A University of Nebraska Medical Center and Child Health Research Institute research team highlights in a July 20 review article that altering fundamental brain development processes can be detrimental for developing babies. The publication suggests that reducing the use of certain medications during pregnancy could lower the risk for neurodevelopmental pathology in the fetal brain.
The review examined medications including some statins, antidepressants, anxiety medications, and cardiovascular drugs. It notes that cholesterol biosynthesis is essential for proper brain development, and interference with this process may result in complex neurodevelopmental disorders such as autism, fetal fentanyl syndrome, and Smith-Lemli-Opitz syndrome.
The article draws on previous publications by members of the same team and their collaborators nationally and internationally. Karoly Mirnics, MD, PhD, corresponding author of the article and dean and director of the Munroe-Meyer Institute at UNMC, said that "the impact of interference in the prenatal sterol biosynthesis pathway with sterol biosynthesis-inhibiting medications (SBIMs) is well-documented." Eric Peeples, MD, PhD, associate professor in the UNMC Division of Neonatology and lead author on both this new review and an earlier publication, said, "A particular concern is that utilization of these medications by pregnant women is on a steep rise, more than tripling over the decade from 2014 to 2024."
An April Molecular Psychiatry study cited by Peeples found prescriptions for these medications during pregnancy increased from 4.6% to 16.8% between 2014 and 2023; among them were fifteen commonly prescribed drugs used more than 400 million times annually in the United States.
Dr. Mirnics and co-author Zeljka Korade were part of a group who first identified how inhibition of sterol biosynthesis underlies fetal fentanyl syndrome. The authors note concerns about SBIMs during pregnancy are longstanding: "Medication package inserts (FDA-approved prescription information) developed by pharmaceutical companies clearly state the risks of medications if taken during pregnancy," but relevant data may be difficult to find amid large volumes of information.
The paper also discusses changes to FDA guidelines in 2015 when letter-based risk categories were replaced with narrative sections; while offering nuanced information for prescribers or patients, it may cause confusion or be counterproductive. Dr. Mirnics concludes: "More research is clearly needed but these grave concerns should not be ignored."
