The decision to use medication during pregnancy requires careful assessment of the risks and benefits of both treatment and non-treatment. We routinely engage in this complex risk-benefit analysis, as do clinicians across all fields of medicine. Consider mothers with epilepsy. We continue anti-seizure medications during pregnancy because the risks of uncontrolled seizures far outweigh the medication risks. The same principle applies to maternal depression and other forms of mental illness.
Decades of data from large population-based studies demonstrate that SSRIs are not associated with adverse outcomes that were previously feared. Large meta-analyses have found no substantial increase in overall congenital malformations among infants with prenatal SSRI exposure. The potential risks that do exist — such as poor neonatal adaptation (affecting 25-30% of exposed newborns but typically transient with no long-term effects) — are generally mild and manageable with supportive care. Importantly, large-scale studies have found no significant increase in neurodevelopmental disorders, including autism, in children exposed to SSRIs in utero.
While antidepressants and psychotherapy can improve depression symptoms, access to any treatment is seriously limited, particularly in rural America. For many mothers — especially those with severe or recurrent depression or those who do not respond to other treatments — medication can be lifesaving.
The American College of Obstetricians and Gynecologists and American Psychiatric Association have made clear, evidence-based recommendations: Screen for depression and anxiety during and after pregnancy and ensure that women have access to the full range of treatment options including medication. The FDA should reinforce these standards, not muddy them with panelists that prioritize unfounded fears over scientific evidence.
The FDA panel sent a dangerous message to patients who may now be even more hesitant to seek help and to clinicians who may refuse to treat pregnant patients. Biased panels like this give undue weight to skepticism and fear over science and the extensive evidence base for antidepressants in pregnancy, putting both mothers and children at risk of preventable harm. The stakes are simply too high to let misinformation guide our approach to maternal mental health. Failing to identify and treat maternal mental illness causes profound harm to mothers, children and families. They deserve better.
Helen G. Kim, MD, is medical director and reproductive psychiatrist, Redleaf Center for Family Healing, Hennepin Healthcare, and clinical assistant professor of psychiatry, University of Minnesota Medical School; Maria Muzik, MD, MS, is professor of psychiatry and obstetrics & gynecology at Michigan Medicine, and co-director at Zero to Thrive; Katherine L. Wisner, MD, MS, of Children’s National Hospital in Washington D.C., is professor of psychiatry and behavioral sciences and pediatrics, and professor of obstetrics and gynecology at George Washington University School of Medicine and Health Sciences; Laura J. Miller, MD, is a reproductive psychiatrist; and Lauren M. Osborne, MD, is associate professor of obstetrics & gynecology, associate professor of psychiatry, and vice chair for clinical research in obstetrics & gynecology at Weill Cornell Medicine in New York.