Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Systematic Review
  • Published:

Depression and antidepressant use in pregnancy and adverse maternal and offspring outcomes: a systematic review and meta-analysis

Molecular Psychiatry (2025)Cite this article

Subjects

Abstract

Objective

Antidepressant use during pregnancy has been increasing in the last few decades. A substantial body of evidence has indicated the increased risks of adverse health outcomes for both pregnant women and their offspring. The association may be biased by uncontrolled confounding of maternity depression or mental health status. We performed a systematic review and meta-analysis to generate comprehensive estimates of the association between depression, antidepressants, and reproductive outcomes.

Methods

The PubMed and Embase were searched from database inception to Jul 29, 2025, for longitudinal cohort studies of pregnant women with exposure to antidepressant or depression. The Newcastle-Ottawa Scale was used for assessing the methodological quality of included studies. Pooled estimates of risk ratio (RR) were calculated by comparing adverse outcomes between antidepressant-exposed pregnancies and unexposed pregnancies. Subsequently, we analyzed the risks of antidepressant-treated, untreated antenatal depression by adjusting for disease factors. Totally, 20 adverse health outcomes including 6 maternal and 14 children’s outcomes were accessed.

Results

A total of 166 studies with 51,596,405 participants were included. When antidepressant-exposed pregnancies were compared to all unexposed pregnancies (with and without depression), an increased risk for the majority (16/20) of the focused adverse outcomes was found. After adjusting for depression, results shows that certain adverse outcomes remained significant among untreated pregnancies. However, compared with untreated depressed women, the treated by antidepressant for depressed women during pregnancy was associated with the increased risk for limited outcomes of preterm birth and NICU admission.

Conclution

The findings indicated that many of the adverse outcomes observed with medication may be attributable to the underlying depression itself rather than of antidepressants. More attention should be paid to depression, and health professionals should estimate the risk of depression and antidepressant comprehensively during counseling and prenatal health care.

Access through your institution
Buy or subscribe

This is a preview of subscription content, access via your institution

Access options

Access through your institution

Buy this article

  • Purchase on SpringerLink
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Flow chart of identification of eligible studies.
Fig. 2: Antidepressant-exposed pregnancies vs. all unexposed pregnancies.
Fig. 3: Comparisons by antidepressant exposure under different depression conditions.
Fig. 4: Specific antidepressant-exposed pregnancies vs. unexposed pregnancies with depression.

Similar content being viewed by others

References

  1. Chatillon O, Even C. Antepartum depression: prevalence, diagnosis and treatment. Encephale. 2010;36:443–51.

    Article  CAS  PubMed  Google Scholar 

  2. Gelaye B, Rondon MB, Araya R, Williams MA. Epidemiology of maternal depression, risk factors, and child outcomes in low-income and middle-income countries. Lancet Psychiatry. 2016;3:973–82.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Hallberg P, Sjöblom V. The use of selective serotonin reuptake inhibitors during pregnancy and breast-feeding: a review and clinical aspects. J Clin Psychopharmacol. 2005;25:59–73.

    Article  CAS  PubMed  Google Scholar 

  4. Abdullah H, Beckmann J, Andonian-Dierks C. Empirical findings on associations between anxiety, depression, and congenital heart disease in adults – a systematic review and meta-analysis. Heart Mind. 2023;7:70–9.

    Article  Google Scholar 

  5. Munir LZ, du Toit EF. Impact of chronic psychological stress on cardiovascular disease risk: a narrative review. Heart Mind. 2024;8:268–78.

    Article  Google Scholar 

  6. Meunier MR, Bennett IM, Coco AS. Use of antidepressant medication in the United States during pregnancy, 2002–2010. Psychiatr Serv. 2013;64:1157–60.

    Article  PubMed  Google Scholar 

  7. Damkier P, Christensen LS, Broe A. Patterns and predictors for prescription of psychotropics and mood-stabilizing antiepileptics during pregnancy in Denmark 2000–2016. Br J Clin Pharmacol. 2018;84:2651–62.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Latendresse G, Elmore C, Deneris A. Selective serotonin reuptake inhibitors as first-line antidepressant therapy for perinatal depression. J Midwifery Womens Health. 2017;62:317–28.

    Article  PubMed  Google Scholar 

  9. Bałkowiec-Iskra E, Mirowska-Guzel DM, Wielgoś M. Effect of antidepressants use in pregnancy on foetus development and adverse effects in newborns. Ginekol Pol. 2017;88:36–42.

    Article  PubMed  Google Scholar 

  10. Mesches GA, Wisner KL, Betcher HK. A common clinical conundrum: antidepressant treatment of depression in pregnant women. Semin Perinatol. 2020;44:151229.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Vlenterie R, van Gelder M, Anderson HR, Andersson L, Broekman BFP, Dubnov-Raz G, et al. Associations between maternal depression, antidepressant use during pregnancy, and adverse pregnancy outcomes: an individual participant data meta-analysis. Obstet Gynecol. 2021;138:633–46.

    Article  PubMed  Google Scholar 

  12. Ghimire U, Papabathini SS, Kawuki J, Obore N, Musa TH. Depression during pregnancy and the risk of low birth weight, preterm birth and intrauterine growth restriction- an updated meta-analysis. Early Hum Dev. 2021;152:105243.

    Article  PubMed  Google Scholar 

  13. Guan HB, Wei Y, Wang LL, Qiao C, Liu CX. Prenatal selective serotonin reuptake inhibitor use and associated risk for gestational hypertension and preeclampsia: a Meta-analysis of Cohort studies. J Womens Health (Larchmt). 2018;27:791–800.

    Article  PubMed  Google Scholar 

  14. Arafa A, Dong JY. Depression and risk of gestational diabetes: a meta-analysis of cohort studies. Diabetes Res Clin Pract. 2019;156:107826.

    Article  PubMed  Google Scholar 

  15. Leshem R, Bar-Oz B, Diav-Citrin O, Gbaly S, Soliman J, Renoux C, et al. Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin Norepinephrine ReuptakeInhibitors (SNRIs) During Pregnancy and the Risk for Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) in the offspring: a true effect or a bias? A systematic review & meta-analysis. Curr Neuropharmacol. 2021;19:896–906.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Jarde A, Morais M, Kingston D, Giallo R, MacQueen GM, Giglia L, et al. Neonatal outcomes in women with untreated antenatal depression compared with women without depression: a systematic review and meta-analysis. JAMA Psychiatry. 2016;73:826–37.

    Article  PubMed  Google Scholar 

  17. Uguz F. Neonatal and childhood outcomes in offspring of oregnant women using antidepressant medications: a critical review of current meta-analyses. J Clin Pharmacol. 2021;61:146–58.

    Article  CAS  PubMed  Google Scholar 

  18. Dragioti E, Solmi M, Favaro A, Fusar-Poli P, Dazzan P, Thompson T, et al. Association of antidepressant use with adverse health outcomes: a systematic umbrella review. JAMA Psychiatry. 2019;76:1241–55.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Ankarfeldt MZ, Petersen J, Andersen JT, Fernandes MFS, Li H, Motsko SP, et al. Duloxetine exposure during pregnancy and the risk of spontaneous and elective abortion: a Danish Nationwide Observational study. Drugs Real World Outcomes. 2021;8:289–99.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Berard A, Zhao JP, Sheehy O. Antidepressant use during pregnancy and the risk of major congenital malformations in a cohort of depressed pregnant women: an updated analysis of the Quebec Pregnancy Cohort. BMJ Open. 2017;7:e013372.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Reis M, Kallen B. Delivery outcome after maternal use of antidepressant drugs in pregnancy: an update using Swedish data. Psychol Med. 2010;40:1723–33.

    Article  CAS  PubMed  Google Scholar 

  22. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25:603–5.

