Summary: An extensive population-based study involving over 1.2 million births has clarified the complex impact of SSRI antidepressant use during pregnancy. The research found that while SSRIs are associated with an increased risk of gestational diabetes and early adaptation challenges for newborns, they simultaneously offer a protective effect against preterm birth and low birth weight.
Crucially, the study utilized sibling comparisons and multiple control groups to distinguish the effects of the medication from the underlying maternal depression. The findings suggest that SSRIs have independent biological effects on fetal development, emphasizing the need for highly individualized clinical decisions that balance maternal mental health with neonatal monitoring.
Key Facts
- Dual Impact on Pregnancy: SSRI use increases the likelihood of gestational diabetes but reduces the risk of very preterm birth and caesarean sections compared to untreated depression.
- Newborn Adaptation: Exposure to SSRIs in utero was linked to lower Apgar scores and breathing difficulties at birth, though no increased risk of major congenital malformations was found.
- Independent Effects: By comparing mothers who discontinued medication before pregnancy with those who continued, researchers confirmed that these risks and benefits are tied to the medication itself rather than just the severity of depression.
Source: University of Turku
An international team of researchers has found that the use of SSRI antidepressants during pregnancy is associated with an increased risk of gestational diabetes and early adaptation problems in newborns, even after taking maternal depression into account.
The study also discovered that taking SSRI medication during pregnancy may reduce the risks of preterm birth and low birth weight.
According to an extensive population-based study, the use of selective serotonin reuptake inhibitor (SSRI) medication during pregnancy was associated with an increased risk of gestational diabetes compared to women with depression who did not use medication. In contrast, the risk of caesarean section, very preterm birth, and low and very low birth weight was lower among those taking SSRIs.
In newborns, SSRI exposure was associated with an increased risk of low 1- and 5-minute Apgar scores, breathing problems, and the need for neonatal care or neonatal intensive care unit treatment. There was no increased risk of major congenital malformations.
When compared with women who had discontinued SSRI use before pregnancy, taking the medication during pregnancy was associated with a lower risk of late preterm birth and low birth weight. However, the risks associated with early adaptation problems in newborns remained elevated.
According to the lead author of the study, Docent Heli Malm, the results show that SSRIs have effects on the early adaptation of newborns that are independent of maternal depression.
“Our results emphasise the significance of individualised treatment decisions during pregnancy. The treatment of depression is important, and the use of SSRIs seems to protect against the risk of preterm birth associated with depression. At the same time, however, it is necessary to closely monitor both the progress of the pregnancy and the health of the newborn,” says Malm.
“The association we have observed with gestational diabetes requires further research in order to better understand the possible cause-and-effect relationship and underlying biological mechanisms,” continues Malm.
Extensive registry-based study with several control groups
The study was conducted in collaboration between the Research Centre for Child Psychiatry at the University of Turku in Finland and Columbia University in New York. It is based on national registry data and covers more than 1.27 million children born in Finland between 1996 and 2018.
Mothers who used SSRIs during pregnancy were compared with women diagnosed with depression who did not use antidepressants during pregnancy, as well as with women who had discontinued taking SSRIs before pregnancy. In addition, the study used sibling comparisons, which allow factors related to heredity and growth environment to be taken into account.
The primary aim of the study was to determine whether the previously reported prenatal risks are attributable to the antidepressant medications themselves or to maternal depression and its severity. The analyses adjusted for several indicators of depression severity.
Funding: The Research Centre for Child Psychiatry is part of the Research Council of Finland’s INVEST Research Flagship Centre for Inequalities, Interventions and New Welfare State.
Key Questions Answered:
A: Decisions regarding medication should always be made with a healthcare provider. While this study identifies certain risks like gestational diabetes, it also shows that SSRIs can protect against serious complications like preterm birth that are often caused by untreated depression.
A: No. The researchers found no increased risk of major congenital malformations in newborns exposed to SSRIs. The primary concerns identified were related to early adaptation issues, such as breathing problems immediately after birth.
