SSRI Use During Pregnancy Associated With Neonatal Adaptation Symptoms

Continuing the use of common antidepressants during pregnancy is tied to slightly lower Apgar scores in babies within moments of birth but no increased risk of congenital malformations, intensive care unit admission, or other serious outcomes, according to a study in JAMA Network Open.

 

The potential risks of taking selective serotonin reuptake inhibitors (SSRIs) during pregnancy have been researched extensively, but retrospective studies have produced varying and conflicting findings. While conducting randomized clinical trials in pregnant women is ethically challenging, this study used an innovative methodological approach to emulate a clinical trial’s strict protocols within existing population-level data.

 

• The target trial emulation included 1,014 pregnant women who used SSRIs within two years of conception: 457 women continued SSRIs during pregnancy, while 557 stopped taking SSRIs at least 90 days before conception. None of the women took any other antidepressants or anxiolytics.
• Infants who were exposed to SSRIs during pregnancy had lower Apgar scores at one and five minutes(differences of -0.39 and -0.28 points, respectively) and an increased risk of meconium in amniotic fluid.
• Continuation of SSRIs during pregnancy was associated with no significant differences in other studied outcomes, including preterm birth, birth weight, cesarean delivery, respiratory distress, feeding problems, congenital anomalies, or neonatal intensive care unit admission.

When accounting for potential bias introduced by excluding women who switched to a non-SSRI antidepressant or anxiolytic, the researchers found that the association between SSRIs and meconium staining was no longer significant while the link with respiratory distress became significant. Further, although the lack of association between SSRIs and congenital anomalies aligns with prior research, the rarity of these outcomes precludes definitive conclusions.

 

“Our findings strengthen prior evidence linking in utero SSRI exposure to lower Apgar scores,” the researchers wrote. “This association aligns with clinical reports of delayed neonatal adaptation to extrauterine life, marked by symptoms such as poor muscle tone, jitteriness, weak cry, and respiratory distress, which are usually transient.” Given the potential for delayed adaptation, the researchers support recommendations that deliveries of SSRI-exposed infants should take place in a facility equipped for neonatal resuscitation.

 

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Layla Aref, et al. Neonatal outcomes following selective serotonin reuptake inhibitor use during pregnancy. JAMA Network Open. Published July 13, 2026. doi:10.1001/jamanetworkopen.2026.22790