Beta-2 Agonists Tied to ASD Risk?

Systematic review of 8 observational studies found limited evidence on associations between prenatal asthma-medication exposure and neurodevelopmental outcomes, with autism spectrum disorder the only outcome suitable for meta-analysis.

By
Andrea Surnit
June 24, 2026
4 min

MDSpire News

Objective:

To evaluate the association between prenatal exposure to beta-2-adrenergic agonists and the risk of autism spectrum disorder (ASD) in offspring.

Approach:

Study Design: Systematic review and meta-analysis of 8 observational studies involving nearly 3.9 million participants from Denmark, Finland, Sweden, Japan, and the United States.
Study Types: Five cohort studies and three case-control studies, primarily using national registry or administrative data, limited to singleton births.
Primary Analysis: Focused on beta-2-adrenergic agonist exposure and ASD, with pooled analyses from three studies involving about 1.4 million participants.

Key Findings:

Prenatal exposure to beta-2-adrenergic agonists was associated with an adjusted pooled effect estimate of 1.29 for ASD.
Preconception exposure had an adjusted pooled effect estimate of 1.34.
Associations were observed across all trimesters with similar estimates.
Evidence for other neurodevelopmental outcomes was limited, with some associations noted for attention-deficit/hyperactivity disorder (ADHD).
Adjustment for maternal asthma showed mixed results, with some studies finding no significant associations.
No eligible studies evaluated educational outcomes.

Interpretation:

The observed associations may reflect confounding by indication or asthma severity rather than a direct treatment effect.

Limitations:

Most studies relied on prescription or registry data lacking details on adherence, dose, duration, and asthma severity.
Inability to distinguish between short-acting and long-acting beta-2-adrenergic agonists.
All studies conducted in high-income countries, limiting generalizability.
No eligible studies evaluated educational outcomes.

Conclusion:

The findings raise concerns about the potential risks of beta-2-adrenergic agonist exposure during pregnancy, but further research is needed to clarify these associations.