This review evaluates the risks and benefits of SSRI use during pregnancy for major depressive disorder (MDD), which affects ~12% of pregnant patients, with 5–6% receiving SSRI treatment; it also addresses the challenge of separating drug effects from the underlying indication in observational studies.
Once confounding by indication is accounted for, accumulated evidence suggests SSRIs carry little or no risk for serious adverse outcomes in pregnancy; untreated or undertreated moderate-to-severe MDD is itself associated with adverse maternal, fetal, and infant outcomes.
Evidence base relies heavily on observational studies prone to confounding by indication; fewer studies define SSRI *benefits* in pregnancy than risks; findings may not generalize across all severity levels of MDD.
Clinicians should not default to SSRI discontinuation in pregnant patients with moderate-to-severe MDD — untreated illness carries its own fetal and maternal risks. A structured shared decision-making process, weighing risks of both untreated MDD and SSRI exposure, should guide perinatal prescribing.
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