    Article  PubMed  Google Scholar 

  23. Adeoye IA, Unogu CO, Adediran K, Gbadebo BM. Determinants of adverse perinatal outcomes in Ibadan, Nigeria: the influence of maternal lifestyle. PLOS Glob Public Health. 2025;5:e0004199.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Al Rawahi A, Al Kiyumi MH, Al Kimyani R, Al-Lawati I, Murthi S, Davidson R, et al. The effect of antepartum depression on the outcomes of pregnancy and development of postpartum depression: a Prospective Cohort study of Omani women. Sultan Qaboos Univ Med J. 2020;20:e179–86.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Avalos LA, Chandran A, Churchill ML, Gao X, Ames JL, Nozadi SS, et al. Prenatal depression and risk of child autism-related traits among participants in the Environmental influences on Child Health Outcomes program. Autism Res. 2023;16:1825–35.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Beyene GM, Azale T, Gelaye KA, Ayele TA. The effect of antenatal depression on birth weight among newborns in South Gondar zone, Northwest Ethiopia: a Population-Based Prospective Cohort study. Arch Public Health. 2021;79:121.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Bindt C, Guo N, Bonle MT, Appiah-Poku J, Hinz R, Barthel D, et al. No association between antenatal common mental disorders in low-obstetric risk women and adverse birth outcomes in their offspring: results from the CDS study in Ghana and Cote D’Ivoire. PloS one. 2013;8:e80711.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Bitew T, Hanlon C, Kebede E, Honikman S, Fekadu A. Antenatal depressive symptoms and perinatal complications: a Prospective study in rural Ethiopia. BMC psychiatry. 2017;17:301.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Björvang RD, Liakea I, Carpentsier B, Kozinszky Z, Skalkidou A, Fransson E. Association of diabetes mellitus in pregnancy and perinatal depression. Psychosom Med. 2024;86:52–8.

    Article  PubMed  Google Scholar 

  30. Chang HY, Keyes KM, Lee KS, Choi IA, Kim SJ, Kim KW, et al. Prenatal maternal depression is associated with low birth weight through shorter gestational age in term infants in Korea. Early Hum Dev. 2014;90:15–20.

    Article  PubMed  Google Scholar 

  31. Chen XN, Hu Y, Hu WH, Xia X, Li XT. Risk of adverse perinatal outcomes and antenatal depression based on the zung self-rating depression scale. Rep Dev Med. 2021;5:23–9.

    Article  Google Scholar 

  32. Chung TK, Lau TK, Yip AS, Chiu HF, Lee DT. Antepartum depressive symptomatology is associated with adverse obstetric and neonatal outcomes. Psychosom Med. 2001;63:830–4.

    Article  CAS  PubMed  Google Scholar 

  33. Dadi AF, Miller ER, Woodman RJ, Azale T, Mwanri L. Effect of antenatal depression on adverse birth outcomes in Gondar town, Ethiopia: a Community-Based Cohort study. PloS one. 2020;15:e0234728.

    Article  Google Scholar 

  34. Dahlen HG, Barnett B, Kohlhoff J, Drum ME, Munoz AM, Thornton C. Obstetric and psychosocial risk factors for Australian-born and non-Australian born women and associated pregnancy and birth outcomes: a Population Based Cohort study. BMC Pregnancy Childbirth. 2015;15:292.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Dayan J, Creveuil C, Marks MN, Conroy S, Herlicoviez M, Dreyfus M, et al. Prenatal depression, prenatal anxiety, and spontaneous preterm birth: a Prospective Cohort study among women with early and regular care. Psychosom Med. 2006;68:938–46.

    Article  PubMed  Google Scholar 

  36. Diego MA, Field T, Hernandez-Reif M, Schanberg S, Kuhn C, Gonzalez-Quintero VH. Prenatal depression restricts fetal growth. Early Hum Dev. 2009;85:65–70.

    Article  PubMed  Google Scholar 

  37. Dole N, Savitz DA, Hertz-Picciotto I, Siega-Riz AM, McMahon MJ, Buekens P. Maternal stress and preterm birth. Am J Epidemiol. 2003;157:14–24.

    Article  CAS  PubMed  Google Scholar 

  38. Dowse E, Chan S, Ebert L, Wynne O, Thomas S, Jones D, et al. Impact of perinatal depression and anxiety on birth outcomes: a retrospective data analysis. Matern Child Health J. 2020;24:718–26.

    Article  PubMed  Google Scholar 

  39. Evans J, Heron J, Patel RR, Wiles N. Depressive symptoms during pregnancy and low birth weight at term: Longitudinal study. Br J Psychiatry. 2007;191:84–5.

    Article  PubMed  Google Scholar 

  40. Fransson E, Ortenstrand A, Hjelmstedt A. Antenatal depressive symptoms and preterm birth: a Prospective study of a Swedish national sample. Birth. 2011;38:10–6.

    Article  PubMed  Google Scholar 

  41. Gavin AR, Holzman C, Siefert K, Tian Y. Maternal depressive symptoms, depression, and psychiatric medication use in relation to risk of preterm delivery. Womens Health Issues. 2009;19:325–34.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Giurgescu C, Engeland CG, Templin TN. Symptoms of depression predict negative birth outcomes in African American women: a Pilot Study. J Midwifery Womens Health. 2015;60:570–7.

    Article  PubMed  Google Scholar 

  43. Giurgescu C, Fahmy L, Slaughter-Acey J, Nowak A, Caldwell C, Misra DP. Can support from the father of the baby buffer the adverse effects of depressive symptoms on risk of Preterm birth in black families? AIMS Public Health. 2018;5:89–98.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Goedhart G, Snijders AC, Hesselink AE, van Poppel MN, Bonsel GJ, Vrijkotte TG. Maternal depressive symptoms in relation to perinatal mortality and morbidity: results from a Large Multiethnic Cohort study. Psychosom Med. 2010;72:769–76.

    Article  PubMed  Google Scholar 

  45. Hemavathy S, Deepa M, Uma R, Gowri R, Pradeepa R, Hannah W, et al. Prevalence of depression and anxiety among pregnant women with gestational diabetes mellitus in South Asia. Prim Care Diabetes. 2025;19:322–8.

    Article  CAS  PubMed  Google Scholar 

  46. Ibanez G, Charles MA, Forhan A, Magnin G, Thiebaugeorges O, Kaminski M, et al. Depression and anxiety in women during pregnancy and neonatal outcome: data from the EDEN mother-child cohort. Early Hum Dev. 2012;88:643–9.

    Article  PubMed  Google Scholar 

  47. Kabir K, Sheeder J, Stevens-Simon C. Depression, weight gain, and low birth weight adolescent delivery: do somatic symptoms strengthen or weaken the relationship? J Pediatr Adolesc Gynecol. 2008;21:335–42.

    Article  PubMed  Google Scholar 

  48. Karim S, Cai B, Merchant AT, Wilcox S, Zhao X, Alston K, et al. Antenatal depressive symptoms and adverse birth outcomes in healthy start participants: the modifying role of utilization of mental health services. Midwifery. 2024;132:103985.

    Article  PubMed  Google Scholar 

  49. Khanam R, Applegate J, Nisar I, Dutta A, Rahman S, Nizar A, et al. Burden and risk factors for antenatal depression and its effect on preterm birth in South Asia: a Population-Based Cohort study. PloS one. 2022;17:e0263091.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Kim DR, Sockol LE, Sammel MD, Kelly C, Moseley M, Epperson CN. Elevated risk of adverse obstetric outcomes in pregnant women with depression. Arch Womens Ment Health. 2013;16:475–82.

    Article  PubMed  Google Scholar 

  51. Kurki T, Hiilesmaa V, Raitasalo R, Mattila H, Ylikorkala O. Depression and anxiety in early pregnancy and risk for preeclampsia. Obstet Gynecol. 2000;95:487–90.

