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Study links prenatal exposure to sterol-inhibiting medications with increased autism spectrum disorder risk

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Study Links Certain Prenatal Medications to Increased Autism Risk

A large-scale analysis of U.S. maternal-child health records has found an association between specific medications taken during pregnancy and an increased risk of autism spectrum disorder (ASD) in children.

The study identified that mothers prescribed medications which inhibit cholesterol production had a 1.47-fold higher risk of having a child later diagnosed with ASD.

Key Details of the Research

The study, published in Molecular Psychiatry, analyzed 6.14 million maternal-child health records from the Epic Cosmos database. This data represents nearly one-third of all U.S. births between 2014 and 2023.

Researchers focused on a class of 14 medications that inhibit sterol biosynthesis (SBIMs). These drugs include certain:

  • Antidepressants
  • Antipsychotics
  • Anxiolytics
  • Beta-blockers
  • Statins

Primary Findings

  • Increased Risk with Exposure: Mothers prescribed at least one SBIM during pregnancy had a 1.47-fold higher risk of having a child diagnosed with ASD.
  • Dose-Response Relationship: The risk increased with the number of SBIM prescriptions. It reached 2.33-fold higher when four or more different SBIMs were prescribed during pregnancy.
  • Prevalence of Exposure: Among the 196,447 children diagnosed with ASD in the cohort, 14.2% had prenatal exposure to at least one SBIM.
  • Rising Use: The use of these medications during pregnancy increased significantly, from 4.3% of pregnancies in 2014 to 16.8% in 2023.

Scientific Context: Cholesterol and Brain Development

The biological rationale for the investigation centers on the critical role of cholesterol in fetal development. Cholesterol is essential for fetal brain development. Genetic conditions that disrupt the body's ability to produce sterols and cholesterol are already known to cause developmental syndromes where a high proportion of children meet the criteria for ASD.

Researcher Statement

Senior author Karoly Mirnics emphasized that the findings raise important questions about medication use during pregnancy but clarified the scope of the results.

"These findings do not suggest that these medications are unsafe for adults," Mirnics stated.

Proposed Recommendations

The research team proposed several actions based on their analysis:

  • Create a comprehensive list of medications with sterol-inhibiting effects.
  • Evaluate new pharmaceuticals for unintended sterol pathway inhibition.
  • Increase provider education about medication-associated sterol disruption.
  • Discuss safer alternatives when discontinuing treatment is not possible.
  • Avoid prescribing multiple SBIMs for pregnant women when feasible.
  • Identify patients with genetic vulnerabilities in sterol metabolism.
  • Invest in further research to understand the mechanisms and how to mitigate potential risk.

Study Information

The study was conducted using the Epic Cosmos national data platform with collaboration from multiple University of Nebraska Medical Center departments and institutes. Support came from UNMC/CHRI internal resources, the Dorothy B. Davis Foundation, and the Nebraska Tobacco Settlement Fund.