CEimpact Podcast

Acetaminophen and Autism

Share episode

As questions continue to surface about the potential link between prenatal acetaminophen use and autism spectrum disorder, pharmacists must be prepared to address patient concerns with confidence and clarity. This episode explores the current body of evidence, public health messaging, and practical strategies for counseling during pregnancy. Tune in to strengthen your knowledge and support safe, evidence-informed guidance for your patients.

HOST
Joshua Davis Kinsey, PharmD
VP, Education
CEimpact

GUEST
John Swegle, PharmD
Clinical Associate Professor
University of Iowa College of Pharmacy

Joshua Davis Kinsey and John Swegle have no relevant financial relationships with ineligible companies to disclose.
 
Pharmacist Members, REDEEM YOUR CPE HERE!
 
Not a member? Get a Pharmacist Membership & earn CE for GameChangers Podcast episodes! (30 mins/episode)


CPE INFORMATION
Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Summarize current evidence regarding the association between prenatal acetaminophen exposure and autism spectrum disorder.
2. Identify patient counseling considerations for the safe use of acetaminophen during pregnancy.

0.05 CEU/0.5 Hr
UAN: 0107-0000-25-310-H01-P
Initial release date: 10/13/2025
Expiration date: 10/13/2026
Additional CPE details can be found here.

Follow CEimpact on Social Media:
LinkedIn
Instagram

SPEAKER_00:

AC Impact subscribers, welcome to the Game Changers Clinical Conversations Podcast. I'm your host, Josh Kinsey, and as always, I'm excited about our conversation of today. Acetaminophen is one of the most widely used medications during pregnancy, yet, recent studies have raised questions about its potential links to autism and ADHD. In this episode, we'll explore the FDA's latest response alongside key research findings to better understand what the evidence does and does not tell us. And it is great to have John Swegel with us again for our guest today. John, welcome. Thanks for coming back to us today.

SPEAKER_01:

Thank you, Josh. It's always a privilege of mine to join you guys on these podcasts.

SPEAKER_00:

Well, thank you. So for those of you that may be new listeners, perhaps you haven't heard John as our guest before. It's been, I don't know, we were talking maybe six or seven months since the last time you were on. So just for those listeners that may not know you yet, go ahead and give us a rundown of who you are, what you do, and why you're passionate about pharmacy practice.

SPEAKER_01:

Absolutely, Josh. Happy to do so. So yeah, I'm John Swegel. I am a pharmacist. I uh went to school at Drake in the University of Iowa, and I practice up in Mason City, Iowa. I'm a pharmacist for a family medicine residency program, and I am fortunate enough to work with a bunch of physicians caring for patients in the inpatient, outpatient, and the nursing home setting. We in family medicine, of course, deal quite a bit with obstetrics as well as part of the training. I also work with the College of Pharmacy at the University of Iowa. I'm a faculty member down there, and so I am privileged enough to be able to teach and precept students and been doing this up here now for 28 years. So that's a little bit about me.

SPEAKER_00:

Yeah, awesome. Well, thank you again. I know you're super busy. This is a busy time of the year. I remember fall in academia is always just, I feel like, just nonstop. So thanks again for giving us your time this afternoon. So, as previously mentioned, our plan for today is to discuss a topic that has been in the headlines recently. So, as our listeners will recall, the FDA's response to research exploring possible links between acetaminophen use during pregnancy and neurodevelopmental outcomes like autism and HDH. Wow, I'm gonna mess that one up. ADHD. That was a mouthful. Autism and ADHD. So again, on September 22nd, 2025, the FDA announced that it will add new labeling to acetaminophen products, noting evidence of a possible association between prenatal use and neurodevelopment outcomes. Notably, the agency emphasized that these findings demonstrate correlation, not causation, and that untreated fever during pregnancy can also pose risks. So acetaminophine may still be appropriate when clinically needed under medical guidance. So we're going to be digging into some studies today, John. But before we do that, can you help us maybe put into layman's terms, perhaps, the FDA's position on this? What exactly were they saying in their announcement a few weeks ago?

SPEAKER_01:

Yeah, for sure, Josh. So the FDA obviously has uh responsibilities for looking out for safety and efficacy of medications. And in light of studies that have uh come out recently, I think that the FDA probably felt the need to share a little information in in light of all those studies. And so they are, again, as Josh, as you mentioned, talked about an association of an increased risk of the neurologic conditions such as autism and ADHD in children. And the FDA is sort of citing the studies which are pointing out that the risk may be most pronounced when the pseudominophane is taken chronically during pregnancy. And that's a very important point, I think what the listeners need to know.

