Table 1: A Look at the effects of antidepressants and depression on birth, the neonate, and the
mother
Outcome
Birth Outcomes
Miscarriage
Effects on growth
Low birth weight
Small for gestational age
Preterm delivery (less than 37
weeks’ gestation)
Structural malformations
Cardiac malformations
Antidepressants
Depression
Increased risk with use in early
pregnancy.
Limitations: other factors not
consistently controlled for.
Increased risk for slower rates of
head growth.
Limitations: hard to determine
duration of exposure, timing of
exposure, how severe
depression was, and other
confounding factors.
Increased risk with SSRI or TCA
use.
In some studies, accounted for
by shorter gestational duration.
Increased risk in mothers who
used SSRIs (small risk however,
compared with depressed
mothers who did not take SSRIs)
Inconclusive.
Increased risk in some but not all
studies (SSRIs, TCAs, SNRI/NRIs)
Dependent on duration of in
utero exposure: more exposure
more likely reduction in
gestational age.
No association between
SNRI/NRI use.
Conflicting associations for TCA
use.
Conflicting association for SSRI
use (specifically paroxetine)
Conflicting results.
No increased rate with SSRI
exposure (4 studies).
First trimester exposure to
paroxetine increased risk of
cardiac malformations (three
studies); this increase not found
in three other studies.
Taking SSRI and benzodiazepine
may increase congenital heart
Inconclusive.
Limitations of sample sizes and
methodologies
Increased risk for slower fetal
body and head growth.
Inconclusive.
Increased risk in some but not all
studies.
Inconclusive.
Increased risk in some but not all
studies.
Inconclusive
Increased risk in some but not all
studies.
No studies
No studies
Other
Neonatal Outcomes
Behavioural
Persistent pulmonary
hypertension
Long term growth, IQ,
behavioural
defects.
Specific defects.
Small risk and not replicated.
Increased risk for irritability,
jitteriness, seizures with TCA use.
Increased risk for irritability,
tachypnea, hypoglycemia,
temperature instability,
weak/absent cry, seizures (1530% of women who were
exposed to SSRIs in late
pregnancy); transient symptoms.
Conflicting results: some studies
show higher risk with later
gestational exposure to SSRIs
while other studies do not.
Limited information; majority of
studies do not show an
association with SSRIs or TCAs.
There have been reported subtle
effects on motor and
developmental control. As well,
reaching developmental
milestones compared to
unexposed neonates has taken
longer, but catches up by 19
months. Possible increased risk
of autism spectrum disorder,
however, small percentage due
to SSRI exposure. Limitations:
inability to control for severity,
whether or not medication had
been taken, and other risk
factors.
In comparing fluoxetine, TCAs,
and controls, no difference in IQ,
language, development,
behavioural development.
IQ negatively related to duration
of depression. Language
negatively correlated with the
amount of depressive episodes
after delivery.
Maternal Outcomes
No studies
Increased risk for irritability,
decreased activity and
attentiveness, less facial
expressions.
No studies
Depressed mothers at 18-32
weeks gestation resulted in
greater developmental delays in
infants. In another study, no
difference. Limitations due to
bias.
Pregnancy-induced
hypertension, pre-eclampsia and
eclampsia
Increased risk (50%-53%).
Conflicting data.
Limitations: control for
depression and other
confounding risk factors, linked
databases, and medication use
reported by the mother.
Chaudron LH. Complex Challenges in Treating Depression During Pregnancy. Am J Psychiatry 2013;
170:12-20.