OMAHA, Nebraska — A landmark study led by researchers at the University of Nebraska Medical Center (UNMC) and published in Molecular Psychiatry has identified a significant association between prenatal prescription of commonly utilized medications and the risk of autism spectrum disorder (ASD) in children.
Analyzing 6.14 million maternal-child health records from the Epic Cosmos database —representing nearly one-third of all U.S. births between 2014 and 2023 — the team found that prescription of medications known to inhibit the cholesterol synthesis pathway were consistently associated with higher rates of ASD in offspring.
While previous studies grouped medications by their indications, the UNMC team grouped prescribed medications together based on common effects and side effects on sterol biosynthesis.
These sterol biosynthesis–inhibiting medications (SBIMs) include certain antidepressants, antipsychotics, anxiolytics, beta-blockers and statins. These are the generic names of the 14 medications studied: aripiprazole, atorvastatin, bupropion, buspirone, fluoxetine, haloperidol, metoprolol, nebivolol, pravastatin, propranolol, rosuvastatin, sertraline, simvastatin and trazodone. Many of these are among the most commonly prescribed medications in the United States, accounting for more than 400 million annual prescriptions.
Key findings
Why sterol biosynthesis matters
Cholesterol is essential for fetal development, especially for the brain, the most cholesterol-rich organ. The fetal brain begins producing its own sterols around 19–20 weeks of gestation. Genetic disruptions in this pathway are known to cause severe developmental syndromes such as Smith-Lemli-Opitz syndrome (SLOS), in which up to 75% of children meet criteria for ASD. Many widely used medications can unintentionally interfere with this pathway. This study is the first nationwide investigation to evaluate the neurodevelopmental outcomes associated with prenatal exposure to this group of medications.
A public health signal requiring attention
“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.”
The authors stress that no pregnant patient should discontinue or 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.
Potential next steps
The research team proposes several actions to improve drug safety for pregnant patients:
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, other UNMC departments and the Child Health Research Institute (CHRI). The study received support from UNMC/CHRI internal resources, the Dorothy B. Davis Foundation and the Nebraska Tobacco Settlement Fund.
About UNMC
As Nebraska’s only public academic health science center, the University of Nebraska Medical Center enrolls more than 4,800 students across six colleges, two institutes and a graduate studies program. A nationally recognized leader in research and innovation, UNMC’s mission is to create a healthier future for Nebraskans through premier education, research and clinical care, but its impact – rooted in a culture of collaboration, big ideas and public-private partnerships – goes far beyond, in areas that include infectious diseases, rural health, cancer research and treatments, global health security, intellectual and developmental disabilities , and simulation and experiential learning technologies.
Molecular Psychiatry
Data/statistical analysis
People
Study suggests link between prenatal exposure to certain medications and increased autism risk
16-Apr-2026
The authors declare no competing interests.