SPEAKER_00:

For sure.

SPEAKER_01:

And they are also pointing out that there is not a causal relationship that's been established, and there's contrary literature out there. Uh, and so the FDA is basically wanting to just, again, in the spirit of patient safety and prudent medicine, as they put it, they want clinicians to try to minimize the use of acetaminophen during pregnancy. And I would argue that we already do that, but I think the FDA just wants to reassure that that patients and clinicians are not overusing acetamenophil or any medication for that matter. Uh, but the FDA also points out that the fact that acetaminophen is the safest of the over-the-counter alternatives, and so we don't have anything else really that is safer than acetaminophine as far as treating things like pain and fever and and so on. So that's where the FDA kind of stands.

SPEAKER_00:

Yeah, and as they mentioned too in the in the statement that you know they acknowledge that an untreated fever during pregnancy can also pose extreme risks to both the mother and the child, right? So so there, you know, again, it's it's kind of going to be one of those things that best discussed with medical providers and pharmacists is in play here. So that's really why we want to be sure that we're talking about it from our perspective as well, because inevitably you're going to have patients ask you questions about this now. And so we want to be sure that you know the facts and know a good response for them. So let's dig into the first study. So there were two specific studies, I think, that are kind of linked to the FDA's recent announcement. And so the first one we're going to look at was a study from 2019. Uh, it looked at acetamenophane use reported during pregnancy and compared it to the use before and after. So, John, I'll turn it over to you to kind of talk a little bit about this study and kind of give us the rundown as to why this one's being used for guidance in these in these recent developments and statements.

SPEAKER_01:

Yeah, absolutely, Josh. And I want to point out to the listeners that that we we don't have any randomized controlled trials on this. And we're not going to probably have a randomized controlled trial of pregnant women using acetaminophane and then following them for many years. We just so what we're left with then are what what some people refer to as kind of these messy observational studies. And as a result of that, you know, we don't have any definitive data. And so the study that you're talking about, Josh, from 2019, when you have associations, you always are going to have these variables. And you try to tie a variable with a cause or potentially a cause to an outcome. The challenge with that is that you have to control the other variables that also have an impact. And that's what this trial tried to do. They did what they call the negative control exposure, which really is designed to try and assess and correct for unmeasured confounding bias and basically help to strengthen a causal claim regarding a primary exposure. And that that was sort of the design that they had used. And this trial specifically was looking at acetamenophil exposure and ADHD. And they had 110,000 plus female nurses that they were giving questionnaires or surveys every other year for a number of years. And one of those questions that they had asked is about using acetamenophil, specifically regular use of acetaminophine. And so when they're talking about regular acetaminophil use, they are also using that term as use at the time of pregnancy. So it's very, very interesting in how they they put this together. But what they found is that in those those nurses that used regularly used acetaminophen during the time of pregnancy, there was an association with an elevated odds of ADHD developing in the offspring. And and that's all fine and dandy, but but that type of a trial does have some limitations. And I think that those are important to point out. One of which is that this study cannot rule out what's considered residual confounding. And basically, there's always a persistent bias that is involved, and you always will have unknown confounders which are not accounted for. And this survey was an example of something that probably had some of those unknown confounders. Uh, there was no details about the exact timing of acetaminophen, and that's important. We didn't have any details on the frequency of how often they used it, or what the dose was that they had used.

SPEAKER_00:

That's what I was gonna ask. Was you said earlier that it was based on, you know, use. Was that ever defined?

SPEAKER_01:

So nope, regular use is the terminology that they said. And so I that could mean daily use, that could mean every week, that could mean four times a day. They did not define that. And that that's an important point to look at.

SPEAKER_00:

Yeah, for sure.

SPEAKER_01:

And the other the other limitation really, again, these are surveys, right? So there's always a potential for recall bias. Um, you know, if there is, you know, looking back in time. But the diagnosis of ADHD, that was also self-reported by the mothers. So that's a potential limitation as well with that particular study.

SPEAKER_00:

So there was no follow-up to see if there was an actual diagnosis of ADHD in their offspring. Correct. Okay. Okay. Interesting. Yeah, very interesting. Yeah, I mean, so it it sounds like it has merit to stand on, but also potentially some, you know, some limitations that we need to take into consideration.

