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Brian Lehrer: Brian Lehrer on WNYC. On Monday, as many of you know, President Trump and his health secretary, RFK Jr., warned against pregnant women taking acetaminophen at a White House news conference, citing unproven claims that the drug could cause autism. In response, the American College of Obstetricians and Gynecologists has reaffirmed, it is safe to use Tylenol during pregnancy.

In a statement, they called Trump's announcement irresponsible, and that, "It is a harmful and confusing message to send to pregnant patients." It's the latest in a series of statements from the Trump administration that continue to put a tremendous onus on pregnant women with little scientific evidence to back up their claims. In May, RFK Jr. removed the recommendation that pregnant women get vaccinated against COVID. Last month, the panel organized by the FDA cast doubts on the safety of antidepressants during pregnancy.

As one writer in The Cut recently put it, "Trump is blaming mothers for what society either doesn't understand or fails to adequately address." Joining us now to discuss what the science says about painkiller use during pregnancy and more is Dr. Veronica Gillispie-Bell, an OB-GYN, obstetrician and gynecologist, and vice chair of the American College of Obstetricians and Gynecologists' Clinical Practice Guidelines Committee of Obstetrics. Dr. Gillispie-Bell, welcome to WNYC.

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Brian Lehrer: Do we have you? Dr. Gillispie-Bell, are you there?

Dr. Veronica Gillispie-Bell: I am here, but I'm sorry, I can't hear you.

Brian Lehrer: Oh, well, we'll try to get that straightened out as I invite our listeners in as well, particularly those of you expecting. I'm sure there are some of you out there because there always are. You're invited. How have you been navigating new Trump administration guidelines for pregnant women, personally or with your doctor? Do you see the recent recommendations on Tylenol, COVID boosters, antidepressants as a form of mom-shaming, as some are now saying mom-shaming?

On a federal level, have they caused any awkward moments between you and friends or family who support the Trump administration's claims, or if any medical professionals out there are listening? Any other OB-GYNS, particularly? How have your conversations changed with your pregnant patients in light of RFK Jr.'s and President Trump's statements? 212-433-WNYC. Pregnant people, OB-GYNs, this is particularly for you on how you're navigating the medicine, the science, and the social aspect. This mom-shaming that some people are calling it, and we can take questions for our guest as well. 212-433-WNYC, 212-433-9692. Dr. Gillispie-Bell, I think you can hear me now, right?

Dr. Veronica Gillispie-Bell: Yes, I can hear you well now.

Brian Lehrer: Great, so I see that on Monday, in response to Trump on acetaminophen, your association released a statement saying it was "harmful and confusing" as a message to send to pregnant patients. What does your organization see in particular as harmful in Trump and RFK Jr.'s claims? The more moderate interpretation that I've seen from some scientists is not simply Tylenol is safe. It's there are some studies that show a potential cause and effect on neurodevelopment if taken in large doses or for a long period of time, and it needs more study. What's your actual position?

Dr. Veronica Gillispie-Bell: The studies show that Tylenol is safe in pregnancy, as you stated. There are no studies that show that Tylenol causes autism. There are some studies that show a link or an association, but a link or an association is very, very different than causation. When we look at those studies that show a link or an association, for example, those studies have many confounding factors. We don't know how much Tylenol those women took. We don't know what the indications were for why they were taking the Tylenol.

Also, these are mostly retrospective studies, meaning that the women in the studies had to recall the information. With all of those confounding factors, we're not able to show causation. I think when we think about the reasons we give Tylenol or we recommend Tylenol is usually to treat fever. It's usually to treat pain. Especially with fever, we do know that if that goes untreated, that it does cause problems for the fetus. To try to draw that conclusion of association to make it to be causation, that is very, very dangerous and very harmful to pregnant women.

Brian Lehrer: Let's take a phone call from Rhianna in Asbury Park, currently expecting. Rhianna, congratulations in advance. Welcome to WNYC.