    CAS  PubMed  Google Scholar 

  52. Lalani S, Premji SS, Shaikh K, Sulaiman S, Yim IS, Forcheh N, et al. Individual and collective contribution of antenatal psychosocial distress conditions and preterm birth in Pakistani women. PLoS One. 2023;18:e0282582.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Larsen A, Pintye J, Abuna F, Bhat A, Dettinger JC, Gomez L, et al. Risks of adverse perinatal outcomes in relation to maternal depressive symptoms: a Prospective Cohort study in Kenya. Paediatr Perinat Epidemiol. 2023;37:489–504.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Li D, Liu L, Odouli R. Presence of depressive symptoms during early pregnancy and the risk of preterm delivery: a Prospective Cohort study. Hum Reprod. 2009;24:146–53.

    Article  CAS  PubMed  Google Scholar 

  55. Li J, Fan W, Wang X, Hou X, Chen Z, Lv M. Mental health in early pregnancy and spontaneous abortion risk: a Prospective Cohort Study. Alpha Psychiatry. 2024;25:648–55.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Li X, Gao R, Dai X, Liu H, Zhang J, Liu X, et al. The association between symptoms of depression during pregnancy and low birth weight: a Prospective study. BMC Pregnancy Childbirth. 2020;20:147.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Li Y, Chang JJ, Zuo R, Xian H, Scharff D. The moderating role of depression in the association between hypertension during pregnancy and birth outcomes. Hypertens Pregnancy. 2023;42:2226703.

    Article  PubMed  Google Scholar 

  58. Liu Y, Murphy SK, Murtha AP, Fuemmeler BF, Schildkraut J, Huang Z, et al. Depression in pregnancy, infant birth weight and DNA methylation of imprint regulatory elements. Epigenetics. 2012;7:735–46.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. López DP, Serna LG, Arnáiz MCS, Ruiz MO, Viladegut JS, Sol J, et al. Outcomes of antenatal depression in women and the new-born: a Retrospective Cohort study. Family Practice. 2024;41:925–31.

    Article  PubMed  Google Scholar 

  60. Luciano M, Di Vincenzo M, Brandi C, Tretola L, Toricco R, Perris F, et al. Does antenatal depression predict post-partum depression and obstetric complications? Results from a Longitudinal, Long-term, Real-world study. Front Psychiatry. 2022;13:1082762.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Misra D, Strobino D, Trabert B. Effects of social and psychosocial factors on risk of preterm birth in black women. Paediatr Perinat Epidemiol. 2010;24:546–54.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Mochache K, Mathai M, Gachuno O, Vander Stoep A, Kumar M. Depression during pregnancy and preterm delivery: a Prospective Cohort study among women attending antenatal clinic at Pumwani Maternity Hospital. Ann Gen Psychiatry. 2018;17:31.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Morrison C, McCook JG, Bailey BA. First trimester depression scores predict development of gestational diabetes mellitus in pregnant rural Appalachian women. J Psychosom Obstet Gynaecol. 2016;37:21–5.

    Article  PubMed  Google Scholar 

  64. Nasreen HE, Pasi HB, Rifin SM, Aris MAM, Rahman JA, Rus RM, et al. Impact of maternal antepartum depressive and anxiety symptoms on birth outcomes and mode of delivery: a Prospective Cohort study in east and west coasts of Malaysia. BMC Pregnancy Childbirth. 2019;19:201.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Navaratne P, Foo XY, Kumar S. Impact of a high Edinburgh Postnatal Depression Scale score on obstetric and perinatal outcomes. Sci Rep. 2016;6:33544.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  66. Ncube CN, Enquobahrie DA, Gavin AR. Racial differences in the association between maternal antenatal depression and Preterm birth risk: a Prospective Cohort study. J Womens Health (Larchmt). 2017;26:1312–8.

    Article  PubMed  Google Scholar 

  67. Netsi E, Coll CVN, Stein A, Silveira MF, Bertoldi AD, Bassani DG, et al. Female infants are more susceptible to the effects of maternal antenatal depression; findings from the Pelotas (Brazil) Birth Cohort study. J Affect Disord. 2020;267:315–24.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Nidey NL, Momany AM, Strathearn L, Carter KD, Wehby GL, Bao W, et al. Association between perinatal depression and risk of attention deficit hyperactivity disorder among children: a retrospective cohort study. Ann Epidemio. 2021;63:1–6.

    Article  Google Scholar 

  69. Pan J, Zhu X, Xu L, Zhou L, Yin S, Qi X, et al. Effects of sleep quality, anxiety, and depression on miscarriage among pregnant women: a multi-center prospective observational study. Transl Psychiatry. 2025;15:131.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  70. Pathirana MM, Andraweera PH, Leemaqz S, Aldridge E, Arstall MA, Dekker GA, et al. Anxiety and depression in early gestation and the association with subsequent gestational diabetes mellitus in a disadvantaged population. Matern Child Health J. 2023;27:2185–93.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Pawlby S, Hay DF, Sharp D, Waters CS, O’Keane V. Antenatal depression predicts depression in adolescent offspring: prospective Longitudinal Community-Based study. J Affect Disord. 2009;113:236–43.

    Article  PubMed  Google Scholar 

  72. Pearson RM, Evans J, Kounali D, Lewis G, Heron J, Ramchandani PG, et al. Maternal depression during pregnancy and the postnatal period: risks and possible mechanisms for offspring depression at age 18 years. JAMA Psychiatry. 2013;70:1312–9.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Rahman A, Bunn J, Lovel H, Creed F. Association between antenatal depression and low birthweight in a developing country. Acta Psychiatr Scand. 2007;115:481–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  74. Roy U, Swain D. A prospective cohort study to assess the prevalence and risk factors of antepartum depression and its effect on maternal and fetal outcome. Asian J Psychiatr. 2024;91:103873.

    Article  PubMed  Google Scholar 

  75. Saeed A, Raana T, Saeed AM, Humayun A. Effect of antenatal depression on maternal dietary intake and neonatal outcome: a prospective cohort. Nutr J. 2016;15:64.

    Article  PubMed  PubMed Central  Google Scholar 

  76. Shuffrey LC, Lucchini M, Morales S, Sania A, Hockett C, Barrett E, et al. Gestational diabetes mellitus, prenatal maternal depression, and risk for postpartum depression: an Environmental influences on Child Health Outcomes (ECHO) study. BMC Pregnancy Childbirth. 2022;22:758.

    Article  PubMed  PubMed Central  Google Scholar 

  77. Stark EL, Shim J, Ross CM, Miller ES. The association between positive antenatal depression screening and breastfeeding initiation and continuation. Am J Perinatol. 2021;38:171–5.

    Article  PubMed  Google Scholar 

  78. Steer RA, Scholl TO, Hediger ML, Fischer RL. Self-reported depression and negative pregnancy outcomes. J Clin Epidemiol. 1992;45:1093–9.

    Article  CAS  PubMed  Google Scholar 

  79. Straub H, Adams M, Kim JJ, Silver RK. Antenatal depressive symptoms increase the likelihood of preterm birth. Am J Obstet Gynecol. 2012;207:329.e1–4.

    Article  PubMed  Google Scholar 

  80. Thombre MK, Talge NM, Holzman C. Association between pre-pregnancy depression/anxiety symptoms and hypertensive disorders of pregnancy. J Womens Health (Larchmt). 2015;24:228–36.

    Article  PubMed  Google Scholar 

  81. Van Ngo T, Gammeltoft T, Nguyen HTT, Meyrowitsch DW, Rasch V. Antenatal depressive symptoms and adverse birth outcomes in Hanoi, Vietnam. PLoS One. 2018;13:e0206650.

    Article  PubMed  PubMed Central  Google Scholar 

  82. Venkataraman R, Yadav SK, Pukale RS. Factors affecting the depression and impact of depression on maternal outcomes: a Prospective Observational study from a rural tertiary care South Indian Hospital. Ital J Gynaecol Obstet. 2023;35:406–14.

