Prenatal use of certain medications can harm developing fetal brain

A review article by a University of Nebraska Medical Center/Child Health Research Institute research team underscores and describes how altering fundamental brain development processes can be detrimental for the developing baby.

The publication suggests that curtailing use of certain medications could reduce the risk for neurodevelopmental pathology in the developing fetal brain. The medications studied include some statins, antidepressants, anxiety medications and cardiovascular drugs.

Cholesterol biosynthesis is essential for the proper development of the brain. When it is interfered with, the article states, children may be born with or develop complex neurodevelopmental disorders, such as autism, fetal fentanyl syndrome and Smith-Lemli-Opitz syndrome.

The July Journal of Clinical Investigation article puts in context previous publications by members of the same team and their national and international collaborators, including more than 125 other well-respected, peer-reviewed publications.

UNMC and CHRI's Karoly Mirnics, MD, PhD, corresponding author of the article and dean and director of the Munroe-Meyer Institute, said the impact of interference in the prenatal sterol biosynthesis pathway with sterol biosynthesis-inhibiting medications (SBIMs) is well-documented.

The April Molecular Psychiatry study found that the prescriptions of these medications during pregnancy increased from 4.6% of pregnancies in 2014 to 16.8% of pregnancies in 2023. Notably, the 15 studied medications were among the most commonly prescribed drugs in the U.S. with more than 400 million times a year.

Concern that SBIMs used during pregnancy could lead to adverse outcomes "is not new," as the authors state in their paper.

"Medication package inserts (FDA-approved prescription information) developed by pharmaceutical companies clearly state the risks of medications if taken during pregnancy," the article states. "Unfortunately, although the package inserts are easily accessible for physicians and patients, the relevant data are often buried in the large amount of information in them."

Dr. Mirnics and his co-authors also point to the 2015 "retirement" of the FDA's A,B,C,D and X pregnancy medication risk categories, in favor of "narrative sections and subsections." According to their view, while this new approach provides more nuanced information, it can cause confusion and could be counterproductive for prescribing healthcare workers and patients.

Dr. Mirnics suggests the studies his team reviewed may be only the tip of the iceberg.

"Apart from the more apparent dysmorphologies and dysfunctions, we are left with the question of whether inhibiting fetal sterol biosynthesis can result in other developmentally rooted challenges, such as anxiety, OCD and ADHD, that do not appear until much later in life.

"More research is clearly needed, but these grave concerns should not be ignored," he said.

Source:

University of Nebraska Medical Center

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