Seems like there has been an ongoing line of inquiry into APAP exposure and neurodevelopmental issues. Wasn't something I was aware of at all. Here is a systematic review published last month. Lead author from Mt Sinai, senior author from Harvard TH Chan: https://ehjournal.biomedcentral.com/articles/10.1186/s12940-025-01208-0
Man, that's a epi challenge. You will never get a definitive answer. Exposure misclassification (OTC drug), impossible to assess all the potential confounders, outcome potentially influenced by variety of genetic and environmental exposures, unethical to do RCT work. The swedish study cited up thread is included in the review, and discussed in some detail in the discussion section. Even if you see an association, you are never gonna pull the drug...guidance will be as it is in current state...minimize dose and duration as indicated.
Results
We identified 46 studies for inclusion in our analysis. Of these, 27 studies reported positive associations (significant links to NDDs), 9 showed null associations (no significant link), and 4 indicated negative associations (protective effects). Higher-quality studies were more likely to show positive associations. Overall, the majority of the studies reported positive associations of prenatal acetaminophen use with ADHD, ASD, or NDDs in offspring, with risk-of-bias and strength-of-evidence ratings informing the overall synthesis.
Conclusions
Our analyses using the Navigation Guide thus support evidence consistent with an association between acetaminophen exposure during pregnancy and increased incidence of NDDs. Appropriate and immediate steps should be taken to advise pregnant women to limit acetaminophen consumption to protect their offspring’s neurodevelopment.