Are SSRIs safe during pregnancy?

This is a great question. Unfortunately, there is not a simple answer. SSRIs are not completely risk free, but neither is untreated maternal illness. Women should decide whether or not to take an SSRI during pregnancy after consultation with a perinatal psychiatric specialist. Together, they can evaluate the risks and benefits of taking an SSRI after considering the woman’s personal psychiatric history, preferences, and values.

Untreated maternal mental illness

Women with a history of depression who stop taking their antidepressant have a 70% chance their depression recurring during pregnancy (compared to a 25% chance for women who continue taking their antidepressant).[i] Depression during pregnancy has been linked to increased rates of miscarriage and exposure of a developing fetus to stress.[ii] It has also been linked to an increased risk of postpartum depression, which, in turn, can affect a mother’s bonding with her baby, her ability to tolerate breastfeeding, and her attention to her baby’s safety.[iii]

Anxiety during pregnancy has also been linked to bad outcomes. Research has found that prenatal anxiety is linked to a developing baby later having childhood emotional and behavioral problems.[iv]

Mental illness during pregnancy is risky, often—but not always—more risky than the use psychiatric medications.


SSRIs are one common antidepressant. They have been relatively well studied. Approximately 8% of pregnant women take an antidepressant during pregnancy and, most commonly, this antidepressant is an SSRI. There are six common SSRIs: citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft).[v]

Benefits of SSRIs in depression

Many women find SSRIs to be very helpful in treating depression. Some studies suggest that 60% of women will benefit from taking an antidepressant. Studies also suggest when women take an SSRI in addition to receiving regular psychotherapy, they have a greater chance of recovery from depression (perhaps ~30% increased chance). If a woman has benefitted in the past from an antidepressant, the likelihood of benefiting from an antidepressant during pregnancy is even greater than it would be in most women.[vi]

Benefits of SSRIs in anxiety

Many women also find SSRIs to be helpful in treating anxiety. For example, one study found that 60% of patients on sertraline experienced a decrease in anxiety. When SSRIs are combined with psychotherapy, the benefits of these treatments are even greater than the use of either treatment alone. One study found that 80% of patients who received both CBT and sertraline were “very much or much improved” compared to 60% of patients who received either CBT or sertraline alone. Some women try to treat their anxiety through psychotherapy only, but find that they continue to have significant anxiety. These women should consider taking an SSRI. Women often report that after starting an SSRI, they are able to more easily put the skills they’ve learned in psychotherapy into practice.[vii]

Risks of SSRIs

Prior to pregnancy

  • Side effects
    It is not possible to list all the possible side effects SSRIs may cause. However, most women are able to tolerate SSRIs. Starting these medications at a low dose and then gradually increasing the medication to an effective dose tends to decrease the risk of any possible side effects. Some side effects, like upset stomach or diarrhea, tend to resolve as the body acclimates to the medication. Other side effects, such as sexual dysfunction, tend to persist until the woman stops taking the medication.[viii]
  • Fertility
    Data regarding SSRIs in women with regards to fertility is encouraging. For example, in one scientific study, depressed infertile couples (meaning at least one partner was depressed) who received treatment for depression (e.g. 6 months of cognitive behavioral therapy, individual supportive therapy, and fluoxetine as needed) were 14 times more likely to become pregnant than those who did not receive treatment. While I would not conclude from this study that fluoxetine increases fertility, it seems likely that it at least it does not decrease fertility in women with depression. Additionally, most studies show that SSRI use in women does not affect the success of fertility treatments like IVF.[ix]

