Comment from Anonymous

I am attaching Escudero’s 2026 Translational Perspective in The Journal of Physiology, “Acetaminophen safety revisited: Integrating placental transfer with the developing blood–brain barrier,” because it directly supports the need for a prenatal warning for acetaminophen. The article explains that acetaminophen safety in pregnancy cannot be evaluated merely by asking whether the drug crosses the placenta. Building on Huang and Koehn’s 2026 work, Escudero emphasizes that unmetabolized acetaminophen readily equilibrates between maternal and fetal circulation and crosses the developing fetal blood-brain barrier, reaching the fetal brain itself. This is highly relevant to the petition because it provides a biologically plausible pathway linking maternal acetaminophen use to fetal neurodevelopmental risk. The developing fetus has immature drug metabolism, with limited glucuronidation capacity, meaning a higher proportion of circulating acetaminophen may remain in the parent, bioactive form during critical developmental windows. Escudero also notes that prolonged exposure, rather than brief short-term use, is the exposure pattern more often associated with adverse neurodevelopmental outcomes. These points support a precautionary prenatal warning advising pregnant patients to avoid unnecessary, repeated, or prolonged acetaminophen use unless medically necessary and discussed with a physician. The article does not argue that acetaminophen must never be used in pregnancy; rather, it supports the narrower and more reasonable position that pregnant patients deserve clear warning language and informed consent about potential fetal brain exposure and possible neurodevelopmental risk.