    Article  Google Scholar 

  83. Venkatesh KK, Riley L, Castro VM, Perlis RH, Kaimal AJ. Association of antenatal depression symptoms and antidepressant treatment with Preterm birth. Obstet Gynecol. 2016;127:926–33.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  84. Versteegen M, Bozlak CT, Larkin H, Appleton AA. Maternal depression, adverse childhood experiences, and social support in relation to gestational diabetes risk: results from the Albany Infant and Mother Study (AIMS). BMC Pregnancy Childbirth. 2021;21:335.

    Article  PubMed  PubMed Central  Google Scholar 

  85. Wado YD, Afework MF, Hindin MJ. Effects of maternal pregnancy intention, depressive symptoms and social support on risk of low birth weight: a Prospective study from southwestern Ethiopia. PLoS One. 2014;9:e96304.

    Article  PubMed  PubMed Central  Google Scholar 

  86. Weobong B, ten Asbroek AH, Soremekun S, Manu AA, Owusu-Agyei S, Prince M, et al. Association of antenatal depression with adverse consequences for the mother and newborn in rural Ghana: findings from the DON Population-Based Cohort study. PLoS One. 2014;9:e116333.

    Article  PubMed  PubMed Central  Google Scholar 

  87. Yang J, Xu A, Zhang Y, Deng J, Lin X, Xie L, et al. Promoter methylation changes in the placenta involved in the relationship between prenatal depression and small for gestational age. BMC Pregnancy Childbirth. 2022;22:741.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  88. Zhang ZY, Yu JJ, Zeng WT, Zhou MC, Duan CC, Zhu LL. Association between antenatal depression and adverse perinatal outcomes: a Prospective Cohort study. J Affect Disord. 2023;323:490–5.

    Article  PubMed  Google Scholar 

  89. Aliaga A, Cunillera O, Amador MDC, Aliaga M, Arquerons M, Almeda J. Association between affective disorders presenting before and during pregnancy and pre-term birth, considering socio-demographic factors, obstetric factors, health conditions, and use of medication. Aten Primaria. 2019;51:626–36.

    Article  PubMed  Google Scholar 

  90. Andersen JT, Andersen NL, Horwitz H, Poulsen HE, Jimenez-Solem E. Exposure to selective serotonin reuptake inhibitors in early pregnancy and the risk of miscarriage. Obstet Gynecol. 2014;124:655–61.

    Article  CAS  PubMed  Google Scholar 

  91. Andrade SE, McPhillips H, Loren D, Raebel MA, Lane K, Livingston J, et al. Antidepressant medication use and risk of persistent pulmonary hypertension of the newborn. Pharmacoepidemiol Drug Saf. 2009;18:246–52.

    Article  PubMed  Google Scholar 

  92. Ankarfeldt MZ, Petersen J, Andersen JT, Li H, Motsko SP, Fast T, et al. Exposure to duloxetine during pregnancy and risk of congenital malformations and stillbirth: a Nationwide Cohort study in Denmark and Sweden. PLoS Med. 2021;18:e1003851.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  93. Ankarfeldt MZ, Petersen J, Andersen JT, Fernandes MFS, Li H, Motsko SP, et al. Duloxetine exposure during pregnancy and the risk of offspring being born small for gestational age or prematurely: a Nationwide Danish and Swedish Safety study. Drugs - Real World Outcomes. 2023;10:69–81.

    Article  PubMed  Google Scholar 

  94. Berard A, Sheehy O, Zhao JP, Vinet E, Bernatsky S, Abrahamowicz M. SSRI and SNRI use during pregnancy and the risk of persistent pulmonary hypertension of the newborn. B J Clin Pharmacol. 2017;83:1126–33.

    Article  CAS  Google Scholar 

  95. Bliddal M, Wesselhoeft R, Strandberg-Larsen K, Ernst MT, Weissman MM, Gingrich JA, et al. Prenatal antidepressant exposure and emotional disorders until age 22: a Danish Register study. Child Adolesc Psychiatry Ment Health. 2023;17:73.

    Article  PubMed  PubMed Central  Google Scholar 

  96. Boukhris T, Sheehy O, Berard A. Antidepressant use in pregnancy and the risk of attention deficit with or without hyperactivity disorder in children. Paediatr Perinat Epidemiol. 2017;31:363–73.

    Article  PubMed  Google Scholar 

  97. Boukhris T, Sheehy O, Mottron L, Berard A. Antidepressant use during pregnancy and the risk of autism spectrum disorder in children. JAMA Pediatr. 2016;170:117–24.

    Article  PubMed  Google Scholar 

  98. Brown HK, Ray JG, Wilton AS, Lunsky Y, Gomes T, Vigod SN. Association between serotonergic antidepressant use during pregnancy and autism spectrum disorder in children. JAMA. 2017;317:1544–52.

    Article  CAS  PubMed  Google Scholar 

  99. Calderon-Margalit R, Qiu C, Ornoy A, Siscovick DS, Williams MA. Risk of preterm delivery and other adverse perinatal outcomes in relation to maternal use of psychotropic medications during pregnancy. Am J Obstet Gynecol. 2009;201:579.e1–8.

    Article  PubMed  Google Scholar 

  100. Cantarutti A, Merlino L, Monzani E, Giaquinto C, Corrao G. Is the risk of preterm birth and low birth weight affected by the use of antidepressant agents during pregnancy? A population-based investigation. PLoS One. 2016;11:e0168115.

    Article  PubMed  PubMed Central  Google Scholar 

  101. Chan JKN, Lee KCK, Wong CSM, Chang WC. Prenatal antidepressant use and risk of congenital malformations: a Population-Based Cohort study. Psychiatry Res. 2024;339:116038.

    Article  CAS  PubMed  Google Scholar 

  102. Chen LF, Lin CE, Chung CH, Lai CH, Chien WC. Association between the use of antidepressants and the risk of preterm birth among pregnant women with depression: a Retrospective Cohort study in Taiwan. J Investig Med. 2021;69:999–1007.

    Article  PubMed  Google Scholar 

  103. Colvin L, Slack-Smith L, Stanley FJ, Bower C. Dispensing patterns and pregnancy outcomes for women dispensed selective serotonin reuptake inhibitors in pregnancy. Birth Defects Res A Clin Mol Teratol. 2011;91:142–52.

    Article  CAS  PubMed  Google Scholar 

  104. Davis RL, Rubanowice D, McPhillips H, Raebel MA, Andrade SE, Smith D, et al. Risks of congenital malformations and perinatal events among infants exposed to antidepressant medications during pregnancy. Pharmacoepidemiol Drug Saf. 2007;16:1086–94.

    Article  PubMed  Google Scholar 

  105. Esen BO, Ehrenstein V, Sørensen HT, Laugesen K, Pedersen L. Prenatal antidepressant exposure and the risk of attention-deficit/hyperactivity disorder in childhood: a Cohort study with triangulation. Epidemiology. 2022;33:581–92.

    Article  PubMed  Google Scholar 

  106. Furu K, Kieler H, Haglund B, Engeland A, Selmer R, Stephansson O, et al. Selective serotonin reuptake inhibitors and venlafaxine in early pregnancy and risk of birth defects: Population Based Cohort study and sibling design. BMJ. 2015;350:h1798.

    Article  PubMed  PubMed Central  Google Scholar 

  107. Grzeskowiak LE, Gilbert AL, Morrison JL. Neonatal outcomes after late-gestation exposure to selective serotonin reuptake inhibitors. J Clin Psychopharmacol. 2012;32:615–21.

    Article  CAS  PubMed  Google Scholar 

  108. Grzeskowiak LE, McBain R, Dekker GA, Clifton VL. Antidepressant use in late gestation and risk of postpartum haemorrhage: a Retrospective Cohort study. BJOG. 2016;123:1929–36.

