Mol Psychiatry
Common medications used in pregnancy tied to higher autism risk
Clinical takeaway: These findings raise a safety signal for medications used during pregnancy across several mental health and cardiovascular conditions. They support careful medication review and consideration of safer alternatives when feasible.
Prior studies have raised concern about some antidepressants and antipsychotics in pregnancy, but most grouped drugs by indication rather than by a shared biologic effect. This study tested whether medications that inhibit sterol biosynthesis, across several drug classes and indications, were associated with later autism spectrum disorder diagnoses in children.
Investigators examined prenatal exposure to 14 commonly prescribed sterol biosynthesis–inhibiting medications, including selected antidepressants, antipsychotics, beta-blockers, anxiolytics, and statins, across 6.1 million linked U.S. maternal-child records from the Epic Cosmos database for births from 2014 through 2023, with follow-up into 2025. They then modeled later autism spectrum disorder risk after adjustment for demographic and maternal clinical factors.
The main signal was a 47% higher autism risk with exposure to at least one sterol biosynthesis–inhibiting medication (SBIM) during pregnancy. Risk increased with polypharmacy, rising by 33% for each additional co-prescribed medication and reaching 2.33-fold with 4 or more concurrent agents. Overall, 3.8% of children in the cohort were diagnosed with autism spectrum disorder, and 15.0% of those cases had prenatal exposure to at least 1 of these medications.
Use of sterol biosynthesis–inhibiting medications during pregnancy also rose sharply in the dataset, reaching 16.8% in 2023, up from 4.6% in 2014.
The findings suggest a possible shared biologic pathway linking prenatal exposure to these medications with neurodevelopmental vulnerability. The authors suggest that disrupting sterol biosynthesis during pregnancy could lower cholesterol availability and increase reactive sterol byproducts during a period when the fetal brain depends on this pathway, potentially disrupting neuronal growth, differentiation, and circuit formation.
“Our findings do not suggest that these medications are unsafe for adults,” said senior author Karoly Mirnics, MD, PhD, dean and director of the UNMC Munroe-Meyer Institute. “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.”
Potential next research steps are to define a more complete list of medications that disrupt sterol pathways, test newer drugs for similar effects, and clarify whether risk varies by dose, timing, duration, or concurrent exposure. Future work should also identify genetically susceptible patients and test strategies that could reduce fetal risk while preserving needed maternal treatment.
The study concludes, “Given that these drugs account for over 400 million prescriptions annually in the U.S. we recommend these findings be considered before prescribing SBIM medications during pregnancy.”
Source: Peeples ES. Mol Psychiatry. 2026 Apr 16. Sterol pathway disruption in pregnancy: a link to autism