During pregnancy

  • Miscarriage
    The scientific data regarding SSRIs and the risk of miscarriage is, in general, quite reassuring. There are contradictory studies, so the quality of each study is important to consider. Some studies appear to show that women on SSRIs are slightly more likely to have a miscarriage, but on further inspection, the studies are better interpreted as showing that depression, not an SSRI, is what is associated with the increased risk. One possible exception to this may be paroxetine (Paxil), but even this is controversial.[x]
  • Congenital defects
    SSRIs are not considered major teratogens, certainly not like Accutane or Thalidomide. A casual google search may bring up poorly conducted studies, some of which suggest that SSRIs may be associated with congenital defects. One of the most common flaws in these studies occurs when the researchers compare women with depression on SSRIs to women without depression. A much better comparison for understanding the effect of SSRIs on fetal development is to compare women with depression on SSRIs to women with depression not on SSRIs. One of the best studies did exactly this when it compared ~8,000 women on SSRIs with ~13,000 women with depression not on SSRIs. This study found no increase in congenital defects with the possible exception of paroxetine, which was associated with a small increased risk of heart defects (1.4% vs 0.8%). It should be noted that any pregnancy carries a 3-5% risk of major congenital anomalies. While we cannot conclusively state that SSRIs have absolutely no risk of congenital birth defects, the risk, if present, is small and is often outweighed by the risks of not treating maternal depression.[xi]
  • Preterm birth
    SSRIs may reduce the gestation period. However, studies suggest that the average reduction is about three days. This is unlikely to have a meaningful impact on a baby’s development.[xii]
  • Birth weight
    Evidence suggests that depression, but not SSRI use, may be linked to slightly lower birth weight.[xiii]

At delivery

  • Postpartum hemorrhage
    SSRIs have been associated with an increased risk of postpartum hemorrhage. Any pregnancy carries a 3% chance of postpartum hemorrhage. Use of an SSRI increases this risk to about 4%. Postpartum hemorrhage in developed countries has a low mortality rate (~0.05%). Thus, in the developed world, the risk of death from postpartum hemorrhage is about 1 in 70,000. For women on SSRIs, the risk is increased to about 1 in 50,000.[xiv]
  • Neonatal adaptation syndrome
    Babies born to mothers on SSRIs have an increased risk of a syndrome called “Neonatal adaptation syndrome.” This syndrome is generally mild and short-lived, resolving within two weeks but sometimes lasting up to one month. Babies with this syndrome may appear restless or irritable. They may not feed as well. These cases generally resolve without medical intervention. Severe cases are rare, but these cases can include seizures (0.7% of births of women on SSRIs) or respiratory distress (14% of births of women on SSRIs versus 8% of births of women not on SSRIs). Because severe cases may require medical intervention, women on SSRIs should deliver in a hospital. I also recommend that women on SSRIs remain in the hospital with their infant for 48 hours after delivery. That said, doctors in other medical specialties may find this recommendation overly conservative.[xv]
  • Persistent pulmonary hypertension of the newborn
    Persistent pulmonary hypertension of the newborn (PPHN) is a serious condition that occurs in approximately 2 of 1000 newborns. It is rare. Untreated, it is frequently fatal. Some studies have associated SSRIs with this condition. Newborns of mothers who have taken SSRIs in late pregnancy may be twice as likely to develop the condition. Part of his risk may be related to the mother having depression, but part of the risk may be attributable to the SSRI itself. That said, the FDA recommended in 2011 that physicians not to change their practice because the association was not clear. It stated that it “does not find sufficient evidence to conclude that SSRI use causes PPHN.” Additionally, while a risk being doubled is concerning, the absolute increased risk of this condition is still very small. Other risk factors have a much greater association with the condition. For example, the risks of PPHN are doubled (x2) in women who identify as black or Asian and in babies born after 41 weeks. It is quintupled (x5) in women who have taken aspirin, sextupled (x6) in women who have taken NSAIDs (like ibuprofen), and septupled (x7) in babies delivered by Caesarean section. Again, possible risks of medication must be weighed against known risks of untreated maternal illness.[xvi]

After delivery

  • Future development of the baby
    Many studies have examined whether or not maternal SSRI use during pregnancy is associated with babies having poor development later in life. In general, these studies are reassuring. SSRIs are unlikely to cause growth delays, abnormal development of motor skills, general cognitive delays, decreased intelligence, intellectual disability, or decreased scholastic achievement. Risks of impaired language development are small to nonexistent. While some studies that received media attention suggested that there might be an associated between maternal SSRI use and children developing autism, this possibility was later examined by multiple studies and found to be unlikely.[xvii]
  • Breastfeeding
    Breastfeeding is permissible while taking SSRIs. While SSRIs can be passed into a mother’s breastmilk, the levels of the drug to which babies are exposed can be quite low. For example, when the serum of infants has been examined, mothers who are breastfeeding on sertraline generally pass on so little to their infant that researchers cannot detect sertraline or its metabolites in 70% of infants. Other SSRIs can be found in greater abundance in infants’ serum, but many experts consider the benefit women receive from SSRIs to far outweigh the risks posed by exposure of the baby to the drug through breastfeeding.[xviii]