    Article  CAS  PubMed  Google Scholar 

  109. Hanley GE, Smolina K, Mintzes B, Oberlander TF, Morgan SG. Postpartum hemorrhage and use of serotonin reuptake inhibitor antidepressants in pregnancy. Obstet Gynecol. 2016;27:553–61.

    Article  Google Scholar 

  110. Heller HM, Ravelli ACJ, Bruning AHL, de Groot CJM, Scheele F, van Pampus MG, et al. Increased postpartum haemorrhage, the possible relation with serotonergic and other psychopharmacological drugs: a Matched Cohort study. BMC Pregnancy Childbirth. 2017;17:166.

    Article  PubMed  PubMed Central  Google Scholar 

  111. Heuvelman H, Davies NM, Ben-Shlomo Y, Emond A, Evans J, Gunnell D, et al. Antidepressants in pregnancy: applying causal epidemiological methods to understand service-use outcomes in women and long-term neurodevelopmental outcomes in exposed children. Health Technol Assess. 2023;27:1–83.

    Article  PubMed  Google Scholar 

  112. Hutchison SM, Brain U, Grunau RE, Kuzeljevic B, Irvine M, Mâsse LC, et al. Associations between maternal depressive symptoms and selective serotonin reuptake inhibitor antidepressant treatment on internalising and anxiety behaviours in children: 12-year Longitudinal study. BJPsych Open. 2023;9:e26.

    Article  PubMed  PubMed Central  Google Scholar 

  113. Huybrechts KF, Bateman BT, Palmsten K, Desai RJ, Patorno E, Gopalakrishnan C, et al. Antidepressant use late in pregnancy and risk of persistent pulmonary hypertension of the newborn. JAMA. 2015;313:2142–51.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  114. Huybrechts KF, Bateman BT, Pawar A, Bessette LG, Mogun H, Levin R, et al. Maternal and fetal outcomes following exposure to duloxetine in pregnancy: Cohort study. BMJ. 2020;368:m237.

    Article  PubMed  PubMed Central  Google Scholar 

  115. Hwang YM, Roper RT, Piekos SN, Enquobahrie DA, Hebert MF, Paquette AG, et al. Timing of selective serotonin reuptake inhibitor use and risk for preterm birth and related adverse events: with a consideration of the COVID-19 pandemic period. J Matern Fetal Neonatal Med. 2024;37:2313364.

    Article  PubMed  Google Scholar 

  116. Jimenez-Solem E, Andersen JT, Petersen M, Broedbaek K, Lander AR, Afzal S, et al. SSRI use during pregnancy and risk of stillbirth and neonatal mortality. Am J Psychiatry. 2013;170:299–304.

    Article  PubMed  Google Scholar 

  117. Jordan S, Morris JK, Davies GI, Tucker D, Thayer DS, Luteijn JM, et al. Selective Serotonin Reuptake Inhibitor (SSRI) antidepressants in pregnancy and congenital anomalies: analysis of linked databases in wales, Norway and Funen, Denmark. PLoS One. 2016;11:e0165122.

    Article  PubMed  PubMed Central  Google Scholar 

  118. Kieler H, Artama M, Engeland A, Ericsson O, Furu K, Gissler M, et al. Selective serotonin reuptake inhibitors during pregnancy and risk of persistent pulmonary hypertension in the newborn: Population Based Cohort study from the five Nordic countries. BMJ. 2012;344:d8012.

    Article  PubMed  Google Scholar 

  119. Kim DR, Pinheiro E, Luther JF, Eng HF, Dills JL, Wisniewski SR, et al. Is third trimester serotonin reuptake inhibitor use associated with postpartum hemorrhage? J Psychiatr Res. 2016;73:79–85.

    Article  PubMed  Google Scholar 

  120. Kivisto J, Lehto SM, Halonen K, Georgiadis L, Heinonen S. Maternal use of selective serotonin reuptake inhibitors and lengthening of the umbilical cord: indirect evidence of increased foetal activity-a Retrospective Cohort study. PLoS One. 2016;11:e0154628.

    Article  PubMed  PubMed Central  Google Scholar 

  121. Kolding L, Ehrenstein V, Pedersen L, Sandager P, Petersen OB, Uldbjerg N, et al. Antidepressant use in pregnancy and severe cardiac malformations: Danish register-based study. BJOG. 2021;128:1949–57.

    Article  CAS  PubMed  Google Scholar 

  122. Laine MK, Masalin S, Rono K, Kautiainen H, Gissler M, Pennanen P, et al. Risk of preterm birth in primiparous women with exposure to antidepressant medication before pregnancy and/or during pregnancy - impact of body mass index. Ann Med. 2019;51:51–7.

    Article  PubMed  Google Scholar 

  123. Laugesen K, Olsen MS, Telen Andersen AB, Froslev T, Sorensen HT. In utero exposure to antidepressant drugs and risk of attention deficit hyperactivity disorder: a nationwide Danish Cohort study. BMJ Open. 2013;3:e003507.

    Article  PubMed  PubMed Central  Google Scholar 

  124. Lee KCK, Fung VSC, Chan JKN, Wong CSM, Cheung KW, Seto MTY, et al. Antidepressant use during pregnancy and risk of obstetrics and neonatal outcomes: a Propensity Score-Weighted Population-Based Cohort study in 2003–2018. Eur Neuropsychopharmacol. 2025;96:36–45.

    Article  CAS  PubMed  Google Scholar 

  125. Lee MJ, Chen YL, Wu SI, Huang CW, Dewey ME, Chen VC. Association between maternal antidepressant use during pregnancy and the risk of autism spectrum disorder and attention deficit hyperactivity disorder in offspring. Eur Child Adolesc Psychiatry. 2024;33:4273–83.

    Article  PubMed  Google Scholar 

  126. Leibovitch L, Rymer-Haskel N, Schushan-Eisen I, Kuint J, Strauss T, Maayan-Metzger A. Short-term neonatal outcome among term infants after in utero exposure to serotonin reuptake inhibitors. Neonatology. 2013;104:65–70.

    Article  CAS  PubMed  Google Scholar 

  127. Lindqvist PG, Nasiell J, Gustafsson LL, Nordstrom L. Selective serotonin reuptake inhibitor use during pregnancy increases the risk of postpartum hemorrhage and anemia: a Hospital-Based Cohort study. J Thromb Haemost. 2014;12:1986–92.

    Article  CAS  PubMed  Google Scholar 

  128. Lund N, Pedersen LH, Henriksen TB. Selective serotonin reuptake inhibitor exposure in utero and pregnancy outcomes. Arch Pediatr Adolesc Med. 2009;163:949–54.

    Article  PubMed  Google Scholar 

  129. Lupattelli A, Barone-Adesi F, Nordeng H. Association between antidepressant use in pregnancy and gestational diabetes mellitus: results from the Norwegian Mother, Father and Child Cohort study. Pharmacoepidemiol Drug Saf. 2022;31:247–56.

    Article  CAS  PubMed  Google Scholar 

  130. Lupattelli A, Wood M, Lapane K, Spigset O, Nordeng H. Risk of preeclampsia after gestational exposure to selective serotonin reuptake inhibitors and other antidepressants: a study from The Norwegian Mother and Child Cohort study. Pharmacoepidemiol Drug Saf. 2017;26:1266–76.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  131. Malm H, Artama M, Gissler M, Ritvanen A. Selective serotonin reuptake inhibitors and risk for major congenital anomalies. Obstet Gynecol. 2011;118:111–20.

    Article  PubMed  Google Scholar 

  132. Malm H, Brown AS, Gissler M, Gyllenberg D, Hinkka-Yli-Salomaki S, McKeague IW, et al. Gestational exposure to selective serotonin reuptake inhibitors and offspring psychiatric disorders: a National Register-Based study. J Am Acad Child Adolesc Psychiatry. 2016;55:359–66.