SPEAKER_01:

So absolutely.

SPEAKER_00:

Was there anything else on this study that you wanted to highlight or point out?

SPEAKER_01:

No, not really. It's it's it's an example of, you know, there's other studies out there that that are probably similar to this, um, but nonetheless, there's not a whole lot more to this study, I don't think, that needs to be highlighted.

SPEAKER_00:

Okay. So then we'll jump to the second study that was kind of that we've chosen to highlight, and that was, you know, kind of again the basis for this. It was conducted in 2020 and it employed a different approach than the one we previously just talked about, where it utilizes biomarkers from umbilical cord blood to assess exposure to acetaminophen. So that sounds like an interesting setup. And I don't know whoever came up with that. So, but I'll turn it over to you, John, to talk a little bit about that study and how it was designed and what kind of the outcomes were.

SPEAKER_01:

Absolutely. So, this, yeah, you're right, Josh. It's it's uh uh looking at core plasma metabolites of acetaminophens, what they were doing with this one. And part of the reason, yeah, exactly. And part of the reason for that, that they they figured is that the acetaminophen can remain in the infant circulation for longer periods of time. And so what they did is they took you know 990 or so mother-infant dyads at at Boston Medical Center that had chlorophore plasma samples from metabolite uh assays, and and the final sample had about 226 kids in it. And the intent of doing it this way is now you have a direct measure of acetamenophine exposure rather than maternal self-reporting. And so that's a different twist to this. And and that's that's that's a good thing because now you're taking that recall bias part out as well. But they were looking for a link between acetamenophine exposure and ADHD and autism autism spectrum disorders, and they did find a positive association between core acetamenophine and ADHD and ASD. And they also, and this is an important point too, they also noted there was a dose dose response pattern to this, which a lot of studies have have kind of come out and said, you know, the higher the dose, the more the exposure, the stronger the association. Like all studies, there are limitations, right? This one, it was just a one-time cord measurement. That's all they took. And and the interesting thing too is that you know that the the levels there may actually reflect the maternal use of acetaminophen during that peripartum period. And there was no non-exposed group as a reference, so they didn't really have a reference to to go by. And the other thing, and this this arguably is one of the most important things, they were not able to exclude potential confounders, specifically genetics or environmental factors. And that's a very important limitation that we'll get into here in just a bit, but those were limitations with this study as well.

SPEAKER_00:

Yeah. One thing I find interesting in that, well, let me clarify too. So what if the, you know, as the mother got closer to birth, she took more. And so like wouldn't that show more of the metabolites then? So was it is it really indicative of how much was happening throughout pregnancy, or is it really just kind of like right before birth? Does that make sense?

SPEAKER_01:

Yeah, that's a great question. And that's that's one of the limitations they had because clearly uh, you know, do we use Tylenol a lot in moms and labor? Well, we'll probably step it up a notch or two. Sure. But but certainly they could use it, right? And so that's a great question. And I don't know that they necessarily addressed that. Um, because again, they're just looking at cord measurements. And so I'm not aware of them looking at how long the mom had used acetaminoph and they used it throughout the entire pregnancy versus, like you're pointing out, Josh, closer to time of delivery where they might need something more. Yep, absolutely.

SPEAKER_00:

Yeah, okay, interesting. Okay, so then so those were kind of the two, I guess you would say, supporting studies. Um, and then there there is one that we're gonna highlight, which would we would, I guess, maybe consider a contrasting evidence or a contrasting study. So several large studies, such as one in particular that we're gonna look at, such as a Swedish sibling analysis, have found little to no association once genetic and family factors are controlled for. Um, how do we reconcile findings that seem to point in different directions like this?

SPEAKER_01:

Yeah, so that's that's it's it's so interesting.

SPEAKER_00:

Is that a loaded question? Absolutely, absolutely.