SSRIs during pregnancy are not entirely risk free, but neither is untreated maternal mental illness. Women should decide whether or not to take an SSRI during pregnancy after consultation with a perinatal psychiatric specialist. Together, they can evaluate the risks and benefits of taking an SSRI after considering the woman’s personal psychiatric history, preferences, and values.



  1. Cohen LS, Altshuler LL, Harlow BL, Nonacs R, Newport DJ, Viguera AC, Suri R, Burt VK, Hendrick V, Reminick AM, Loughead A, Vitonis AF, Stowe ZN. Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. JAMA. 2006 Feb 1;295(5):499-507. Erratum in: JAMA. 2006 Jul 12;296(2):170.


  1. Bonari L, Pinto N, Ahn E, Einarson A, Steiner M, Koren G. Perinatal risks of untreated depression during pregnancy. Can J Psychiatry. 2004 Nov;49(11):726-35.
  2. Siu AL; US Preventive Services Task Force (USPSTF), Bibbins-Domingo K, Grossman DC, Baumann LC, Davidson KW, Ebell M, García FA, Gillman M, Herzstein J, Kemper AR, Krist AH, Kurth AE, Owens DK, Phillips WR, Phipps MG, Pignone MP. Screening for Depression in Adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2016 Jan 26;315(4):380-7.
  3. Vigod SN, Wilson CA, Howard LM. Depression in pregnancy. BMJ. 2016 Mar 24;352:i1547.
  4. Schaffir J. Consequences of Antepartum Depression. Clin Obstet Gynecol. 2018 Apr 13.


  1. Field T. Postpartum depression effects on early interactions, parenting, and safety practices: a review. Infant Behav Dev. 2010 Feb;33(1):1-6.
  2. Banti S, Mauri M, Oppo A, Borri C, Rambelli C, Ramacciotti D, Montagnani MS, Camilleri V, Cortopassi S, Rucci P, Cassano GB. From the third month of pregnancy to 1 year postpartum. Prevalence, incidence, recurrence, and new onset of depression. Results from the perinatal depression-research & screening unit study. Compr Psychiatry. 2011 Jul-Aug;52(4):343-51
  3. Viguera AC, Tondo L, Koukopoulos AE, Reginaldi D, Lepri B, Baldessarini RJ. Episodes of mood disorders in 2,252 pregnancies and postpartum periods. Am J Psychiatry. 2011 Nov;168(11):1179-85.


  1. Glover V. Maternal depression, anxiety and stress during pregnancy and child outcome; what needs to be done. Best Pract Res Clin Obstet Gynaecol. 2014 Jan;28(1):25-35.


  1. Huybrechts KF, Palmsten K, Mogun H, Kowal M, Avorn J, Setoguchi-Iwata S, Hernández-Díaz S. National trends in antidepressant medication treatment among publicly insured pregnant women. Gen Hosp Psychiatry. 2013 May-Jun;35(3):265-71.


  1. Mulrow CD, Williams JW Jr, Chiquette E, Aguilar C, Hitchcock-Noel P, Lee S, Cornell J, Stamm K. Efficacy of newer medications for treating depression in primary care patients. Am J Med. 2000 Jan;108(1):54-64.
  2. Cuijpers P, van Straten A, Warmerdam L, Andersson G. Psychotherapy versus the combination of psychotherapy and pharmacotherapy in the treatment of depression: a meta-analysis. Depress Anxiety. 2009;26(3):279-88.


  1. Brawman-Mintzer O, Knapp RG, Rynn M, Carter RE, Rickels K. Sertraline treatment for generalized anxiety disorder: a randomized, double-blind, placebo-controlled study. J Clin Psychiatry. 2006 Jun;67(6):874-81
  2. Walkup JT, Albano AM, Piacentini J, Birmaher B, Compton SN, Sherrill JT, Ginsburg GS, Rynn MA, McCracken J, Waslick B, Iyengar S, March JS, Kendall PC. Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. N Engl J Med. 2008 Dec 25;359(26):2753-66.


