropriately. Most importantly, the high-quality evidence does not show that Tylenol causes autism. What it does show is the need for better communication, more compassionate care, and more rigorous research to guide both providers and parents. If you’re pregnant or supporting someone who is the takeaway symbol, don’t navigate pain alone and don’t rely on headlines or social media alone. Talk with your healthcare provider. They can help you weigh your personal risk factors, your pain levels, and your treatment options for those who want to dig deeper we’ll link the Swedish Sibling Study, the Iowa Prams Research, and the Cochrane reviews in the show notes so you can read the evidence for yourself. We’re grateful to Julie Vignato for helping us cut through the noise and bring clarity to such an important and emotional subject. And as always, thank you for tuning in. Until next time, stay curious, stay informed, and stay plugged in to public health. This episode was hosted and written by Lauren Lavin and edited and produced by Lauren Lavin.

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