Today, nearly one in five women of childbearing age takes an antidepressant, most often a selective serotonin reuptake inhibitor (SSRI) like Zoloft, Prozac, or Lexapro. For many, these medications provide a lifeline when dealing with severe depression, persistent anxiety disorders, and more; for others, treatment began as support during a difficult season, perhaps with the hopes of someday weaning off the medication. No matter why you started on an SSRI, if you’re a woman of childbearing age, you might wonder: what happens when I want to get pregnant?
Doctors often reassure women that SSRIs are completely safe in pregnancy, but the science is less settled than it sounds. In truth, a growing body of research, led by physicians like Dr. Adam Urato (a maternal-fetal medicine specialist with over two decades of experience caring for pregnant women in Massachusetts), tells a more nuanced story.
A growing body of research suggests that the question of SSRI safety in pregnancy requires a nuanced conversation
For more than ten years, Urato has challenged the medical establishment’s simplified messaging around SSRIs, documenting associations between SSRI use and nacimiento prematuro, preeclampsia, postpartum hemorrhage, and concerning effects on fetal brain development. He has co-authored large meta-analyses examining thousands of pregnancies and testified before FDA expert panels, consistently urging more honest risk disclosure. As he notes, many patients report being told only that SSRIs pose no risk to the baby, which he argues is neither accurate nor adequate.
In this article, we’ll discuss the conflicting research around the impact of SSRIs in pregnancy, with an honest discussion about the risks of untreated depresión in pregnancy as well. Nothing in this article should be construed as medical advice, or as fear-mongering around SSRIs and other mental health therapies. As always, our goal at Natural Womanhood is to present women with the best information possible, so they can make empowered, informed decisions about their own health and pregnancies.
Potential SSRI risks in various pregnancy stages: What the research shows
SSRIs don’t simply stay in the mother’s system. During pregnancy, they cross the placenta, entering the baby’s developing system at critical stages of growth. Outcomes can vary depending on the specific case, but here’s what multiple studies have found across the board.
First trimester
Cardiac malformations: Some studies have linked paroxetine (Paxil) specifically to mayor riesgo of certain heart defects [1,2], and a 2016 meta-análisis found paroxetine use during the first trimester was associated with approximately doubled risk of some cardiac malformations [3].
But here’s the nuance: a large 2014 US study of over 949,000 pregnancies found no statistically significant increase in overall cardiac defects after controlling for maternal factors [4]. Other comprehensive reseñas similarly found no substantial increase in overall congenital malformations [5]. Why the discrepancy between study outcomes? The answer seems to be that específico SSRIs (particularly paroxetine) may carry different risks than others, and the absolute risk for fetal cardiac defects fortunately remains relatively small.
Why the discrepancy between study outcomes? The answer seems to be that específico SSRIs (particularly paroxetine) may carry different risks than others, and the absolute risk for fetal cardiac defects fortunately remains relatively small.
Later pregnancy and immediately after birth
Preterm birth: The evidence here has been evolving. A 2014 meta-analysis by Huybrechts and colleagues similarly found associations between antidepressant use in the 2nd and 3rd trimesters and increased preterm birth risk [6]. A 2016 meta-analysis found that women who received SSRIs during pregnancy had significantly higher risk of preterm birth (OR 1.45), even after adjusting for maternal depression [7].
In 2024, however, a meta-análisis found that maternal use of antidepressants in pregnancy was not associated with preterm birth when properly adjusting for maternal depression, regardless of timing [8]. This newer evidence suggests that earlier studies may have been confounded by the underlying depression rather than the medication itself. In brief, this particular area still needs further research.
Again, why the discrepancy? In this case, it seems largely due to how depression itself was categorized within the studies, and it is fair to say that not all depressions are the same. Women with more serious, treatment-resistant depression are both more likely to receive SSRIs y are independently more likely to deliver early, and the primary studies pooled in the 2016 analysis varied widely in how well they controlled for this association.
Women with more serious, treatment-resistant depression are both more likely to receive SSRIs y are independently more likely to deliver early.
Poor neonatal adaptation: This one is pretty consistent across studies. Approximately 25–30% of newborns exposed to SSRIs in late pregnancy show withdrawal-like symptoms after birth. These include: jitteriness, tremors, irritability, difficulty breathing [9,10,11]. The good news is that these symptoms are typically mild and transient, resolving within days to weeks, and so far with no apparent long term consequences. But watching a newborn experiencing withdrawals might be difficult for new moms to experience, especially if they are already experiencing heightened anxiety themselves.
Persistent pulmonary hypertension (PPHN): A 2019 network meta-analysis found that SSRI or SNRI exposure during pregnancy was associated with approximately doubled risk of this serious lung condition (OR 1.82) [12]. “Doubled risk” sounds like a lot, but it is worth considering that that is approximately 2-3 cases per 1,000 live births compared to a background rate of about 1.2 cases per 1,000 live births [13,14]. So yes, the risk doubles relatively-speaking, but in absolute terms, it’s still rare.
The neurodevelopmental question
Everyone wants to know about autismo. The research here is frustratingly unclear. Some studies have suggested associations between prenatal SSRI exposure and increased autism risk [15,16], while others have found no significant association after accounting for maternal psychiatric illness [17,18]. A 2023 Kaiser Permanente study found that mothers with psychiatric conditions were more likely to have children with autism, but found no association with SSRI use itself [19].
What does this mean? As with many of the other conditions discussed above, it’s difficult to say with certainty whether any neurodevelopmental risks stem from the medication o the underlying maternal mental health condition(s).
As with many of the other conditions discussed above, it’s difficult to say with certainty whether any neurodevelopmental risks stem from the medication o the underlying maternal mental health condition(s).
On the flip side, untreated depression also carries significant risks
With all this uncertainty, the simplest way to reduce the potential risk of SSRIs is to avoid them during pregnancy. Of course, the reality is much more complicated than that. While we’re examining the risks of SSRIs, we also have to acknowledge that untreated depression (and other mental health issues) during pregnancy is also potentially dangerous.
Suicide is one of the leading causes of maternal death in the United States. Untreated maternal depression is associated with poor prenatal care, preterm birth, low birth weight, compromised maternal-infant bonding, higher rates of substance use, and progression to postpartum depression [20]. What’s more, women who discontinue antidepressants during pregnancy have markedly higher relapse rates, with one landmark study finding a 68% relapse rate among those who discontinued antidepressant use, compared to 26% among those who continued using antidepressants [21].
Women who discontinue antidepressants during pregnancy have markedly higher relapse rates, with one landmark study finding a 68% relapse rate among those who discontinued antidepressant use, compared to 26% among those who continued using antidepressants.
A 2021 meta-analysis found that when analyses were restricted to women with a diagnosis of depression, there were no associations between antidepressant use and most adverse neonatal outcomes [22]. This suggests that some of the risk may be related to the underlying condition rather than the medication itself. This is partially why studies struggle to reach a clear and cohesive consensus, and why in practice, it is important for pregnant women to consult their prenatal care professionals, psychiatrists, and anyone else needed for appropriate care and support.
So we’re left with a genuinely difficult calculus: potential medication risks versus potential depression risks. And that’s exactly why these decisions need to be individualized—and why women deserve the information they need to make informed decisions about their health (and the health of their babies).
Whether you’re pregnant or considering pregnancy, stay tuned for Part II and your options for managing mental health conditions during pregnancy.
