Do antidepressants in pregnancy raise a child's risk of autism or ADHD?

A meta-analysis pooled 37 studies covering 648,626 antidepressant-exposed pregnancies and 24,967,806 unexposed ones. Raw estimates showed 35% higher ADHD risk and 69% higher autism risk in exposed children, but the associations shrank or disappeared once confounding was accounted for, and fathers' antidepressant use during pregnancy showed a similar pattern.

This is one of the most common worries in perinatal psychiatry: is it safe to stay on an antidepressant while pregnant? Researchers searched four databases through May 2025 and pooled 37 studies comparing children born after prenatal antidepressant exposure with children who were not exposed, covering roughly 650,000 exposed and 25 million unexposed pregnancies. At first glance, the numbers look worrying: exposed children had about 35% higher relative risk of ADHD and 69% higher relative risk of autism. But the team then pushed on those numbers. Higher doses were not linked to higher autism risk. Exposure before conception, when the drug could not have reached the fetus, showed similar associations. And in the study's clever check, fathers' antidepressant use during pregnancy was also tied to more ADHD and autism in the children, which points toward shared family, genetic, and illness-related explanations rather than the medication itself. In analyses that adjusted for maternal mental illness and familial factors, most associations weakened or lost significance, and no specific SSRI or SNRI stood out. The authors rated the certainty of evidence as low to very low, and note that observational data can never fully rule out confounding. Their stated interpretation is that antidepressant treatment should continue for pregnant women with moderate-to-severe depression.