pregnant woman

BATON ROUGE, La. — Women taken into custody by U.S. immigration agents while pregnant say they received inadequate care in a letter Wednesday that calls on the Trump administration to stop holding expectant mothers in federal detention facilities.

The letter to U.S. Immigration and Customs Enforcement is part of a broader campaign in recent months by Democrats and immigrant rights groups to draw attention to what they say is the mistreatment of pregnant detainees.

The Department of Homeland Security has defended its care, saying pregnant detainees get regular prenatal visits, mental health services, nutritional support and accommodations “aligned with community standards of care.”

In addition, Homeland Security Department spokesperson Tricia McLaughlin said in a written statement Wednesday that such detentions are “rare” and involve “elevated oversight and review.” The agency didn’t provide figures on the number of pregnant women in detention, a number Democrats have sought for months.

The letter sent by the American Civil Liberties Union cites accounts from pregnant women who say they were shackled while being transported, placed in solitary confinement for multiple days and given insufficient food and water while detained in Louisiana and Georgia.

The ACLU said that over the last five months it has met with more than a dozen females who were pregnant while in ICE custody — including some who had a miscarriage while detained. The women reported “gravely troubling experiences,” the letter states, including lack of translation during medical encounters and medical neglect. One suffered a “severe” infection after her miscarriage.

In an interview with the Associated Press, one of the women said she was kept in handcuffs while being transported to Louisiana — a journey that lasted five hours and spanned two plane rides. The woman, who has since been released from custody and given birth, spoke on the condition of anonymity out of fear of facing retaliation during her ongoing case.

An officer told her he considered taking off the handcuffs but worried she would escape. “How am I going to escape if I’m pregnant?” the woman said she responded.

She said she felt as if she’d been kidnapped and experienced dizziness, nausea and vaginal bleeding. During her time in detention, she said pregnant women were not offered special diets and described the food as horrible. She alleged that detainees had to “beg” for water and toilet paper.

The ACLU’s letter is the latest call for an investigation into the arrests and treatment of pregnant detainees.

Senate Democrats wrote Homeland Security Secretary Kristi Noem in September, expressing concerns about the “prevalence and treatment” of pregnant, postpartum and nursing women in ICE custody. They demanded that the agency stop detaining such people unless there are “exceptional circumstances.”

“Proper care for pregnancy is a basic human right, regardless of whether you are incarcerated or not and regardless of your immigration status,” said Rep. Sydney Kamlager-Dove, a California Democrat. She signed on to a Democratic Women’s Caucus letter to Homeland Security officials in July sharing concerns about the “treatment of women” and demanding answers — including how many have given birth while detained.

Kamlager-Dove said she’s working on legislation that would “severely restrict the use of restraints on pregnant, laboring and postpartum women who are in federal custody.”

ICE guidelines already say that agents “should not detain, arrest, or take into custody for an administrative violation of the immigration laws” people “known to be pregnant, postpartum or nursing,” based on a policy sent to the AP by Homeland Security. But the document does state that such people may be detained and held in custody under “exceptional circumstances” or if their release is prohibited by law.

The policy also prohibits using restraints on pregnant detainees, but here too there are exceptions — including if there is a serious threat that the detainee will hurt herself or others, or if “an immediate and credible risk” of escape cannot be “reasonably minimized” through other methods.

Cline and Gonzalez write for the Associated Press. Gonzalez reported from McAllen, Texas.

During this week’s White House press conference in which President Trump named the over-the-counter drug Tylenol as a possible cause of rising autism rates, he did not mince words, urging pregnant women to “fight like hell” not to take it.

But outside those remarks in the Roosevelt Room — during which Trump himself acknowledged “I’m not so careful with what I say” — the discussion on the common fever and pain reliever’s role during pregnancy is a lot more nuanced.

What the research on Tylenol use during pregnancy actually says

Physicians, researchers on the very studies cited in support of Trump’s position and even other members of the president’s administration are largely united on a few key facts: untreated fevers in pregnancy pose real risks to the fetus, acetaminophen (Tylenol’s active ingredient) remains the safest medication to treat them and any pregnant person seeking advice on the issue should consult their doctor.

“All that we should be asking of the medical profession [is] to actually weigh the risks and benefits for the women, with the women, and be cautious about chronic use of pain medications,” said Dr. Beate Ritz, a UCLA professor of epidemiology who co-authored a paper published last month that the White House cited as evidence for the link between Tylenol and autism.

Ritz said it has been misinterpreted.