SPEAKER_01:

Um I I I want to just kind of jump in with this whole autism diagnosis thing. And and the reason I want to do that is we know that the the rates of autism are are increasing. And so the question is why? Everyone wants to know why. But we can't help but think also that part of the reason that we have an increase is probably due to the fact that we have more public awareness about autism. We have more expanded screening for autism, and we also have improved diagnostic methods for for autism diagnosis. And so that does play a role. And so the cause, and this is the genetic part, Josh. This is this is fascinating. So the cause for autism, what causes it? And that it's so complex that it's hard to pinpoint. But there is a general consensus that that genetics is involved. Okay. And part of the problem with that, because these genes and mutations that are central to brain function, there's hundreds of genes that potentially could be linked to autism. And you probably have some environmental play in that as well. So those are things that that you know, the genetic component is is vitally important, which gets us back to the study that you're referring to with with which which was conducted in Sweden. And this came out in JAMA in in 2024. And then there's a one earlier too in 2021 that also looked at a genetic link. And and and the interesting thing about the JAMA one is that this actually was replicated in a Japanese population and came out with the same results.

SPEAKER_00:

Oh, wow. Okay.

SPEAKER_01:

Yeah, exactly. Very, very interesting. So what they did is they did what they called sibling control analysis. And so this study, they did they did two separate things. Okay. First thing that they did was they looked at children born to mothers who used acetamenophine during pregnancy, and they compared them to children born to mothers who didn't use acetamenophine. And they what they saw with that was this apparent uh association between acetomenophine use and risk of autism, uh, ADHD and intellectual disability. Okay. But then they said, okay, well, what if we did this sibling thing where they did the comparison? So what they did basically is they they had kids that uh with the same parents, siblings where one was exposed to acetamenophen in the womb and one was not. And when they re-ran the analysis, all those associations disappeared. So what they are saying is that that's probably a genetic component that was not captured in a lot of other studies. And this was in like 2.5, 2.4 million kids that were followed over time.

SPEAKER_02:

Yeah.

SPEAKER_01:

So both this study in JAMA and the one that came out in 2021 that did use the sibling control analysis, but neither one showed an association. And arguably, arguably, these are more methodologically sound studies. But that's what this one found. And that's, you know, sometimes I think that we we always want to find the answer. We probably will never find a true answer, but using studies like this, I think, you know, kind of goes against some of the earlier studies we had talked about.

SPEAKER_00:

Right. So just to just to reiterate and make it clear to make sure that I'm fully understanding. So basically, in in this most recent study with the sibling analysis, one sibling was confirmed exposed to acetaminophen, one was not. And when they ran those again, there was no correlation to an increase in autism or ADHD or other neurodevelopment diagnoses. And so therefore, it wasn't linked to acetaminophen or or that's the idea. It was more of a genetic cause. Correct. Correct.

SPEAKER_01:

And that's sort of the trend that they're finding that when you do these sibling analysis, the data that uses those tends to not find any evidence supporting a causal association.

SPEAKER_00:

Interesting. One thing I thought of, and and this is random, and you may not, I may be putting on the spot here again with another question. Um, apologies if so, but do you know what sparked the interest in acetaminophen in general? Like clearly, this if there are all these studies that have been going on for the last almost decade, maybe, like what who what was the initial spark of, oh, you know what? I bet it's acetaminophen. Or was that ever the case, or did they just stumble upon it? Do you know the answer to that at all?

SPEAKER_01:

Well, I know that for for you know, for I think part of it is that, you know, we've been using acetaminophine in pregnancy, thinking it's safe for for for decades, right? True. And then you have autism rates that that just keep going up. And so you're looking for why is that? And is there any exposure? You know, we went through this with immunizations, as you know. Interestingly enough, back in 2015, the FDA reviewed available data and they did not find evidence to be what they found is that that all the evidence was inconclusive. The Society for Maternal Fetal Medicine in 2017 also looked at the data and they reached the same conclusion. So, yeah, this has been looked at over and over and over again. Uh, and I think when you have, you know, some studies say there is potentially an associate or there is an association, some studies say there isn't. That tends to lead to more studies to see if we can't get a better answer.

SPEAKER_00:

Fair point. Yep, fair point. Yeah, so that makes sense. Because I'm, you know, I was just wondering why we zeroed in on acetaminophen in the last decade. But as you said, it's because it's been a common medication that pregnant women take. So that that would make sense that we would look to it as a potential culprit. So yeah. Okay, so let's get into what I would like to, well, what I find more interesting. I've never been super good at or excited about digging into studies and breaking them apart, but you you did such a great job and put it on a level that we all can understand. So thank you. But really, what I want to dig into are what are these practical implications? Like what does this mean for pharmacists in everyday practice? We are going to have questions asked of us. We are going to have family members ask questions of us, and we need to know, you know, an appropriate response that is evidence-based. So, right now, just kind of restating a fact, acetaminophen is still the only over-the-counter pain and fever reducer that's generally considered appropriate use during pregnancy. So, if we're cautious about its use, what realistic alternatives would patients and providers have? So if if we are, if we take this information and and really are overzealous and cautious on it, what are the options? Is there anything out there?