    Article  PubMed  PubMed Central  Google Scholar 

  133. Malm H, Sourander A, Gissler M, Gyllenberg D, Hinkka-Yli-Salomäki S, McKeague IW, et al. Pregnancy complications following prenatal exposure to SSRIs or maternal psychiatric disorders: results from Population-Based National Register data. Am J Psychiatry. 2015;172:1224–32.

    Article  PubMed  Google Scholar 

  134. Man KKC, Chan EW, Ip P, Coghill D, Simonoff E, Chan PKL, et al. Prenatal antidepressant use and risk of attention-deficit/hyperactivity disorder in offspring: Population Based Cohort study. BMJ. 2017;357:j2350.

    Article  PubMed  PubMed Central  Google Scholar 

  135. Mao Y, Pedersen LH, Christensen J, Vestergaard M, Zhou W, Olsen J, et al. Prenatal exposure to antidepressants and risk of epilepsy in childhood. Pharmacoepidemiol Drug Saf. 2016;25:1320–30.

    Article  CAS  PubMed  Google Scholar 

  136. Nishigori H, Obara T, Nishigori T, Mizuno S, Metoki H, Hoshiai T, et al. Selective serotonin reuptake inhibitors and risk of major congenital anomalies for pregnancies in Japan: a Nationwide Birth Cohort study of the Japan Environment and Children’s study. Congenit Anom (Kyoto). 2017;57:72–8.

    Article  CAS  PubMed  Google Scholar 

  137. Norby U, Forsberg L, Wide K, Sjors G, Winbladh B, Kallen K. Neonatal morbidity after maternal use of antidepressant drugs during pregnancy. Pediatrics. 2016;138:e20160181.

    Article  PubMed  Google Scholar 

  138. Nordeng H, van Gelder MM, Spigset O, Koren G, Einarson A, Eberhard-Gran M. Pregnancy outcome after exposure to antidepressants and the role of maternal depression: results from the Norwegian Mother and Child Cohort study. J Clin psychopharmacol. 2012;32:186–94.

    Article  CAS  PubMed  Google Scholar 

  139. Oberlander TF, Warburton W, Misri S, Riggs W, Aghajanian J, Hertzman C. Major congenital malformations following prenatal exposure to serotonin reuptake inhibitors and benzodiazepines using population-based health data. Birth Defects Res B Dev Reprod Toxicol. 2008;83:68–76.

    Article  CAS  PubMed  Google Scholar 

  140. Öndemark M, Nordström L, Lindqvist PG. Dose-dependent increase in risk of bleeding and bleeding complications in relation to SSRI use at delivery. Eur J Obstet Gynecol Reprod Biol. 2024;296:265–9.

    Article  PubMed  Google Scholar 

  141. Ostenfeld A, Petersen TS, Pedersen LH, Westergaard HB, Løkkegaard ECL, Andersen JT. Mirtazapine exposure in pregnancy and fetal safety: a Nationwide Cohort study. Acta Psychiatr Scand. 2022;145:557–67.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  142. Palmsten K, Chambers CD, Wells A, Bandoli G. Patterns of prenatal antidepressant exposure and risk of preeclampsia and postpartum haemorrhage. Paediatr Perinat Epidemiol. 2020;34:597–606.

    Article  PubMed  PubMed Central  Google Scholar 

  143. Palmsten K, Hernández-Díaz S, Huybrechts KF, Williams PL, Michels KB, Achtyes ED, et al. Use of antidepressants near delivery and risk of postpartum hemorrhage: Cohort study of low income women in the United States. BMJ. 2013;347:f4877.

    Article  PubMed  PubMed Central  Google Scholar 

  144. Palmsten K, Huybrechts KF, Michels KB, Williams PL, Mogun H, Setoguchi S, et al. Antidepressant use and risk for preeclampsia. Epidemiology. 2013;24:682–91.

    Article  PubMed  PubMed Central  Google Scholar 

  145. Palmsten K, Setoguchi S, Margulis AV, Patrick AR, Hernandez-Diaz S. Elevated risk of preeclampsia in pregnant women with depression: depression or antidepressants? Am J Epidemiol. 2012;175:988–97.

    Article  PubMed  PubMed Central  Google Scholar 

  146. Rai D, Lee BK, Dalman C, Newschaffer C, Lewis G, Magnusson C. Antidepressants during pregnancy and autism in offspring: population Based Cohort study. BMJ. 2017;358:j2811.

    Article  PubMed  PubMed Central  Google Scholar 

  147. Skalkidou A, Sundström-Poromaa I, Wikman A, Hesselman S, Wikström AK, Elenis E. SSRI use during pregnancy and risk for postpartum haemorrhage: a National Register-Based Cohort study in Sweden. BJOG. 2020;127:1366–73.

    Article  CAS  PubMed  Google Scholar 

  148. Skurtveit S, Selmer R, Tverdal A, Furu K, Nystad W, Handal M. Drug exposure: inclusion of dispensed drugs before pregnancy may lead to underestimation of risk associations. J Clin Epidemiol. 2013;66:964–72.

    Article  PubMed  Google Scholar 

  149. Sørensen MJ, Grønborg TK, Christensen J, Parner ET, Vestergaard M, Schendel D, et al. Antidepressant exposure in pregnancy and risk of autism spectrum disorders. Clin Epidemiol. 2013;5:449–59.

    Article  PubMed  PubMed Central  Google Scholar 

  150. Stephansson O, Kieler H, Haglund B, Artama M, Engeland A, Furu K, et al. Selective serotonin reuptake inhibitors during pregnancy and risk of stillbirth and infant mortality. JAMA. 2013;309:48–54.

    Article  CAS  PubMed  Google Scholar 

  151. Suarez EA, Bateman BT, Hernández-Díaz S, Straub L, Wisner KL, Gray KJ, et al. Association of antidepressant use during pregnancy with risk of neurodevelopmental disorders in children. JAMA Intern Med. 2022;182:1149–60.

    Article  PubMed  PubMed Central  Google Scholar 

  152. Sujan AC, Rickert ME, Oberg AS, Quinn PD, Hernandez-Diaz S, Almqvist C, et al. Associations of maternal antidepressant use during the first trimester of pregnancy with Preterm birth, small for gestational age, autism spectrum disorder, and attention-deficit/hyperactivity disorder in offspring. JAMA. 2017;317:1553–62.

    Article  PubMed  PubMed Central  Google Scholar 

  153. Toh S, Mitchell AA, Louik C, Werler MM, Chambers CD, Hernandez-Diaz S. Selective serotonin reuptake inhibitor use and risk of gestational hypertension. Am J Psychiatry. 2009;166:320–8.

    Article  PubMed  PubMed Central  Google Scholar 

  154. Tran YH, Huynh HK, Faas MM, de Vos S, Groen H. Antidepressant use during pregnancy and development of preeclampsia: a focus on classes of action and specific transporters/receptors targeted by antidepressants. J Psychiatr Res. 2022;146:92–101.

    Article  PubMed  Google Scholar 

  155. Ulbrich KA, Zumpf K, Ciolino JD, Shah M, Miller ES, Wisner KL. Acute delivery room resuscitation of neonates exposed to selective serotonin reuptake inhibitors. J Pediatr. 2021;232:103–8.

    Article  CAS  PubMed  Google Scholar 

  156. Vasilakis-Scaramozza C, Aschengrau A, Cabral H, Jick SS. Antidepressant use during early pregnancy and the risk of congenital anomalies. Pharmacotherapy. 2013;33:693–700.

    Article  CAS  PubMed  Google Scholar 

  157. Vignato JA, Gumusoglu SB, Davis HA, Scroggins SM, Hamilton WS, Brandt DS, et al. Selective serotonin reuptake inhibitor use in pregnancy and protective mechanisms in preeclampsia. Reprod Sci. 2023;30:701–12.