The conclusion of the paper, which reviewed existing studies on the topic, was that the association between acetaminophen use in pregnancy and later diagnoses of neurodevelopmental disorders in kids was strong enough to merit doctors’ consideration when determining how to treat fever or pain in pregnancy. The group did not determine a causal relationship between the drug and autism, or suggest barring the drug altogether, she said.

“Looking at all of these studies, yes, there is a risk,” Ritz said. “It’s not very big, but it’s there, but the risk increases are more seen in regular users of Tylenol. This is not a woman who has a fever and takes three Tylenols.”

“There is always a weighing of the risks and the benefits, and fever in women is no good either. … Not having to take any pain medications when you are in severe pain or in chronic pain is also very cruel,” she said. “We all should have an interest in helping out here, making the right decisions without blaming the victim and putting it all on the individual woman.”

Her co-author, University of Massachusetts epidemiologist Ann Bauer, has made similar statements.

“What we recommend is judicious use — the lowest effective dose [for] the shortest duration of time under medical guidance and supervision, tailored to the individual,” Bauer told the news outlet Politico.

The administration’s confusing recommendations

Ultimately, that’s what the administration is recommending as well.

The letter that U.S. Food and Drug Administrator Dr. Marty Makary sent to physicians this week made clear that “a causal relationship” between autism and acetaminophen “has not been established and there are contrary studies in the scientific literature.”

It went on to recommend that clinicians consider limiting their use of acetaminophen for routine low-grade fevers during pregnancy, while noting that medical advice “should also be balanced with the fact that acetaminophen is the safest over-the-counter alternative in pregnancy among all analgesics and antipyretics.” (An analgesic is a pain reliever; an antipyretic reduces fever.)

Untreated fevers during pregnancy are associated with higher rates of birth defects, particularly those of the heart, brain and spinal cord; premature birth; low birth weight; neurodevelopmental disorders including autism; and fetal death, said Dr. E. Nicole Teal, an assistant professor of maternal-fetal medicine at UC San Diego.

“The FDA’s letter, while significantly more nuanced than the president’s comments on the issue, still gives too much weight to findings from poorly designed studies,” she said.

She said she will continue to prescribe acetaminophen to pregnant patients who need to treat fevers or severe pain, as it has the fewest known risks in pregnancy.

Are there other pain-relief and fever-reducing drugs that can be used during pregnancy?

Nonsteroidal anti-inflammatory drugs like ibuprofen (often sold as Advil) or naproxen (often sold as Aleve) are linked to problems with blood vessel and kidney development, as well as oligohydramnios, a condition in which there isn’t enough amniotic fluid to support a healthy pregnancy. Aspirin raises the risk of bleeding complications, and narcotics — which can relieve pain but not fever — pose addiction risks for the mother and infant alike, Teal said.

She referred to a statement from the American College of Obstetricians and Gynecologists noting that two decades of research on the question had failed to find a causal relationship between acetaminophen and autism.

“Acetaminophen is one of the few options available to pregnant patients to treat pain and fever, which can be harmful to pregnant people when left untreated,” American College of Obstetricians and Gynecologists president Dr. Steven J. Fleischman said in the statement.

The group also noted that reviews in 2015 and 2017 from the FDA and the Society for Maternal-Fetal Medicine respectively found no risks associated with appropriate usage of the drug in pregnancy.

How to navigate government communications around Tylenol use

Nonetheless, the mixed messaging from the Trump administration about Tylenol seems likely to continue.

The Department of Health and Human Services this week reposted a 2017 tweet from the Tylenol brand’s account that said, “We actually don’t recommend using any of our products while pregnant.”

A spokesperson for Kenvue, the company that owns Tylenol, said the post was taken out of context and incomplete.

“Consistent with regulations, our label states clearly ‘if pregnant or breast-feeding, ask a health professional before use,’ ” Melissa Witt said in an email. “We do not make recommendations on taking any medications in pregnancy because that is the job of a healthcare provider.”

Vice President JD Vance offered similar guidance this week.

“My guidance to pregnant women would be very simple, which is follow your doctor. Right?” Vance said in an interview with the outlet NewsNation after Trump’s press conference. “Talk to your doctor about these things.”

President Trump blamed the over-the-counter drug acetaminophen, commonly known by the brand name Tylenol, as a significant factor in the rise of U.S. autism diagnoses on Monday, at a news conference in which he offered often inaccurate medical advice for the nation’s children and pregnant women.

“Taking Tylenol is not good. I’ll say it. It’s not good,” Trump said, flanked by Health and Human Services Secretary Robert F. Kennedy Jr. and Centers for Medicare & Medicaid Services Administrator Dr. Mehmet Oz.