  1. Hu XH, Bull SA, Hunkeler EM, Ming E, Lee JY, Fireman B, Markson LE. Incidence and duration of side effects and those rated as bothersome with selective serotonin reuptake inhibitor treatment for depression: patient report versus physician estimate. J Clin Psychiatry. 2004 Jul;65(7):959-65.
  2. Wu CH, Farley JF, Gaynes BN. The association between antidepressant dosage titration and medication adherence among patients with depression. Depress Anxiety. 2012 Jun;29(6):506-14.


  1. Klock SC, Sheinin S,  Kazer R,  Zhang X. A pilot study of the relationship between selective serotonin reuptake inhibitors and in vitro fertilization outcome, Fertil Steril , 2004, vol. 82 (pg. 968-969)
  2. Friedman BE, Rogers JL,  Shahine LK,  Westphal LM,  Lathi RB. Effect of selective serotonin inhibitors on in vitro fertilization outcome, Fertil Steril , 2009, vol. 92 (pg. 1312-1314)
  3. Serafini P, Lobo DS,  Grosman A,  Seibel D,  Rocha AM,  Motta ELA. Fluoxetine treatment for anxiety in women undergoing in vitro fertilization, Int J Gynceol Obstet , 2009, vol. 105 (pg. 136-139)
  4. Ramezanzadeh F, Noorbala AA, Abedinia N, Rahimi Forooshani A, Naghizadeh MM. Psychiatric intervention improved pregnancy rates in infertile couples. Malays J Med Sci. 2011 Jan;18(1):16-24.


  1. Schick-Boschetto B, Zuber C. Fluoxetine exposure in early human pregnancy. Teratology 1992;45:460.
  2. Chambers CD, Johnson KA, Jones KL. Pregnancy outcome in women exposed to fluoxetine. Teratology 1993;47:386.
  3. Pastuszak A, Schick-Boschetto B, Zuber C et al. Pregnancy outcome following first-trimester exposure to fluoxetine (Prozac). JAMA 1993;269:2246-2248.
  4. Goldstein DJ, Marvel DE: Psychotropic medications during pregnancy: risk to the fetus. JAMA 270:2177, 1993.
  5. McElhatton PR, Garbis HM, Elefant E, Vial T, Bellemin B, Mastroiacovo P, Arnon J, Rodriguez-Pinilla E, Schaefer C, Pexieder T, Merlob P, dal Verme S. The outcome of pregnancy in 689 women exposed to therapeutic doses of antidepressants. A collaborative study of the European Network of Teratology Information Services (ENTIS). Reprod Toxicol 1996;10:285-94.
  6. Goldstein DJ, Corbin LA, Sundell KL. Effects of first-trimester fluoxetine exposure on the newborn. Obstet Gynecol 1997;89:713-8.
  7. Sivojelezova A, Shuhaiber S, Sarkissian L, Einarson A, Koren G. Citalopram use in pregnancy: prospective comparative evaluation of pregnancy and fetal outcome. Am J Obstet Gynecol 2005.193:2004-9.
  8. Rahimi R, Nikfar S, Abdollahi M. Pregnancy outcomes following exposures to serotonin reuptake inhibitors: a meta-analysis of clinical trials. Reprod Toxicol 2006;22:571-575.
  9. Vial T, Cournot MP, Bernard N, Carlier P, Jonville-Bera AP, Jean-Pastor MJ, Barjhoux C, Robert E, Elefant E, Decotes J, et al. Paroxetine and congenital malformations: a prospective comparative study. Drug Safety 2006;29:970.
  10. Nakhai-Pour HR, Broy P, Berard A. Use of antidepressants during pregnancy and the risk of spontaneous abortion. CMAJ. 2010;182(10):1031-7.
  11. Nikfar S, Rahimi R, Hendoiee N, Abdollahi M. Increasing the risk of spontaneous abortion and major malformations in newborns following use of serotonin reuptake inhibitors during pregnancy: A systematic review and updated meta-analysis. Daru. 2012 Nov 1;20(1):75.
  12. Domar AD, Moragianni VA, Ryley DA, Urato AC. The risks of selective serotonin reuptake inhibitor use in infertile women: a review of the impact on fertility, pregnancy, neonatal health and beyond. Hum Reprod. 2013 Jan;28(1):160-71.
  13. Jimenez-Solem E, Andersen JT, Petersen M, Broedbaek K, Lander AR, Afzal S, Torp-Pedersen C, Poulsen HE. SSRI use during pregnancy and risk of stillbirth and neonatal mortality. Am J Psychiatry. 2013;170(3):299-304.
  14. Kjaersgaard MI, Parner ET, Vestergaard M, Sorensen MJ, Olsen J, Christensen J, Bech BH, Pedersen LH. Prenatal antidepressant exposure and risk of spontaneous abortion – a population-based study. PLoS One. 2013;8(8):e72095.
  15. Ross LE, Grigoriadis S, Mamisashvili L, Vonderporten EH, Roerecke M, Rehm J, Dennis CL, Koren G, Steiner M, Mousmanis P, Cheung A. Selected pregnancy and delivery outcomes after exposure to antidepressant medication: a systematic review and meta-analysis. JAMA Psychiatry. 2013 Apr;70(4):436-43.
  16. 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.
  17. Johansen RL, Mortensen LH, Andersen AM, Hansen AV, Strandberg-Larsen K. Maternal use of selective serotonin reuptake inhibitors and risk of miscarriage – assessing potential biases. Paediatr Perinat Epidemiol. 2015;29(1):72-81. doi:10.1111/ppe.12160.



