Treating Mental Illness During Pregnancy the Same as Any Medical Illness: In Conversation With Jennifer L. Payne, MD

CLINICAL CONVERSATIONS

The use of medications during pregnancy has recently become a subject of hot debate in the United States. On September 22, the US Food and Drug Administration (FDA) announced a label change for acetaminophen (Tylenol and similar products) that reflect supposed evidence suggesting that the use of acetaminophen by pregnant women may be associated with an increased risk of neurological conditions such as autism and attention-deficit/hyperactivity disorder (ADHD) in children.¹ Before that, on July 21, 2025, the FDA led an expert panel on selective serotonin reuptake inhibitors and pregnancy, in which they questioned the validity of psychiatric medication use during pregnancy.² Both of these decisions, and their resulting speculation in the general public, have led to increased fear around pregnancy. To quell some of this anxiety, Psychiatric Times spoke with Jennifer Payne, MD, an expert in reproductive psychiatry, about best practices for treating pregnant patients.

Psychiatric Times: The FDA has issued a statement that acetaminophen use during pregnancy causes neurological conditions such as autism and ADHD in children. What are your thoughts on this announcement? Can you share any helpful data?

Jennifer Payne, MD: The studies that have found an association between acetaminophen use during pregnancy and autism or other neurological conditions have had significant methodological limitations, such as lack of controlling for confounding factors or the use of self-report data. “Confounding by indication” is an important factor to control for in studies that examine whether a medication exposure in utero is associated with a negative pregnancy or child outcome. Confounding by indication means that that the reason the medication was taken in pregnancy might result in a negative outcome rather than the medication exposure itself. For example, acetaminophen is often taken in the setting of an infection, fever, or inflammation, all of which may be associated with negative pregnancy outcomes. Studies that do not control for confounding by indication may find associations between in utero medication exposure and a negative outcome that are not accurate. Well controlled studies have not found an association between acetaminophen use during pregnancy and neurological conditions in children. An example of a well-controlled study is “Acetaminophen Use During Pregnancy and Children’s Risk of Autism, ADHD, and Intellectual Disability.”³ This study used sibling controls to help to control for confounding factors.

PT: Do you believe claims like this increase pressure or fear for mothers-to-be? Overall, how will this impact maternal mental health?

Payne: Yes, I think there is more pressure than ever for women to have a “perfect and pristine” pregnancy. Women are being subtly and not so subtly encouraged to ignore their own needs in favor of having a pregnancy that is not exposed to any medications. This additional pressure is not good for anyone, least of all pregnant persons.

PT: How can clinicians address these fears? What resources can you recommend sharing with patients?

Payne: First, it is important to stay informed and to check reputable resources when controversial statements are being made that make the headline news. For example, the American College of Obstetrics and Gynecology, the National Medical Association, and the World Health Organization issued statements discrediting the FDA statement.^4-6 It is important that doctors seek out credible reviews of the evidence and help their patients sort out what is disinformation and what is an accurate representation of the currently available evidence.

PT: On July 21, 2025, the FDA led an expert panel on selective serotonin reuptake inhibitors and pregnancy, in which they questioned the validity of psychiatric medication use during pregnancy. Can you share your thoughts on that panel? How does medical mistrust put mothers in particular at risk?

Payne: I shared my thoughts on the FDA panel and the disinformation spread about major depressive disorder and its treatment in a recent article.⁷ The panel also shared disinformation on the use of the antidepressants in pregnancy linking it to autism and other negative pregnancy outcomes. Well controlled studies have not found that antidepressant use in pregnancy is associated with autism in exposed children and the studies that have found that association are examples of poorly controlled studies with methodological flaws. It is quite unfortunate that this disinformation continues to be pushed as the literature is robust in terms of the negative pregnancy outcomes associated with untreated maternal depression. Depression during pregnancy is clearly associated with preterm birth, low birth weight, a higher risk of C-section, and the development of postpartum depression. In turn, postpartum depression is associated with lower IQ, slower language development, and increased behavioral problems in children. It is important not to forget the effects of untreated maternal mental health on the pregnancy and the exposed children when considering whether to use antidepressants in pregnancy.

PT: What medications are NOT safe to use during pregnancy? Are there any you’d like to draw attention to?

Payne: Since I am a psychiatrist, I will limit myself to discussion of psychiatric medication use during pregnancy. There are 2 psychiatric medications that should not be used during pregnancy, if at all possible: valproic acid and carbamazepine. All other psychiatric medications can be used during pregnancy when necessary and appropriate to treat maternal mental illness.

PT: Can you share any best practices for clinicians who might be seeing pregnant patients? How do you approach prescribing medication in pregnant patients or in patients who might become pregnant?

Payne: First and foremost, assume every reproductive age woman may get pregnant and may get pregnant unexpectedly. Approximately 50% of pregnancies in the US are unplanned. I recommend discussing whether a medication you are prescribing should be used during pregnancy and what the plan is for contraception, an unplanned pregnancy, and ideally a planned pregnancy. It is important to not only discuss the potential risks of a medication used during pregnancy but also the risk of untreated maternal illness (including mental illness) during pregnancy. It is a risk-risk discussion.

PT: Anything else you would like to share?

Payne: In my opinion, clinicians should be treating mental illness during pregnancy the same way they treat medical illnesses during pregnancy. If a pregnant patient develops gestational diabetes or high blood pressure during pregnancy, clinicians treat the illness with the idea that “healthy mom means health baby.” The same is true for treating maternal mental illness. The goal during pregnancy should be to keep mom both physically and mentally health, not just for the mother, but for the baby as well.

PT: Thank you!

Dr Payne is vice chair of research, professor of psychiatry and neurobehavioral sciences, and director of the Reproductive Psychiatry Research Program at the University of Virginia in Charlottesville.

References

1. FDA Responds to Evidence of Possible Association Between Autism and Acetaminophen Use During Pregnancy. News release. September 22, 2025. Accessed October 14, 2025. https://www.fda.gov/news-events/press-announcements/fda-responds-evidence-possible-association-between-autism-and-acetaminophen-use-during-pregnancy

2. FDA expert panel on selective serotonin reuptake inhibitors (SSRIs) and pregnancy. FDA. July 21, 2025. Accessed October 14, 2025. https://www.fda.gov/patients/fda-expert-panels/fda-expert-panel-selective-serotonin-reuptake-inhibitors-ssris-and-pregnancy-07212025

3. Ahlqvist VH, Sjöqvist H, Dalman C, et al. Acetaminophen use during pregnancy and children’s risk of autism, ADHD, and intellectual disability. JAMA. 2024;331(14):1205-1214.

4. ACOG affirms safety and benefits of acetaminophen during pregnancy. ACOG. September 22, 2025. Accessed October 14, 2025. https://www.acog.org/news/news-releases/2025/09/acog-affirms-safety-benefits-acetaminophen-pregnancy

5. NMA statement on federal government’s misleading announcement on acetaminophen use in pregnancy. NMA. September 23, 2025. Accessed October 14, 2025. https://nmanet.org/news/nma-statement-on-federal-governments-misleading-announcement-on-acetaminophen-use-in-pregnancy/

6. WHO statement on autism-related issues. WHO. September 24, 2025. Accessed October 14, 2025. https://www.who.int/news/item/24-09-2025-who-statement-on-autism-related-issues

7. Payne JL. Why getting major depression right matters-for mothers, babies, and all of us. J Clin Psychiatry. 2025;86(4):25com16092.