A landmark study\u00a0led by researchers at the University of Nebraska Medical Center (UNMC) and published in\u202fMolecular Psychiatry\u202fhas\u202fidentified\u202fa significant association between prenatal\u202fprescription\u202fof\u202fcommonly\u202futilized\u202fmedications and the risk of autism spectrum disorder (ASD) in children.\u00a0<\/p>\n
Analyzing\u202f6.14\u202fmillion maternal-child health records from the Epic Cosmos database\u202f-representing\u202fnearly one-third of all U.S. births between 2014 and 2023\u202f-\u202fthe team found that\u202fprescription of\u202fmedications known to inhibit\u202fthe cholesterol synthesis pathway\u202fwere consistently associated with higher rates of ASD in offspring.\u00a0<\/p>\n
While\u202fprevious\u202fstudies grouped medications by their indications, the UNMC team grouped prescribed medications together based on common effects and side effects on sterol biosynthesis.\u00a0<\/p>\n
These sterol biosynthesis\u2013inhibiting medications (SBIMs) include certain antidepressants, antipsychotics, anxiolytics,\u202fbeta-blockers\u202fand statins.\u202fThese are the generic names of the 14 medications studied:\u202faripiprazole, atorvastatin, bupropion, buspirone, fluoxetine, haloperidol, metoprolol, nebivolol, pravastatin, propranolol, rosuvastatin, sertraline,\u202fsimvastatin\u202fand trazodone.\u202fMany of these are among the\u202fmost commonly prescribed\u202fmedications in the United States, accounting for more than\u202f400 million annual prescriptions.\u00a0<\/p>\n
Key findings\u00a0<\/p>\n
\n\tMothers prescribed at least one SBIM during pregnancy had a 1.47-fold higher risk\u202fof having a child diagnosed with ASD.\u202fRisk increased in a dose-dependent manner.\u202fFor each\u202fadditional\u202fSBIM co-prescribed, there was a 1.33 times increased risk of ASD, reaching\u202f2.33-fold risk when\u202ffour\u202for more SBIMs were prescribed simultaneously.\u00a0
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\n\tAmong the 196,447 children diagnosed with ASD in the cohort,\u202f14.2% had prenatal SBIM exposure.\u00a0
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\n\tUse of SBIMs during pregnancy increased sharply over time, rising from 4.3% of pregnancies in 2014 to 16.8% in 2023.\u00a0
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Why sterol biosynthesis matters\u00a0<\/p>\n
Cholesterol is essential for\u202ffetal development, especially for the brain,\u202fthe most cholesterol-rich organ. The fetal brain begins producing its own sterols around 19\u201320 weeks\u202fof gestation.\u202fGenetic disruptions in this pathway are known to cause severe developmental syndromes such as Smith-Lemli-Opitz syndrome (SLOS), in which\u202fup to\u202f75% of children meet criteria for ASD.\u00a0Many widely used medications\u202fcan\u202funintentionally interfere with this pathway.\u202fThis\u202fstudy is the first nationwide investigation to evaluate the neurodevelopmental outcomes associated with prenatal exposure to\u202fthis group of\u202fmedications.\u00a0<\/p>\n
A public health signal requiring attention\u00a0<\/p>\n
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Our findings do not suggest that these medications are unsafe for adults. But they raise important questions about their use during pregnancy, a period when even small biochemical disruptions may have outsized effects on fetal brain development.”\u00a0<\/p>\n
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Karoly Mirnics, MD, PhD, senior author, dean and director of the UNMC Munroe-Meyer Institute<\/p>\n
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The authors stress that\u202fno pregnant patient should\u202fdiscontinue\u202for alter medication without medical supervision, as many SBIMs are essential, often life-saving treatments. Instead, the study calls for a re-evaluation of prescribing practices and for developing safer alternatives for use during pregnancy.\u00a0<\/p>\n
Potential\u202fnext steps\u00a0<\/p>\n
The research team proposes several actions to improve drug safety for pregnant patients:\u00a0<\/p>\n
\n\tCreate a comprehensive list of medications with sterol-inhibiting effects.\u00a0
\n\tEvaluate all new pharmaceuticals for unintended sterol pathway inhibition.\u00a0
\n\tIncrease provider education\u202fabout medication-associated sterol disruption\u202fduring pregnancy.\u00a0
\n\tDiscuss safer alternatives\u202fwhen\u202fdiscontinuing\u202ftreatment is not possible.\u00a0
\n\tAvoid\u202fprescribing multiple\u202fSBIMs\u202ffor pregnant women\u202fwhenever\u202ffeasible.\u00a0
\n\tIdentify\u202fpatients with genetic vulnerabilities\u202fin sterol metabolism, as they might be particularly sensitive to SBIM\u202feffects.\u00a0
\n\tInvest in further research\u202fto understand mechanisms and mitigate risk.\u00a0
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The work was conducted using the Epic Cosmos national data platform and included collaboration among UNMC’s Department of Pediatrics, Department of Biostatistics, Munroe-Meyer Institute,\u202fother UNMC\u202fdepartments\u202fand the\u202fChild Health Research Institute\u202f(CHRI).\u202fThe study received support from UNMC\/CHRI\u202finternal resources,\u202fthe Dorothy B. Davis Foundation\u202fand\u202fthe\u202fNebraska\u202fTobacco Settlement\u202fFund.\u00a0<\/p>\n
Source:<\/p>\n
University of Nebraska Medical Center<\/a><\/p>\n Journal reference:<\/p>\n