President’s Tylenol statements make more work for already-busy doctors

President Donald Trump’s announcement Monday that the government will warn doctors Tylenol use by pregnant women increases an unborn child’s risk of autism was derided by the worldwide medical community for drawing conclusions not supported by sufficient medical evidence. But that was just the start for the medical professionals who serve expecting mothers.

Three San Diego obstetricians interviewed this week said the president’s advice has been on most maternal minds. Reactions have run the gamut from sincere concern to dark humor.

Dr. Ronald Salzetti, medical director of women’s health services at Scripps Health and department chair of obstetrics and gynecology at Scripps Clinic, said that his first day seeing patients after Tylenol got Trumped included an encounter with a quite-concerned patient.

“She asked me, ‘Do I have to be worried, because I did take Tylenol at various points during the pregnancy?’” Salzetti said. “We kind of went through the studies that the President was quoting during the press conference, and then other data that we have access to through our societies and the opinions of both the American College of Obstetrics and Gynecology and the Society for Maternal Fetal Medicine.

“After that, I think I was able to reassure her and that she was happy with that.”

Another late-term patient called, double-checking Tylenol as a recommended medication for pain and bringing down fever, while another, early in her pregnancy, wanted to discuss the drug in the context of Monday’s statements.  All in all, Salzetti said, women seemed accepting of his evidence-backed advice that Tylenol can be safely used to address symptoms in pregnancy.

Cynthia Gyamfi-Bannerman, MD, chair and professor of obstetrics, gynecology and reproductive sciences at UC San Diego School of Medicine and perinatologist at UC San Diego Health, said that she has also found her recent patients eager to discuss Tylenol, though none have accepted the advice out of Washington Monday.

“It was really funny because, I mean, I wasn’t sure what to expect, but everyone was like ‘Oh, yeah, of course I’m going to take Tylenol,’” Gyamfi-Bannerman said.

One pregnant patient, she said, found the situation humorous, asking for Tylenol at work as a joke. “And then she said, ‘Yeah, I would never take my medical advice from Donald Trump,” Gyamfi-Bannerman said.

Dr. Joanna Adamczak, chief medical officer at Sharp Mary Birch Hospital for Women and Newborns, said her doctors have been inundated with serious questions and concerns around Tylenol this week.

“The sense that I’m getting from patients is sort of a mix of fear and guilt if women have taken acetaminophen during the pregnancy because, for example, they were suffering from a headache or a migraine,” Adamczak said. “Now some are worried or very concerned that they may have potentially caused harm to their unborn baby.”

The President’s remarks included advice for women to avoid Tylenol during pregnancy and to dose themselves only “in cases of extremely high fever that you feel you can’t tough it out.”

That’s where obstetricians have their greatest worry. Tylenol alternatives such as aspirin and ibuprofen can also bring down fevers, but both have strong evidence of detrimental effects to pregnant women and unborn babies. There is a caveat with aspirin. While it is not recommended in regular or high doses during pregnancy, low-dose baby aspirin is generally considered safe in certain applications.

Having women turn away from the drug with the least evidence of possible harm could have serious consequences. Concerns are greatest for fevers that are severe enough to cause hospital stays, including those caused by deadly conditions such as sepsis, a runaway overreaction of the immune system often triggered by an infection and resulting in high fever in addition to deadly inflammation that can shut down vital organs.

None of the local experts said they had yet encountered a pregnant patient who is unwilling to take Tylenol or its generic forms while suffering a severe fever, but there is concern that advice from such a formal source could prove overpowering.

“If the leader of our country, the President, plus the health secretary, say this, you’re supposed to take those types of announcements seriously and actually listen to them,” Adamczak said. “I think some women, unfortunately, will take this to heart and will not listen to their doctor.”

And there are other conditions beyond fever that can be fraught. Preeclampsia is a common medical complication in pregnancy that causes very high blood pressure that can have significant consequences, even death, if not treated quickly.

Tylenol, Gyamfi-Bannerman notes, is used as a sort of medical test in patients suspected of this condition. If Tylenol eases a pregnant woman’s severe headache, then preeclampsia is generally not the cause. But if it persists, then obstetricians generally induce delivery, which makes the condition abate.

An unwillingness to take Tylenol in this scenario, then, could send mother and baby down the wrong path.

“We haven’t seen it yet, but, you know, (I’m) just concerned that we’re going to tell someone they have this really bad headache and their blood pressure is high, we’re going to give you Tylenol, and they turn around and say ‘no,’” Gyamfi-Bannerman said. “That might cause people to have preterm deliveries that weren’t needed.”

In addition to complicating risky situations, there is also concern that the federal advice on Tylenol simply makes more work for doctors, nurses and other medical professionals who already struggle to keep up with crushing workloads.

While efforts are underway to spread the burden of explaining drug studies to worried patients, Salzetti said that the early going has revealed a possible Tylenol time sink.

“With my first patient, we definitely went into a little bit more detail because of her level of concern was much greater,” Salzetti said. “That definitely took some time out of my morning to make sure she understood the data, understood what was said on both sides, and felt as comfortable as she could be that the risk, if any, was very low.”