    Article  CAS  PubMed  Google Scholar 

  158. Wen SW, Yang Q, Garner P, Fraser W, Olatunbosun O, Nimrod C, et al. Selective serotonin reuptake inhibitors and adverse pregnancy outcomes. Am J Obstet Gynecol. 2006;194:961–6.

    Article  CAS  PubMed  Google Scholar 

  159. Wichman CL, Moore KM, Lang TR, St Sauver JL, Heise RH Jr, Watson WJ. Congenital heart disease associated with selective serotonin reuptake inhibitor use during pregnancy. Mayo Clin Proc. 2009;84:23–7.

    Article  PubMed  PubMed Central  Google Scholar 

  160. Wiggs KK, Sujan AC, Rickert ME, Quinn PD, Larsson H, Lichtenstein P, et al. Maternal serotonergic antidepressant use in pregnancy and risk of seizures in children. Neurology. 2022;98:e2329–36.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  161. Wu P, Velez Edwards DR, Gorrindo P, Sundermann AC, Torstenson ES, Jones SH, et al. Association between first trimester antidepressant use and risk of spontaneous abortion. Pharmacotherapy. 2019;39:889–98.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  162. Yamamoto-Sasaki M, Yoshida S, Takeuchi M, Tanaka-Mizuno S, Ogawa Y, Furukawa TA, et al. Association between antidepressant use during pregnancy and autism spectrum disorder in children: a Retrospective Cohort study based on Japanese claims data. Matern Health Neonatol Perinatol. 2019;5:1.

    Article  PubMed  PubMed Central  Google Scholar 

  163. Zakiyah N, Ter Heijne LF, Bos JH, Hak E, Postma MJ, Schuiling-Veninga CCM. Antidepressant use during pregnancy and the risk of developing gestational hypertension: a Retrospective Cohort study. BMC Pregnancy Childbirth. 2018;18:187.

    Article  PubMed  PubMed Central  Google Scholar 

  164. Zeskind PS, Stephens LE. Maternal selective serotonin reuptake inhibitor use during pregnancy and newborn neurobehavior. Pediatrics. 2004;113:368–75.

    Article  PubMed  Google Scholar 

  165. Adhikari K, Patten SB, Lee S, Metcalfe A. Risk of adverse perinatal outcomes among women with pharmacologically treated and untreated depression during pregnancy: a Retrospective Cohort study. Paediatr Perinat Epidemiol. 2019;33:323–31.

    Article  PubMed  Google Scholar 

  166. Avalos LA, Chen H, Li DK. Antidepressant medication use, depression, and the risk of preeclampsia. CNS Spectr. 2015;20:39–47.

    Article  PubMed  PubMed Central  Google Scholar 

  167. Ban L, Gibson JE, West J, Fiaschi L, Sokal R, Smeeth L, et al. Maternal depression, antidepressant prescriptions, and congenital anomaly risk in offspring: a Population-Based Cohort study. BJOG. 2014;121:1471–81.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  168. Beck-Pancer D, Aghaee S, Swint A, Acker J, Deardorff J, Kubo A. Maternal depression and antidepressant use during pregnancy and associations with depressive symptoms and suicidality in adolescent children. Clin Epidemiol. 2023;15:613–28.

    Article  PubMed  PubMed Central  Google Scholar 

  169. Cheng CC, Siong K, Lee HC, Kau Y. Effect of depressive disorders and other psychiatric disorders on pregnancy and perinatal outcomes in a Hong Kong obstetrics unit. Hong Kong J Gynaecol Obstet Midwifery. 2020;20:22–6.

    Article  Google Scholar 

  170. El Marroun H, Jaddoe VW, Hudziak JJ, Roza SJ, Steegers EA, Hofman A, et al. Maternal use of selective serotonin reuptake inhibitors, fetal growth, and risk of adverse birth outcomes. Arch Gen Psychiatry. 2012;69:706–14.

    Article  PubMed  Google Scholar 

  171. Engelstad HJ, Roghair RD, Calarge CA, Colaizy TT, Stuart S, Haskell SE. Perinatal outcomes of pregnancies complicated by maternal depression with or without selective serotonin reuptake inhibitor therapy. Neonatology. 2014;105:149–54.

    Article  CAS  PubMed  Google Scholar 

  172. Hagberg KW, Robijn AL, Jick S. Maternal depression and antidepressant use during pregnancy and the risk of autism spectrum disorder in offspring. Clin Epidemiol. 2018;10:1599–612.

    Article  PubMed  PubMed Central  Google Scholar 

  173. Herrero T, Driebe A, Fratto V, Hamlin A, Lacoursiere DY, Ramos GA. Positive antenatal Edinburgh Depression Scale: examining behavioral and pharmacological therapy on maternal and neonatal outcomes. J Matern Fetal Neonatal Med. 2020;33:212–6.

    Article  CAS  PubMed  Google Scholar 

  174. Huang HC, Sung FC, Chen PC, Chang CY, Muo CH, Shiue HS, et al. Obstetric outcomes in pregnant women with and without depression: population-based comparison. Sci Rep. 2017;7:13937.

    Article  PubMed  PubMed Central  Google Scholar 

  175. Jensen HM, Gron R, Lidegaard O, Pedersen LH, Andersen PK, Kessing LV. Maternal depression, antidepressant use in pregnancy and Apgar scores in infants. Br J Psychiatry. 2013;202:347–51.

    Article  PubMed  Google Scholar 

  176. Jensen HM, Gron R, Lidegaard O, Pedersen LH, Andersen PK, Kessing LV. The effects of maternal depression and use of antidepressants during pregnancy on risk of a child small for gestational age. Psychopharmacology (Berl). 2013;228:199–205.

    Article  CAS  PubMed  Google Scholar 

  177. Jordan S, Davies GI, Thayer DS, Tucker D, Humphreys I. Antidepressant prescriptions, discontinuation, depression and perinatal outcomes, including breastfeeding: a population cohort analysis. PLoS One. 2019;14:e0225133.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  178. Kjaersgaard MI, Parner ET, Vestergaard M, Sorensen MJ, Olsen J, Christensen J, et al. Prenatal antidepressant exposure and risk of spontaneous abortion - a Population-Based study. PLoS One. 2013;8:e72095.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  179. Michihata N, Shigemi D, Yamana H, Matsui H, Jo T, Yasunaga H. Safety of Japanese herbal Kampo medicines for the treatment of depression during pregnancy. Int J Gynaecol Obstet. 2022;159:865–9.

    Article  CAS  PubMed  Google Scholar 

  180. Oberlander TF, Warburton W, Misri S, Aghajanian J, Hertzman C. Neonatal outcomes after prenatal exposure to selective serotonin reuptake inhibitor antidepressants and maternal depression using population-based linked health data. Arch Gen Psychiatry. 2006;63:898–906.

    Article  PubMed  Google Scholar 

  181. Sahingoz M, Yuksel G, Karsidag C, Uguz F, Sonmez EO, Annagur BB, et al. Birth weight and preterm birth in babies of pregnant women with major depression in relation to treatment with antidepressants. J Clin Psychopharmacol. 2014;34:226–9.

    Article  PubMed  Google Scholar 

  182. Seebeck J, Sznajder KK, Kjerulff KH. The association between prenatal psychosocial factors and autism spectrum disorder in offspring at 3 years: a Prospective Cohort study. Soc Psychiatry Psychiatr Epidemiol. 2024;59:1639–49.

    Article  PubMed  Google Scholar 

  183. Suri R, Altshuler L, Hellemann G, Burt VK, Aquino A, Mintz J. Effects of antenatal depression and antidepressant treatment on gestational age at birth and risk of preterm birth. Am J Psychiatry. 2007;164:1206–13.

