A large meta-analysis of nearly 650,000 pregnancies with antidepressant exposure and about 25 million unexposed pregnancies found no clear evidence that prenatal antidepressant use increases risk of neurodevelopmental disorders like autism or ADHD after adjusting for maternal mental health, family history, and other confounders.

Initial links between maternal antidepressant use and higher autism/ADHD diagnoses faded to non-significance once confounding factors were accounted for, suggesting shared familial or maternal factors rather than a causal effect from the medication.

Some elevated risk signals appeared when considering paternal antidepressant use during the pregnancy or maternal use before pregnancy, reinforcing that the pregnancy exposure itself is unlikely the driver.

The lead author urged clinicians and patients to consider continuing treatment for moderate-to-severe depression during pregnancy to prevent relapse, while weighing individual risks and benefits.

Experts not involved in the study stressed the distinction between correlation and causation, noting maternal mental health and family factors can explain observed associations.

Limitations include gaps in socioeconomic data, lifestyle information, birth weight, and trimester-specific dosing, along with residual bias from maternal depression severity.

Strengths include adjusting for maternal mental health, but there was substantial heterogeneity across studies and missing data on key perinatal factors.

Additional limitations point to the need for richer, longitudinal datasets with broader socioeconomic and perinatal variables in future research.

Sibling-matched analyses reduced observed associations, suggesting shared familial factors contribute to the findings.

The study’s conclusions support reassessing public concern about antidepressant use in pregnancy and basing medical decisions on comprehensive, confounder-adjusted evidence.

No significant links were found for intellectual disabilities, motor disorders, or speech and language disorders.

For mild depression during pregnancy, nonpharmacological approaches like psychotherapy may be suitable, but abrupt discontinuation of antidepressants solely over neurodevelopmental risk is discouraged due to risks of untreated maternal depression.