In a series of rambling, error-filled remarks that touched upon pain relievers, pregnancy, vaccines and the Amish — who he inaccurately said have no autism prevalence in their communities — Trump also said that the mumps, measles and rubella vaccine should be broken up into multiple shots and that children defer until age 12 the hepatitis B vaccine series now started at birth.

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“I’m just making these statements from me, I’m not making them from these doctors,” he said. “It’s too much liquid. Too many different things are going into that baby.”

The announcement was met with dismay from autism researchers and advocates who said that research thus far into causal links between acetaminophen and autism has turned up minimal evidence.

“Researchers have been studying the possible connections between acetaminophen and autism for more than a decade,” said Dr. David Mandell, a professor of psychiatry at the University of Pennsylvania Perelman School of Medicine. The Trump administration, he said, “has cherry-picked findings that are not in line with most of the research.”

Physicians and researchers also took issue with Trump’s insistence that there was “no downside” to women avoiding fever-reducing drugs in pregnancy. In fact, studies show that untreated fever in pregnancy is associated with higher risk of heart and facial birth defects, miscarriage and neurodevelopmental disorders — including autism.

The U.S. Food and Drug Administration will initiate a safety-label update for Tylenol and other acetaminophen products and send a letter to physicians about potential links between the drug’s use and autism, Kennedy said.

The actual text of the letter is much milder than Trump’s impassioned critique.

“In the spirit of patient safety and prudent medicine, clinicians should consider minimizing the use of acetaminophen during pregnancy for routine low-grade fevers. This consideration should also be balanced with the fact that acetaminophen is the safest over-the-counter alternative in pregnancy among all analgesics and antipyretics,” states the letter, signed by FDA Commissioner Dr. Marty Makary.

Monday’s announcement followed weeks of speculation that Kennedy planned to publicly link Tylenol usage to autism, which prompted multiple medical associations to release statements clarifying that any evidence of a causal relationship between the two is limited, and that the drug is safe to take during pregnancy with medical advice.

“All of us in the advocacy community, and all of us who have children with autism, had very high hopes that RFK and the President were serious when they said they wanted to find the causes of autism,” said Alison Singer, co-founder and president of the Autism Science Foundation. “The problem is that so far, what we’ve heard has not been gold-standard science.”

The administration also said it would fast-track the labeling of leucovorin, a generic drug currently used to reduce side effects of chemotherapy, as a treatment for autism-related speech deficits. Also known as folinic acid, leucovorin is a form of the B vitamin folate. Research into its effect on autistic children is still in its early stages, researchers said. The few studies that have been published had small sample sizes and found only minimal improvements in symptoms of concern, Mandell said.

“I want to see a large, rigorous, independent trial. In the absence of that, to tout this as a cure is reckless,” he said. “Families deserve better.”

Autism spectrum disorder is a complex neurological and developmental condition. Symptoms cluster around difficulties in communication, social interaction and sensory processing, and the condition can manifest in many different ways based on co-occurring disabilities and other factors.

Diagnoses in the U.S. have risen steadily since the Centers for Disease Control and Prevention began tracking data in 2000, thanks in large part to a broadening definition of the disorder and increased efforts to identify children with ASD.

Today one in 31 U.S. 8-year-olds has been identified as having autism spectrum disorder, according to the most recent CDC data, up from one in 150 in 2000.

Kennedy has long asserted that’s due to an external environmental cause, often using inaccurate statements to describe both the condition and the research around it.

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Most experts believe genetic links and changing diagnostic criteria play a significant role in the trend. In April, Kennedy dismissed such research and arguments as “epidemic denial.” He said he was certain an external factor was to blame.

“We know it’s an environmental exposure. It has to be,” Kennedy said. “Genes do not cause epidemics.” He said at the time that the administration would find an environmental cause by September.

Research into causal links between acetaminophen and autism have not found strong evidence.

Last year, a team of researchers from the U.S. and Europe reviewed records of 2.5 million babies born in Sweden between 1995 and 2019. At first glance, it did seem like children exposed to acetaminophen in the womb were 5% to 7% more likely to be diagnosed with autism than those who weren’t. But when the researchers compared those children to their siblings, they found that kids from the same parents were equally likely to be diagnosed with autism, whether their mother took acetaminophen during pregnancy or not.

“If you actually do an apples to apples comparison, you see absolutely zero effect. The association flatlines. In other words, there’s no real risk that’s attributable to acetaminophen,” said Brian K. Lee, a professor of epidemiology and biostatistics at Drexel University who was on the study team. “A large elephant in the room is being ignored, and that’s genetics.” Hundreds of studies over the years have explored the complex genetics of autism, with both inherited and spontaneous genes contributing to the condition.