    Article  PubMed  Google Scholar 

  184. Watson SJ, Spigset O. Depression and antidepressant treatment in the development of hypertensive disorders of pregnancy: results from a Prospective Cohort study. Aust N Z J Psychiatry. 2023;57:520–7.

    Article  PubMed  Google Scholar 

  185. Wisner KL, Sit DK, Hanusa BH, Moses-Kolko EL, Bogen DL, Hunker DF, et al. Major depression and antidepressant treatment: impact on pregnancy and neonatal outcomes. Am J Psychiatry. 2009;166:557–66.

    Article  PubMed  PubMed Central  Google Scholar 

  186. Kautzky A, Slamanig R, Unger A, Höflich A. Neonatal outcome and adaption after in utero exposure to antidepressants: a systematic review and meta-analysis. Acta Psychiatr Scand. 2022;145:6–28.

    Article  PubMed  Google Scholar 

  187. Cornet MC, Wu YW, Forquer H, Avalos LA, Sriram A, Scheffler AW, et al. Maternal treatment with selective serotonin reuptake inhibitors during pregnancy and delayed neonatal adaptation: a Population-Based Cohort study. Arch Dis Child Fetal Neonatal Ed. 2024;109:294–300.

    Article  PubMed  Google Scholar 

  188. MacQueen GM, Frey BN, Ismail Z, Jaworska N, Steiner M, Lieshout RJ, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: section 6. Special Populations: Youth, Women, and the Elderly. Can J Psychiatry. 2016;61:588–603.

    Article  PubMed  PubMed Central  Google Scholar 

  189. Eke AC, Saccone G, Berghella V. Selective serotonin reuptake inhibitor (SSRI) use during pregnancy and risk of preterm birth: a systematic review and meta-analysis. BJOG. 2016;123:1900–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  190. Roubinov D, Don B, Blades R, Epel E. Is it me or my child? The association between maternal depression and children’s behavior problems in mothers and their children with or without autism. Fam Process. 2023;62:737–53.

    Article  PubMed  Google Scholar 

  191. Glover V. Maternal depression, anxiety and stress during pregnancy and child outcome; what needs to be done. Best Pract Res Clin Obstet Gynaecol. 2014;28:25–35.

    Article  PubMed  Google Scholar 

  192. Hu R, Li Y, Zhang Z, Yan W. Antenatal depressive symptoms and the risk of preeclampsia or operative deliveries: a meta-analysis. PLoS One. 2015;10:e0119018.

    Article  PubMed  PubMed Central  Google Scholar 

  193. Liu M. Potenitial risk factors of cardiovascular diseases and mental disorders. Heart Mind. 2023;7:55–6.

    Article  Google Scholar 

  194. Clark H, Khosla R. The partnership for maternal, newborn, and child health: 2026–30 strategy. Lancet. 2025;406:596–7.

    Article  PubMed  Google Scholar 

  195. Carlini SV, Deligiannidis KM. Poor neonatal adaptation syndrome: toward a clinical consensus to guide research and counseling. Acta Psychiatr Scand. 2022;145:3–5.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This study was supported by a grant from the National Programs for Brain Science and Brain-like Intelligence Technology of China (STI2030-Major Projects, 2021ZD0200800, 2021ZD0200700, 2021ZD0202100), and the National Natural Science Foundation of China (no. 82288101, 82171514, 82471550), the Natural Science Foundation of Beijing Municipality of China (M23013), and National Key Research and Development Program of China (2024YFC2707801). The authors declare that the research was conducted in the absence of any commercial or financial relationship that could be constructed as a potential conflict of interests.

Author contributors

Liu T, Zeng N, and Xu Y contributed equally to this article. Lu L, BaoY and Shi J proposed the topic and main idea. Liu T, Zeng N, and Xu Y were responsible for the literature search and study selection. Liu TT, Zeng N, Xu Y, Fan T, Wang F, Liu C, Zhao Y, Ni S, Mei H, Wu S were responsible for the data extraction and quality assessment. Liu T and Xu Y wrote the initial draft. Liu T, Zeng N, Xu Y, Zhang X, Wang YX, Wang YM, Li S, Shi J, Lu L and Bao Y commented on and revised the manuscript. Lu L, Shi J, and Bao Y made the final version. All authors contributed to the final draft of the manuscript.

Author information

Author notes

  1. These authors contributed equally: Tingting Liu, Na Zeng, Yingying Xu.

Authors and Affiliations

  1. National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, 100191, China

    Tingting Liu, Na Zeng, Yingying Xu, Chang Liu, Yimiao Zhao, Shuyu Ni, Huan Mei, Shuilin Wu, Suxia Li, Jie Shi, Lin Lu & Yanping Bao

  2. Institute of Mental Health, National Clinical Research Center for Mental Disorders, Key Laboratory of Mental Health and Peking University Sixth Hospital, Peking University, Beijing, 100191, China

    Tingting Liu, Tengteng Fan & Lin Lu

  3. Department of Pharmacy, Anqing Medical College, Anqing, Anhui Province, 246052, China

    Tingting Liu

  4. School of Public Health, Peking University, Beijing, 100191, China

    Na Zeng, Yingying Xu, Chang Liu, Yimiao Zhao, Shuyu Ni, Huan Mei, Shuilin Wu & Yanping Bao

  5. Department of Infection Control, Peking University First Hospital, Beijing, 100034, China

    Na Zeng

  6. Health Education Center of China, Beijing, 100011, China

    Feng Wang

  7. School of Psychology, College of Public Health, North China University of Science and Technology, Tangshan, Hebei Province, 063210, China

    Xiujun Zhang

  8. Institute of Brain Science and Brain-inspired Research, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong Province, 250117, China

    Yongxiang Wang

  9. Department of Psychology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong Province, 250021, China

    Yumei Wang

  10. Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, 100191, China

    Lin Lu

  11. Shandong Institute of Brain Science and Brain-inspired Research, Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong Province, 250117, China

    Lin Lu

Authors
  1. Tingting Liu
    View author publications

    Search author on:PubMed Google Scholar

  2. Na Zeng
    View author publications

    Search author on:PubMed Google Scholar

  3. Yingying Xu
    View author publications

    Search author on:PubMed Google Scholar

  4. Tengteng Fan
    View author publications

    Search author on:PubMed Google Scholar

  5. Feng Wang
    View author publications

    Search author on:PubMed Google Scholar

  6. Chang Liu
    View author publications

    Search author on:PubMed Google Scholar

  7. Yimiao Zhao
    View author publications

    Search author on:PubMed Google Scholar

  8. Shuyu Ni
    View author publications

    Search author on:PubMed Google Scholar

  9. Huan Mei
    View author publications

    Search author on:PubMed Google Scholar

  10. Shuilin Wu
    View author publications

    Search author on:PubMed Google Scholar

  11. Xiujun Zhang
    View author publications

    Search author on:PubMed Google Scholar

  12. Yongxiang Wang
    View author publications

    Search author on:PubMed Google Scholar

  13. Yumei Wang
    View author publications

    Search author on:PubMed Google Scholar

  14. Suxia Li
    View author publications

    Search author on:PubMed Google Scholar

  15. Jie Shi
    View author publications

    Search author on:PubMed Google Scholar

  16. Lin Lu
    View author publications

    Search author on:PubMed Google Scholar

  17. Yanping Bao
    View author publications

    Search author on:PubMed Google Scholar

Corresponding authors

Correspondence to Jie Shi, Lin Lu or Yanping Bao.

Ethics declarations

Comprting interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Liu, T., Zeng, N., Xu, Y. et al. Depression and antidepressant use in pregnancy and adverse maternal and offspring outcomes: a systematic review and meta-analysis. Mol Psychiatry (2025). https://doi.org/10.1038/s41380-025-03263-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1038/s41380-025-03263-y

Search

Advanced search

Quick links