Depression and anxiety affect up to one in five pregnancies, yet decisions about how to treat these conditions are often clouded by fear, mixed messages, and incomplete information. For many expecting parents, the question of whether to take antidepressants — particularly selective serotonin reuptake inhibitors (SSRIs) — can feel overwhelming, especially when there are concerns about impacts to a child’s long-term development.
Over the past three decades, researchers have been working to better understand how maternal mental health, antidepressant use during pregnancy, genetics, and a child’s environment interact to shape developmental outcomes. While early studies raised questions about possible risks, newer research is painting a more nuanced picture — one that emphasizes the importance of treating maternal depression and anxiety, and why this matters for a child’s long-term health.
Dr. Tim Oberlander has been at the forefront of this work. A developmental pediatrician at BC Children’s Hospital and an investigator at BC Children’s Hospital Research Institute (BCCHR), Dr. Oberlander has followed a cohort of children exposed to antidepressants during pregnancy from birth through adolescence. His research explores not just medication exposure, but also the broader context of maternal mental health, family environment, genetics, and child development across the early lifespan.
We spoke with Dr. Oberlander about what decades of research tell us about antidepressant use during pregnancy; why untreated maternal depression carries real risks; and how a more holistic, compassionate approach to mental health care can help children and families live their best lives.
What inspired you to study maternal mental health and child development?
Early in my career as a developmental pediatrician, I was caring for babies who had been exposed to a range of substances during pregnancy, including methadone, cocaine, and other psychotropic drugs. Many of these babies required medical support after birth, and my job was to help them safely adapt and, when necessary, withdraw from those substances.
What surprised me was that many of these children went on to develop in healthy ways, even when their early circumstances seemed quite adverse. That observation sparked a long-standing interest in resilience — why some children thrive despite early risks. Over time, it became clear that maternal mental health, particularly depression and anxiety, was often at the centre of these stories. That realization ultimately led to a focus on how mental health during pregnancy, and the treatments used to support it, influence child development across the lifespan.
How common are depression and anxiety during pregnancy?
Depression and anxiety during pregnancy are far more common than many people might realize. Up to 20 per cent of pregnant individuals experience symptoms severe enough to require clinical attention, whether through counselling, lifestyle changes, medication, or a combination of approaches. Antidepressant use during pregnancy occurs in roughly three to five per cent of pregnancies, though some studies report rates as high as eight per cent.
These numbers tell us that this is not a niche issue. It’s a public health concern with important implications for maternal and child health, and one that deserves thoughtful, evidence-based discussion rather than fear-driven messaging.
What are the risks of leaving depression or anxiety untreated during pregnancy?
Untreated or undertreated maternal depression and anxiety are associated with several potential risks to mothers and their infants. During pregnancy and around the time of birth, we may see lower birth weight, shorter gestational age, and signs of altered neonatal behaviour, such as difficulties with feeding and sleeping.
As children grow, there may be increased risks for language delays, anxiety, depression, or challenges with emotional and behavioural regulation. That said, it’s important to be clear that these outcomes are influenced by many factors. Maternal mental health during pregnancy is only one part of a much larger developmental picture that includes genetics, ongoing family mental health, social supports, and the child’s physical and emotional environment.
Many expecting parents worry about antidepressant use during pregnancy. What tips do you have around this decision?
This is one of the most challenging and personal decisions an expecting parent can face, and there is no one-size-fits-all answer. It’s important to recognize that non-treatment is not a neutral option. Untreated depression and anxiety carry risks for both the parent and the child.
Current evidence, including recent clinical guidelines, suggests that the risks associated with commonly used antidepressants during pregnancy are generally low and should not prevent their use when clinically indicated. The goal is not to ask whether antidepressants are “safe” or “unsafe” in isolation, but rather how to reduce overall risk and support the healthiest possible outcomes for the family.
What role do non-pharmacologic treatments play during pregnancy?
Non-pharmacologic approaches are often the first line of treatment and can be very effective for many people. These include improving sleep, physical activity, stress management, psychotherapy such as cognitive behavioural therapy and, in some cases, light therapy.