A: The study used a “sibling comparison” method to isolate the drug’s effects. It found that even when accounting for the mother’s mental health, the medication itself contributes to newborn adaptation challenges but also helps prevent the low birth weight often associated with depression.
Editorial Notes:
- This article was edited by a Neuroscience News editor.
- Journal paper reviewed in full.
- Additional context added by our staff.
About this psychopharmacology and developmental neuroscience research news
Author: Tuomas Koivula
Source: University of Turku
Contact: Tuomas Koivula – University of Turku
Image: The image is credited to Neuroscience News
Original Research: Open access.
“SSRI use during pregnancy and maternal depression – a nationwide birth cohort study on risks to the mother and the newborn” by Heli Malm, Alan S. Brown, Keely Cheslack-Postava, Mika Gissler, David Gyllenberg, Emmi Heinonen, Susanna Hinkka-Yli-Salomäki, Ian W. McKeague, Aleksi Tornio, Subina Upadhyaya, and Andre Sourander. American Journal of Obstetrics & Gynecology MFM
DOI:10.1016/j.ajogmf.2026.101910
Abstract
SSRI use during pregnancy and maternal depression – a nationwide birth cohort study on risks to the mother and the newborn
Background: Maternal underlying depression may confound previously reported associations between SSRI use and adverse pregnancy and neonatal outcomes.
Objective: To determine whether SSRI use during pregnancy is associated with an increased risk of pregnancy and neonatal complications after adjusting for indicators of maternal depression severity.
Study design: This population-based birth cohort study used data from national registers in Finland and included 1,272,587 singleton live births from 1996 to2018. Pregnancy outcome of women with two or more SSRI purchases during pregnancy (N=19,020) were compared to women with a diagnosis of depression but no antidepressant use (N=19,625), and women who discontinued SSRIs before pregnancy (n=3,145). Analyses included adjustment for several indicators of depression severity, and within-family sibling comparisons.
Results: After adjusting for confounders and comparing to women with depression who did not use antidepressants, maternal SSRI use was associated with an increased risk of gestational diabetes (OR 1.14; 95% CI 1.07–1.22), while the risk of caesarean section (CS), late (32–36+6 weeks’ gestation) and very preterm birth (<32 weeks’ gestation), small for gestational age (SGA), and low and very low birth weight was lower.
Among SSRI-exposed infants, risk of a low (<7) 5-minute Apgar score (OR 2.02; 95% CI 1.78–2.30), breathing problems (OR 1.61; 95% CI 1.48–1.75), and neonatal care unit (NCU) treatment (OR 1.23; 95% CI 1.16–1.31) was higher, whereas the risk of hospital stay at 7 days and major congenital anomalies was lower.
Third-trimester exposure further increased the risk of a low 5-minute Apgar score (OR 3.44; 95% CI 2.93–4.04). After adjustment for indicators of depression severity, the increased risk of gestational diabetes persisted (OR 1.20; 95% CI 1.09–1.32) as did the lower risk of CS, very preterm birth, and low and very low birth weight, and the risks of a low 5-minute Apgar score, breathing problems, and NCU treatment remained higher.
Compared to women who discontinued SSRI use before pregnancy, SSRI use was associated with lower risks of late preterm birth and low birth weight (OR 0.83; 95% CI 0.70–0.999 and OR 0.78; 95% CI 0.64–0.96, respectively), while the neonatal risks described above remained elevated.
In the sibling-pair analysis, SSRI use was associated with an increased risk of gestational diabetes and neonatal complications other than malformations, including an increased risk of needing hospital stay at 7 days of age.
Conclusions: SSRI use during pregnancy affects neonatal health beyond maternal depression by increasing symptoms related to delayed neonatal adaptation, although it may reduce the risk of preterm birth. The observed increase in the risk of gestational diabetes warrants further study.