Rhianna: Thank you so much. Longtime listener, first-time caller. Pleasure to be on the show. I just wanted to comment. I'm 32 weeks pregnant. Thank you for your congratulations. This has been a very difficult journey just to get here. I was absolutely appalled when Trump stated that women have to "tough it out." The just ignorance about what it means to be pregnant, what it means to get pregnant for some people, it's been very difficult. You can hear I'm a little bit out of breath because I'm very pregnant. [laughs]

Brian Lehrer: 32 weeks is very pregnant.

Rhianna: [chuckles] I was taking IVIg treatment in order to maintain a pregnancy. For that reason, you needed to take Tylenol because there's a chance of an allergic reaction. For him to say "tough it out" from an allergic reaction is ridiculous. It's so sad to me that the majority of this country, people in this country don't know how to read a research study. I think that's something that really needs to be addressed in schools because it's just ignorance. What he's saying is ignorance, and it can hurt so many people.

Brian Lehrer: Rhianna, besides the science, did you feel like viscerally and personally considering that what you just described about your own experience, did you feel like there was an element of mom-shaming there?

Rhianna: Oh, of course. Everything that you put in your body and everything that you do, everything that you breathe, you're constantly thinking about how to protect your baby. Constant, it's a full-time job. For someone to say, based on no medical knowledge and just sounding ignorant, like crazy ignorant, "Oh, you should be toughing it out," just a disregard for mothers, disregard for women in general.

Brian Lehrer: Thank you for your call, Rhianna. Good luck with your labor and delivery. Dr. Gillispie-Bell, do you see this at all? I don't know if this is what you want to get into as an OB-GYN per se, but do you see all of this as related at all to the long history of doctors dismissing women's pain sometimes as all in their head? It seems to maybe be related to this "tough it out."

Dr. Veronica Gillispie-Bell: Yes, I absolutely do. To Rhianna, congratulations on your pregnancy. I 100% agree with all of the things that you raised. Myself being a mom that had to undergo IVF to get pregnant. I do think that all of the statements around "toughen it out" during the pregnancy all just really, really devalue women. I do think it really feeds into some of the stereotypes and biases that we have created about women and women being super bodies and being able to withstand pain, and just certain different narratives that are just really unfair to women. What I hope is that no woman is made to feel guilty for taking a medication that we know is safe to treat their pain. No one should feel that they are not "tough enough" because they have to treat their conditions.

Brian Lehrer: Michelle in Manhattan, you're on WNYC. Hi, Michelle.

Michelle: Hi there. I wanted to reach out to say, as a high-risk pregnancy, my children are now older, having dotted every I, crossed every T, not eaten the soft cheeses of Brie, not had cold cuts, to now be told that something that we had taken that was medically approved is problematic. I wonder what women felt like in the 50s and 60s that took thalidomide and had children born without limbs. I also want to bring up the point that other countries' health agencies have not made proclamations against acetaminophen.

The National Health Services in the United Kingdom, totally okay for pregnant women, Europe, all these other agencies in other countries. For anyone that might feel terrible and walk around and say, "I tried to do everything I could," and like, "Maybe I have a kid that's neurodivergent. Maybe they have ADHD. Maybe they're on the spectrum because the detection is so much higher now," to say you try to do everything, it feels terrible to be worried like this, and just wanted to bring it up since you have a professional to know. Do we know anything about other countries, and if they're changing their recommendations?

Brian Lehrer: Thank you, Michelle. Dr.?

Dr. Veronica Gillispie-Bell: Yes, so great question. As far as we have noted, there are no other countries that are changing their recommendations, primarily because there is no data to support Tylenol causing autism. As you were mentioning, we have really broadened the category and the criteria for the diagnosis of neurodivergent disorders. Part of that is to make sure that those babies, those children have access to resources. There is a question, are we really seeing more cases of autism, or have we gotten better at our detection? To address your original question, there is no data that we are seeing from other countries to make the proclamations that we are making against Tylenol.