However, access to these supports can be limited by cost, availability, geography, and other social factors. When symptoms are moderate to severe or do not respond to these approaches, antidepressants can be an important and appropriate part of care. Ideally, treatment decisions are made within a broader, holistic plan that considers the individual’s needs, supports, and circumstances.
What has your research revealed about antidepressant exposure and child outcomes?
In our research, we followed children whose mothers were treated with antidepressants during pregnancy from early childhood into adolescence. Early on, we observed higher levels of anxiety reported in young children who had been exposed prenatally to antidepressants. Similar patterns were seen in animal studies, which initially raised concern about possible long-term effects.
However, as we continued to follow these children, a more complex picture emerged. Over time, the influence of prenatal antidepressant exposure became less pronounced, while the impact of maternal mood — both during pregnancy and throughout childhood — became increasingly important. By later childhood and early adolescence, ongoing maternal mental health was a much stronger predictor of child anxiety than prenatal medication exposure.
These findings highlight the challenge of separating the effects of medication from the effects of the condition being treated. Antidepressants are prescribed because someone is experiencing depression or anxiety, which themselves have genetic and environmental components that can influence child development.
This is known as “confounding by indication,” where both the very reason (depression) for a particular treatment (the SSRI) is also associated with similar outcomes. This makes it difficult to separate the SSRI effect from the underlying depression, and also means that simple cause-and-effect conclusions are inappropriate. When we account for maternal mood, genetics, and the child’s environment, associations between prenatal antidepressant exposure and later anxiety or other behavioural outcomes diminish.
What about claims linking SSRIs in pregnancy to autism?
This is an area where it’s especially important to distinguish association from causation. Early studies reported an association between prenatal antidepressant exposure and autism, but more rigorous research that controlled for genetics, maternal mental health, and family factors has shown that this association does not persist.
When these confounding factors are carefully accounted for, such as through sibling comparisons, the link between SSRIs and autism disappears. Based on the large body of current evidence, we know that antidepressant use during pregnancy does not cause autism.
How do genetics and environment shape child development alongside prenatal exposures?
Child development is the result of ongoing interactions between biology and environment. Genes matter, but so do family relationships, stress levels, housing stability, access to green space, education, and social supports. Through our work, we’ve shown that certain genetic profiles may make children more or less sensitive to environmental factors, including maternal mood.
This means that the same prenatal exposure can have very different outcomes depending on the context in which a child grows up. Prenatal exposures are not destiny.
What do you want expecting parents to take away from this research?
Supporting maternal mental health is essential! Depression and anxiety during pregnancy deserve serious attention and compassionate care. Treatment — whether pharmacologic, non-pharmacologic, or both — should be individualized and grounded in a holistic understanding of the family’s needs.
When parents are supported and their mental health is well managed, children tend to do well, too.
How does your research help children live their best lives?
Our work has helped shift the conversation away from fear and toward understanding. By recognizing that child development is shaped by many interacting factors, we can better support families, avoid unnecessary guilt or anxiety, and focus on what truly makes a difference: stable environments, supported parents, and responsive care.
After all, it’s not just where we start from, but where we end up that makes the difference.
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This Q&A was inspired by our Best Lives podcast episode titled, “Prenatal antidepressant exposure and child development.”
Are you looking for the latest in pediatric research? Check out our podcast — Best Lives — on Apple Podcasts, Spotify, or wherever you get your podcasts!
Learn more about the topics discussed in this article:
"Potential risks and benefits of prenatal selective serotonin reuptake inhibitor medications for maternal mental health and child development," Nature Mental Health
"The question is not whether SSRIs are universally good or bad, but how best to support maternal mental health," Springer Nature Research Communities
An article that references the above work: "Prenatal SSRI risks and benefits: Maternal, child impact," Scienmag
CANMAT’s clinical practice guidelines for the management of perinatal mood, anxiety, and related disorders: "Canadian Network for Mood and Anxiety Treatments 2024 Clinical Practice Guideline for the Management of Perinatal Mood, Anxiety, and Related Disorders," The Canadian Journal of Psychiatry