  1. Grigoriadis S, VonderPorten EH, Mamisashvili L, Roerecke M, Rehm J, Dennis CL, Koren G, Steiner M, Mousmanis P, Cheung A, Ross LE. Antidepressant exposure during pregnancy and congenital malformations: is there an association? A systematic review and meta-analysis of the best evidence. J Clin Psychiatry. 2013 Apr;74(4):e293-308.
  2. Marchocki Z, Russell NE, Donoghue KO. Selective serotonin reuptake inhibitors and pregnancy: A review of maternal, fetal and neonatal risks and benefits. Obstet Med. 2013 Dec;6(4):155-8.
  3. Ban L, Gibson JE, West J, Fiaschi L, Sokal R, Smeeth L, Doyle P, Hubbard RB, Tata LJ. Maternal depression, antidepressant prescriptions, and congenital anomaly risk in offspring: a population-based cohort study. BJOG. 2014 Nov;121(12):1471-81.
  4. Knudsen TM, Hansen AV, Garne E, Andersen AM. Increased risk of severe congenital heart defects in offspring exposed to selective serotonin-reuptake inhibitors in early pregnancy–an epidemiological study using validated EUROCAT data. BMC Pregnancy Childbirth. 2014 Sep 25;14:333.
  5. Wang S, Yang L, Wang L, Gao L, Xu B, Xiong Y. Selective Serotonin Reuptake Inhibitors (SSRIs) and the Risk of Congenital Heart Defects: A Meta-Analysis of Prospective Cohort Studies. J Am Heart Assoc. 2015 May 19;4(5).
  6. Bérard 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 Jan 12;7(1):e013372.
  7. Zhang TN, Gao SY, Shen ZQ, Li D, Liu CX, Lv HC, Zhang Y, Gong TT, Xu X, Ji C, Wu QJ. Use of selective serotonin-reuptake inhibitors in the first trimester and risk of cardiovascular-related malformations: a meta-analysis of cohort studies. Sci Rep. 2017 Feb 21;7:43085.


  1. Ross LE, Grigoriadis S, Mamisashvili L, Vonderporten EH, Roerecke M, Rehm J, Dennis CL, Koren G, Steiner M, Mousmanis P, Cheung A. Selected pregnancy and delivery outcomes after exposure to antidepressant medication: a systematic review and meta-analysis. JAMA Psychiatry. 2013 Apr;70(4):436-43.
  2. Huang H, Coleman S, Bridge JA, Yonkers K, Katon W. A meta-analysis of the relationship between antidepressant use in pregnancy and the risk of preterm birth and low birth weight. Gen Hosp Psychiatry. 2014 Jan-Feb;36(1):13-8.