SPEAKER_01:

Yeah, that's that's always a great question, right? So we know NSADs are out. They just are. I mean, they've been associated with fetal risks, miscarriage, kidney defects, you know, premature closure, abductus, arteriosis, all that sort of thing. Yep. So NSADs are out. We're obviously not going to want to use anything more strong, I guess, for lack of a better description, like opioids, things like that. There are, you know, and a lot of people advocate, and and this is funny you mentioned this because you're seeing things coming out over and over and over again. And I got something sent to me 45 minutes ago before this started. Oh, wow. Talking about what do we do, what do we do. And but the stepwise approach is always a good thing to do. So if we can do non-pharmacologic things, hot packs, cold packs, stretching, physical therapy, things like that, for example, for pain, uh, those are those are certainly viable approaches. OTC things like with menthol or lidocaine are probably going to be okay, not salicylate containing products and things like that. But then you have, you know, arguably the one that is potentially the safest, that's Tyler or acetamenophine. That's just something that that we we still are going to be using. And so, you know, when patients come in, we we have a general rule, right, with with any any pregnant woman, we don't want to expose anybody to medications that are not necessary. And so the general rule is the lowest dose for the shortest time. And so if patients come in saying, I have I have a headache that is just really bothering me, or if somebody comes in and they have a fever, well, we don't want to let those just go. Don't just ignore them. Right. And so it's better to, and we can talk more about the risks that are associated with those if you want to, but it's definitely better to treat those with acetaminophen than not treat them based on a theoretical risk.

SPEAKER_00:

Right. And and that's a great segue to go right into those because that was one of my next questions, is there are conditions like fever and severe pain that, if left untreated, also pose an extreme risk to the pregnant patient and the baby. And, you know, as far as even birth issues as well as miscarriages, right? So those kind of things can have severe negative outcomes as well.

SPEAKER_01:

Oh, for sure. I mean, these are known. Okay, these are known. So fever, for example, fevers associated and high fevers are associated with increased risk of neurotube defects, uh, increased risks of miscarriage, premature birth. There's some link as well to oral clefts and cardiac defects with fevers. Pain in and of itself. Pain can cause destabilization of maternal physiology, which can lead to depression, which can lead to anxiety, which can lead to high blood pressure. And all of those can have potentially negative effects on fetal well-being. Sure. So those are known. And so we can't just ignore them and say, no, you're you're gonna be fine, just don't take anything. We don't want those that to happen. So please, you know, the listeners, please don't just just let those go. We need to do something to help reduce those known risks associated with those.

SPEAKER_00:

And I like your approach, as you mentioned earlier, where the non-pharmacologic approach is first, you know, trying, like you said, stretching and recommending potentially, you know, yoga aerobic classes or something that is getting, you know, more exercise and and more flow of blood and everything like that. And then using the acetaminophen as kind of I hate to say last resort because it's not really what what we're going for, but using it as the backup, as the option, but not always as the go-to, I guess.

SPEAKER_01:

So right, right. I don't think a pill is always the answer for everything. And that's true outside of pregnancy.

SPEAKER_00:

In general, yeah. I mean, that's that's I always find it funny because you know, a lot of friends who are not pharmacists, a lot of our friends are pharmacists, but because my husband and I are both pharmacists, but you know, kind of keep that circle. But a lot of our friends that aren't, they always, you know, talk about, oh, you're the you're the pill pushers, you're the ones that, and and I always, you know, get back and say that that's we don't always love a pill for fixing things, you know, like that's that's kind of a second or third option. So so I think just keeping that in line here as well, just realizing that there are other options that we can use before we uh resort to that, unless, as we stated, super high fever or something like that, which correct it's gonna require that treatment, you know, to get under control. So how should we handle patient concerns when we're approached? Um, any specific tips or tricks for counseling or uh not I don't want to say like squashing their fears, but you know, you know what I mean? Like what what can we relay to them to where, yes, I understand all of the facts. Here is what our plan is, you know, and maybe it's just as simple as that.