The paper also noted that women who took acetaminophen while pregnant were, unsurprisingly, more likely to suffer from the kinds of ailments for which the medication is indicated, like fevers or chronic pain.

They were also more likely to have diagnoses of autism or other neurodevelopmental disorders, to have pre-existing mental health conditions or to be taking other prescribed medications, the team found. Their results were published in the Journal of the American Medical Association.

“People don’t take acetaminophen for fun. They are taking it for a health condition,” Lee said.

He compared the correlation between Tylenol exposure and autism to the correlation between ice cream sales and drownings. Both of those things tend to increase at the same time each year, he said, not because ice cream is deadly but because both rise during hot summer months. In other words, the underlying health causes that women are taking acetaminophen to treat could be more likely linked to autism than the pain reliever itself.

“This is just such a shame when there are so many things we could do to help autistic children and adults, and the negative consequences — making parents feel guilty about taking Tylenol during pregnancy and newly pregnant women afraid — are real,” said Catherine Lord, a clinical psychologist and autism researcher at UCLA. “Just sad all around.”

CONCORD, N.H. — A federal judge in New Hampshire said Thursday he will certify a class action lawsuit including all children who will be affected by President Trump’s executive order ending birthright citizenship and issue a preliminary injunction blocking it.

Judge Joseph LaPlante announced his decision after an hour-long hearing and said a written order will follow. The order will include a seven-day stay to allow for appeal, he said.

The class is slightly narrower than that sought by the plaintiffs, who originally included parents as plaintiffs.

The lawsuit was filed on behalf of a pregnant woman, two parents and their infants. It’s among numerous cases challenging Trump’s January order denying citizenship to those born to parents living in the U.S. illegally or temporarily. The plaintiffs are represented by the American Civil Liberties Union and others.

At issue is the Constitution’s 14th Amendment, which states: “All persons born or naturalized in the United States and subject to the jurisdiction thereof, are citizens of the United States.” The Trump administration says the phrase “subject to the jurisdiction thereof” means the U.S. can deny citizenship to babies born to women in the country illegally, ending what has been seen as an intrinsic part of U.S. law for more than a century.

“Prior misimpressions of the citizenship clause have created a perverse incentive for illegal immigration that has negatively impacted this country’s sovereignty, national security, and economic stability,” government lawyers wrote in the New Hampshire case.

LaPlante, who had issued a narrow injunction in a similar case, said while he didn’t consider the government’s arguments frivolous, he found them unpersuasive. He said his decision to issue an injunction was “not a close call” and that deprivation of U.S. citizenship clearly amounted to irreparable harm.

Cody Wofsy, an attorney for the plaintiffs, and his team have been inundated by families who are confused and fearful about the executive order, he said. Thursday’s ruling “is going to protect every single child around the country from this lawless, unconstitutional and cruel executive order,” he said.

Several federal judges had issued nationwide injunctions stopping Trump’s order from taking effect, but the U.S. Supreme Court limited those injunctions in a June 27 ruling that gave lower courts 30 days to act. With that time frame in mind, opponents of the change quickly returned to court to try to block it.

In a Washington state case before the 9th U.S. Circuit Court of Appeals, the judges have asked the parties to write briefs explaining the effect of the Supreme Court’s ruling. Washington and the other states in that lawsuit have asked the appeals court to return the case to the lower court judge.

As in New Hampshire, a plaintiff in Maryland seeks to organize a class-action lawsuit that includes every person who would be affected by the order. The judge set a Wednesday deadline for written legal arguments as she considers the request for another nationwide injunction from CASA, a nonprofit immigrant rights organization.

Ama Frimpong, legal director at CASA, said the group has been stressing to its members and clients that it is not time to panic.

“No one has to move states right this instant,” she said. “There’s different avenues through which we are all fighting, again, to make sure that this executive order never actually sees the light of day.”

The New Hampshire plaintiffs, referred to only by pseudonyms, include a woman from Honduras who has a pending asylum application and is due to give birth to her fourth child in October. She told the court the family came to the U.S. after being targeted by gangs.

“I do not want my child to live in fear and hiding. I do not want my child to be a target for immigration enforcement,” she wrote. “I fear our family could be at risk of separation.”

Another plaintiff, a man from Brazil, has lived with his wife in Florida for five years. Their first child was born in March, and they are in the process of applying for lawful permanent status based on family ties — his wife’s father is a U.S. citizen.

“My baby has the right to citizenship and a future in the United States,” he wrote.

Ramer and Catalini write for the Associated Press. Catalini reported from Trenton, N.J.