  1. Ross LE, Grigoriadis S, Mamisashvili L, Vonderporten EH, Roerecke M, Rehm J, Dennis CL, Koren G, Steiner M, Mousmanis P, Cheung A. Selected pregnancy and delivery outcomes after exposure to antidepressant medication: a systematic review and meta-analysis. JAMA Psychiatry. 2013 Apr;70(4):436-43.


  1. Shakur H, Elbourne D, Gülmezoglu M, Alfirevic Z, Ronsmans C, Allen E, Roberts I. The WOMAN Trial (World Maternal Antifibrinolytic Trial): tranexamic acid for the treatment of postpartum haemorrhage: an international randomised, double blind placebo controlled trial. Trials. 2010 Apr 16;11:40.
  2. Palmsten K, Hernández-Díaz S, Huybrechts KF, Williams PL, Michels KB, Achtyes ED, Mogun H, Setoguchi S. Use of antidepressants near delivery and risk of postpartum hemorrhage: cohort study of low income women in the United States. BMJ. 2013 Aug 21;347:f4877.
  3. Sheldon WR, Blum J, Vogel JP, Souza JP, Gülmezoglu AM, Winikoff B; WHO Multicountry Survey on Maternal and Newborn Health Research Network. Postpartum haemorrhage management, risks, and maternal outcomes: findings from the World Health Organization Multicountry Survey on Maternal and Newborn Health. BJOG. 2014 Mar;121 Suppl 1:5-13.


  1. Moses-Kolko EL, Bogen D, Perel J, Bregar A, Uhl K, Levin B, Wisner KL. Neonatal signs after late in utero exposure to serotonin reuptake inhibitors: literature review and implications for clinical applications. JAMA. 2005 May 18;293(19):2372-83. Review.
  2. Jefferies AL; Canadian Paediatric Society, Fetus and Newborn Committee. Selective serotonin reuptake inhibitors in pregnancy and infant outcomes. Paediatr Child Health. 2011 Nov;16(9):562-3. English, French.
  3. Grigoriadis S, VonderPorten EH, Mamisashvili L, Eady A, Tomlinson G, Dennis CL, Koren G, Steiner M, Mousmanis P, Cheung A, Ross LE. The effect of prenatal antidepressant exposure on neonatal adaptation: a systematic review and meta-analysis. J Clin Psychiatry. 2013 Apr;74(4):e309-20.
  4. Hayes RM, Wu P, Shelton RC, Cooper WO, Dupont WD, Mitchel E, Hartert TV. Maternal antidepressant use and adverse outcomes: a cohort study of 228,876 pregnancies. Am J Obstet Gynecol. 2012 Jul;207(1):49.e1-9. Erratum in: Am J Obstet Gynecol. 2013 Apr;208(4):326.
  5. McDonagh MS, Matthews A, Phillipi C, Romm J, Peterson K, Thakurta S, Guise JM. Depression drug treatment outcomes in pregnancy and the postpartum period: a systematic review and meta-analysis. Obstet Gynecol. 2014 Sep;124(3):526-34.
  6. Yang A, Ciolino JD, Pinheiro E, Rasmussen-Torvik LJ, Sit DKY, Wisner KL. Neonatal Discontinuation Syndrome in Serotonergic Antidepressant-Exposed Neonates. J Clin Psychiatry. 2017 May;78(5):605-611



