Autism risk in children increased 1.4 X if the mother had taken sterol-inhibiting drugs while pregnant

Sterol pathway disruption in pregnancy: a link to autism - April 2026

Molecular Psychiatry; https://doi.org/10.1038/s41380-026-03610-7

Eric S. Peeples, A. Jerrod Anzalone, Ran Dai, Elizabeth Reisher, Zeljka Korade & Karoly Mirnics

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Cholesterol is a vital molecule, especially during embryonic development. Disruption of the cholesterol biosynthetic pathway can arise from pathogenic genetic variants or exposure to prescription medications. We investigated the relationship between fifteen sterol biosynthesis inhibiting medications (SBIM) prescribed during pregnancy and the incidence of autism spectrum disorders (ASD) in the resulting offspring. Our study of the Epic Cosmos database queried linked child and maternal health records for births between 2014 and 2023 with follow-up to December 2025. The study included 6,135,213 children with linked maternal health records. We evaluated the incidence of ASD associated with maternal prescription of aripiprazole, atorvastatin, bupropion, buspirone, fluoxetine, haloperidol, metoprolol, nebivolol, pravastatin, propranolol, rosuvastatin, sertraline, simvastatin, and/or trazodone during pregnancy using Cox proportional hazard modeling.

We found that exposure to at least one SBIM during pregnancy was associated with a 1.47-fold (95% CI 1.45–1.49) increased risk of an ASD after adjusting for potential confounders. For each additional SBIM co-prescribed, there was a 1.33 (95% CI 1.32–1.34) times increased risk of ASD, reaching 2.33-fold risk when 4 or more SBIMs were prescribed simultaneously. In the ten years of our cohort, we identified 234,971 (3.8%) children with an ASD diagnosis. Of the children with an ASD diagnosis, 35,152 (15.0%) of the mothers were prescribed at least one SBIM during pregnancy.

Notably, in our dataset, utilization of SBIM medications by pregnant women increased from 4.6% in 2014 to16.8% in 2023. In conclusion, SBIMs may be potentially harmful to the developing fetus. 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.

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What the drugs might have been taken for - Claude AI April 2026

Question: Which health problems are these drugs prescribed for: aripiprazole, atorvastatin, bupropion, buspirone, fluoxetine, haloperidol, metoprolol, nebivolol, pravastatin, propranolol, rosuvastatin, sertraline, simvastatin, and/or trazodone?

Statins (atorvastatin, pravastatin, rosuvastatin, simvastatin) — HMG-CoA reductase inhibitors for hyperlipidemia and atherosclerotic cardiovascular disease prevention (primary and secondary). Also used post-MI/stroke and in diabetics for CV risk reduction.

Antidepressants (bupropion, fluoxetine, sertraline, trazodone) — Major depressive disorder is the common indication, but each has distinct secondary uses:

  • Fluoxetine (SSRI): OCD, bulimia, panic disorder, PMDD
  • Sertraline (SSRI): OCD, panic disorder, PTSD, social anxiety disorder, PMDD
  • Bupropion (NDRI): seasonal affective disorder, smoking cessation (as Zyban)
  • Trazodone (serotonin modulator): labeled for depression, but overwhelmingly prescribed off-label as a hypnotic for insomnia

Beta blockers (metoprolol, nebivolol, propranolol) — Hypertension is shared across all three.

  • Metoprolol: also angina, heart failure (succinate form), post-MI, arrhythmias, migraine prevention
  • Nebivolol: essentially hypertension only (β1-selective with nitric oxide–mediated vasodilation)
  • Propranolol: the broadest — arrhythmias, migraine prevention, essential tremor, performance/situational anxiety, hyperthyroid symptoms, portal hypertension, infantile hemangioma

Antipsychotics (aripiprazole, haloperidol)

  • Aripiprazole (atypical, D2 partial agonist): schizophrenia, bipolar I, adjunct in MDD, irritability in autism, Tourette's
  • Haloperidol (typical, high-potency D2 antagonist): schizophrenia, acute psychosis/agitation, Tourette's, delirium (off-label but very common in hospitals)

Anxiolytic (buspirone) — Generalized anxiety disorder. Non-sedating, non-addictive 5-HT1A partial agonist, so often chosen when benzodiazepines are contraindicated.

One cross-cutting note relevant to your work: deficiency of 25(OH)D has been associated with most of the indications above — depression, anxiety, cardiovascular disease, dyslipidemia (statins themselves modestly lower 25(OH)D transport via altered cholesterol substrate), and psychosis — though causality and effect sizes vary considerably by condition.

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