SPEAKER_01:

That's that's a great uh that's a great question, Josh. I I I just have to throw in there because we humans and and people with social media and all the links that are out there, I it's tough and in in and for pharmacists to to make recommendations when they can point to something they read on some link somewhere that somebody said. And and all of us have gone through that, right? All of us, all of us have have battled that one, and so it does make it tricky on what do we say to these patients. My advice is I feel that at this point in time, with the evidence that we have, acetaminophen, and even the FDA says this acetaminophen is still considered the safest of the options out there for treating pain and fever. I would also back that up. There are two large governing bodies that that deal in this, and one of which is uh the American College of Astetrics and Gynecology or ACOG. Their opinion on this is that the weight of evidence right now does not support a causal link, and there's no change in clinical practice that's warranted at this time. The other huge governing body is the Society for Maternal Fetal Medicine. So these are the specialists in this area. Their point is you cannot just ignore untreated fever and pain during pregnancy. Right. And the association at this point in time is considered simply inconclusive. So as a as a pharmacist, if I am educating patients on can you take acetaminophen for your fever, for pain. Obviously, we want to limit the amount that you take. Yes, 100% agree with that. Again, lowest dose, shortest period of time. But I would trust the opinions of those governing bodies that specialize in obstetrics and what their statements are. Yeah. And and there are other organizations too. I didn't want to exclude people, but but these are the two big ones in the world of obstetrics and gynecology.

SPEAKER_00:

Sure. So I think that that if we were to summarize this in a sentence, which would be impossible or potentially even damaging to do, but if we were to summarize this in a sentence, the the outcome is be cautious, but don't boycott the use of it, right? Like this is this is not a throw it out the window never to be used again under any circumstance. It's more of a question the intent, make sure that you know non-pharmacologic, non-pharmacologic options have been used, and then use it in emergency situations like high fever and extreme pain.

SPEAKER_01:

So yes, and I and I want people to know that. I mean, it's it is at this point in time the safest, like the FDA says too. It is the safest option we have. Exactly. Exactly. We just we don't want to expose people to things we don't need to expose them to. But if they need it, it's a risk-benefit thing. And right now the benefits uh are there and we know that. So yes.

SPEAKER_00:

Makes sense. So one last question, John. So looking ahead, um what kinds of studies or methods do you think would help us move closer to answering whether there is an a true causal relationship here between Macedon NFN and autism and other neurodevelopment disorders?

SPEAKER_01:

Yeah, sort of a randomized controlled trial, establishing causation is is next to impossible, right? So and we're not gonna have that. And so my my thought is that we're gonna continue probably having studies coming out that some might say that there is a an association, some may say that there isn't. I do think that the studies that do look at the sibling controlled aspect of things and sibling analysis to try to capture that genetic component, which is vitally important in this. I think if we had more of those studies and and have them be sort of prospective, but more in real time to help eliminate some of the other biases that are out there, other confounders that are out there.

SPEAKER_02:

Yep.

SPEAKER_01:

I think that would be helpful. But I don't know if we're ever going to find a definitive answer without for causation at least without a prospective study. I just don't know that we're gonna be able to do that.

SPEAKER_00:

Yep, that makes sense. So, again, as just in summary, I think one of the biggest take home points for our listeners today is. is to stay vigilant, remain up to date with information that's coming out, and be sure that your recommendations to patients are always evidence based and that you are, I love what you've said, and you've said it a few times, lowest dose possible for the shortest amount of time to get the job done. So I think that's that's great advice to take for our listeners today. John, anything else that you'd like to share?

SPEAKER_01:

No, I mean this is this has been great Josh. I I it it's a very hot topic and there's a lot of information out there. But I I appreciate the opportunity to come by and and and share my thoughts with you and look at the look at what's out there for the literature. And but yeah thank you very much for the opportunity.

SPEAKER_00:

Thank you. Super helpful to have someone who can dig in and give us that generalist perspective. So we really appreciate it. So again key takeaway for our listeners is that the FDA is carefully reviewing additional evidence. The associations are not proof of causation and patients should always discuss pain or fever management during pregnancy with their healthcare provider. And remember pharmacists are healthcare providers. So be ready for those questions and we want you to stay up to date and to stay focused on the evidence that's out there. So thanks again John for joining me. We really appreciate it.

SPEAKER_01:

Absolutely my pleasure.

SPEAKER_00:

If you're a CE plan subscriber be sure to claim your CE credit for this episode of Game Changers by logging in at ceimpact.com and as always have a great week and keep learning. We can't wait to dig into another game changing topic with you all next week