  1. Van Marter LJ, Leviton A, Allred EN, Pagano M, Sullivan KF, Cohen A, Epstein MF. Persistent pulmonary hypertension of the newborn and smoking and aspirin and nonsteroidal antiinflammatory drug consumption during pregnancy. Pediatrics. 1996 May;97(5):658-63.
  2. Walsh-Sukys MC, Tyson JE, Wright LL, Bauer CR, Korones SB, Stevenson DK, Verter J, Stoll BJ, Lemons JA, Papile LA, Shankaran S, Donovan EF, Oh W, Ehrenkranz RA, Fanaroff AA. Persistent pulmonary hypertension of the newborn in the era before nitric oxide: practice variation and outcomes. Pediatrics. 2000 Jan;105(1 Pt 1):14-20.
  3. Hernández-Díaz S, Van Marter LJ, Werler MM, Louik C, Mitchell AA. Risk factors for persistent pulmonary hypertension of the newborn. Pediatrics. 2007 Aug;120(2):e272-82.
  4. FDA Drug Safety Communication: Selective serotonin reuptake inhibitor (SSRI) antidepressant use during pregnancy and reports of a rare heart and lung condition in newborn babies. December 14, 2011. Accessed June 24, 2018.
  5. Kieler H, Artama M, Engeland A, Ericsson O, Furu K, Gissler M, Nielsen RB, Nørgaard M, Stephansson O, Valdimarsdottir U, Zoega H, Haglund B. 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 Jan 12;344:d8012.


  1. Pedersen LH, Henriksen TB, Olsen J. Fetal exposure to antidepressants and normal milestone development at 6 and 19 months of age. Pediatrics. 2010 Mar;125(3):e600-8.
  2. Casper RC, Gilles AA, Fleisher BE, Baran J, Enns G, Lazzeroni LC. Length of prenatal exposure to selective serotonin reuptake inhibitor (SSRI) antidepressants: effects on neonatal adaptation and psychomotor development. Psychopharmacology (Berl). 2011 Sep;217(2):211-9. doi: 10.1007/s00213-011-2270-z. Epub 2011 Apr 16.
  3. Nulman I, Koren G, Rovet J, Barrera M, Streiner DL, Feldman BM. Neurodevelopment of children prenatally exposed to selective reuptake inhibitor antidepressants: Toronto sibling study. J Clin Psychiatry. 2015 Jul;76(7):e842-7.
  4. Brown AS, Gyllenberg D, Malm H, McKeague IW, Hinkka-Yli-Salomäki S, Artama M, Gissler M, Cheslack-Postava K, Weissman MM, Gingrich JA, Sourander A. Association of Selective Serotonin Reuptake Inhibitor Exposure During Pregnancy With Speech, Scholastic, and Motor Disorders in Offspring. JAMA Psychiatry. 2016 Nov 1;73(11):1163-1170.
  5. 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 Apr 18;317(15):1544-1552.
  6. Sujan AC, Rickert ME, Öberg AS, Quinn PD, Hernández-Díaz S, Almqvist C, Lichtenstein P, Larsson H, D’Onofrio BM. 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 Apr 18;317(15):1553-1562.
  7. Viktorin A, Uher R, Kolevzon A, Reichenberg A, Levine SZ, Sandin S. Association of Antidepressant Medication Use During Pregnancy With Intellectual Disability in Offspring. JAMA Psychiatry. 2017 Oct 1;74(10):1031-1038.


  1. Weissman AM, Levy BT, Hartz AJ, Bentler S, Donohue M, Ellingrod VL, Wisner KL. Pooled analysis of antidepressant levels in lactating mothers, breast milk, and nursing infants. Am J Psychiatry. 2004 Jun;161(6):1066-78.
  2. Larsen ER, Damkier P, Pedersen LH, Fenger-Gron J, Mikkelsen RL, Nielsen RE, Linde VJ, Knudsen HE, Skaarup L, Videbech P; Danish Psychiatric Society; Danish Society of Obstetrics and Gynecology; Danish Paediatric Society; Danish Society of Clinical Pharmacology. Use of psychotropic drugs during pregnancy and breast-feeding. Acta Psychiatr Scand Suppl. 2015;(445):1-28.
  3. Pinheiro E, Bogen DL, Hoxha D, Ciolino JD, Wisner KL. Sertraline and breastfeeding: review and meta-analysis. Arch Womens Ment Health. 2015 Apr;18(2):139-46.
  4. Weisskopf E, Fischer CJ, Bickle Graz M, Morisod Harari M, Tolsa JF, Claris O, Vial Y, Eap CB, Csajka C, Panchaud A. Risk-benefit balance assessment of SSRI antidepressant use during pregnancy and lactation based on best available evidence. Expert Opin Drug Saf. 2015 Mar;14(3):413-27.