Brian Lehrer: I hope that's helpful, Michelle. Thank you very much for your call. Here's a bit of snark from a listener in a text message. It says, "Donald Trump was born in 1946, would love to know what his mom was consuming while she was pregnant with him that made him the kind of person he is. It's all her fault, right?" says that listener. In the same press conference, as with the acetaminophen, Trump promoted leucovorin, a form of vitamin B9, as a treatment for autism. I know you're an OB-GYN, not a pediatrician, but I'm wondering if you're familiar with that drug, and if you can explain this part of the story that's not getting as much coverage at all.

Dr. Veronica Gillispie-Bell: Yes, I am familiar with leucovorin. It's a medication that we use for other conditions in medicine. Really, there is no data that shows that it has been effective, I think, as he may have stated, reducing the manifestations of autism. Again, making statements that are not really founded in science and literature.

Brian Lehrer: I want to take you back to something that you said in one of your early answers to make sure that people hear it. Just the relationship between a high fever and risks to the fetus, since that's one of the main reasons that pregnant women take Tylenol at all. Can you talk about that? Since the recommendations, I think, from the mainstream medical groups are still to take Tylenol, lowest dose, for the shortest amount of time, talk about the risk of high fever and how you balance what you actually tell your patients.

Dr. Veronica Gillispie-Bell: Yes, so we have plenty of data that shows that a high fever can result in miscarriage. It can also result in fetal defects in the way that the fetus is formed. It is the reason that we recommend Tylenol for fever. It is also the reason that we recommend pregnant women don't go into saunas and hot tubs and situations where they would be exposed to high heat.

Again, for my patients, I rely on the data and the evidence and the guidance that comes from the American College of Obstetricians and Gynecologists, as well as the Society for Maternal-Fetal Medicine. I do recommend that they take Tylenol if they have a fever. We do recommend the smallest dose for the shortest amount of time. We definitely know, again, that it's safe. It doesn't cause autism. We know that when we don't treat fevers that that does cause problems for the pregnancy.

Brian Lehrer: What are you recommending to your patients who are pregnant with respect to COVID vaccines and, I guess, flu vaccines this fall?

Dr. Veronica Gillispie-Bell: Yes. Well, let me just say this. For the way that I practice medicine, I always, always discuss the risk, the benefits, and the alternatives. I work to help my patients navigate to the right answer for them and for their family. Based on our guidance again from ACOG and SMFM, I do recommend the full flu vaccine, and I recommend COVID-19 vaccine. We know that for pregnant women, when we're pregnant, our immune systems are not as strong, and so we cannot fight off viruses.

When we do contract those viruses, we can be very, very, very ill to the point of hospitalization, intubation in the ICU. In fact, in the United States in 2021, our maternal mortality rates skyrocketed because we found during the pandemic that being pregnant and contracting COVID-19 was a risk factor for death because, again, we're just not able to fight off the diseases in the same way when we're pregnant. For those reasons, I do recommend the COVID-19 vaccine as well as the flu vaccine and the RSV vaccine as well.

Brian Lehrer: Dr. Veronica Gillispie-Bell, obstetrician and gynecologist, and vice chair of the American College of Obstetricians and Gynecologists' Clinical Practice Guidelines Committee on Obstetrics. Thank you so much for joining us. We really appreciate you giving us some time today.

Dr. Veronica Gillispie-Bell: Thank you. My pleasure.

Brian Lehrer: That's The Brian Lehrer Show for today, produced by Mary Croak, Lisa Allison, Amina Srna, Carl Boisrond, and Esperanza Rosenbaum. Zach Gottehrer-Cohen produces our Daily Politics Podcast. Juliana Fonda and Amber Bruce at the audio controls today. Have a great weekend, everyone, and stay tuned for Alison.

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