Research by a team from the University of Glasgow has suggested that children whose mothers had depression during pregnancy were at higher risk of having special educational needs that couldn’t be attributed solely to antidepressant exposure, reports CIDRAP News.
Antidepressant use during pregnancy is on the rise, though the long-term effects of these drugs on child development is unclear. At the same time, having untreated depression during pregnancy carries its own risks, making it challenging for women to make informed decisions about medication use during pregnancy.
For the study, the researchers analysed the health and education records of more than 167 000 children born in Wales from 2009 to 2016 and followed until 2022.
They looked for indications of special educational needs, including learning and communication difficulties, autism, and behavioural or emotional difficulties, as well as attention-deficit hyperactivity disorder. They also examined maternal depression diagnoses and antidepressant prescriptions.
Antidepressants linked to slightly higher risk
Of the roughly 167 000 children, 12 630 (7.6%) were exposed to untreated depression in utero, 7 005 (4.2%) were exposed to antidepressant-treated depression; and 5 996 (3.6%) were exposed to antidepressant medication without a recorded depression diagnosis.
After accounting for factors like maternal age, smoking, and the child’s sex, the researchers estimated that 20% of children exposed to neither depression nor antidepressant medications would have a special education need. That estimate rose to 23.6% among children whose mothers had depression but were not prescribed antidepressants.
Among children whose mothers had both depression and an antidepressant prescription, the estimate was 26.5%. The estimate was similar for children whose mothers had an antidepressant prescription but no recorded depression diagnosis: 26.3%.
Overall, the researchers found that antidepressant exposure was associated with a 6.3% rise in special education needs in those not exposed to maternal depression and an additional 2.9% increase in children exposed to maternal depression.
The team concluded that mothers with depression have a higher risk of giving birth to children with special educational needs, regardless of whether they were exposed to antidepressants, but that medication may carry an additional risk.
“We showed that if women with depression took antidepressants while pregnant, their children were more likely to have special educational needs, but it was only a very slight increase and may have been due to them having more severe depression, rather than an effect of the medicine,” said the authors.
Untreated depression carries risks of its own
The study cannot show that antidepressants caused the additional risk, they added.
The team had no measure of depression severity, and women prescribed medication may have had more severe symptoms than those who were not prescribed medication.
Previous research has linked maternal depression with special educational needs. “Specifically, previous systematic reviews and meta-analyses have found that untreated poor perinatal maternal mental health is associated with adverse neurodevelopment in school-age and adolescent children,” wrote the researchers.
The records also lacked information on other potentially relevant factors, including alcohol use and postpartum depression, so the findings don’t provide a reason to stop antidepressant treatment during pregnancy, they said.
“Rather, our study indicates that exposure to antidepressants during pregnancy could serve as a marker for additional support being needed at school.”
The American College of Obstetricians and Gynaecologists recommends against discontinuing mental health medication solely because of pregnancy.
Study details
Prenatal exposure to maternal depression and antidepressants and neurodevelopmental outcomes: A population cohort study
Saraid McIlvride, Neha Rao, Sarjit Singh, Scott Nelson, Jill Pell, Michael Fleming.
Published in PLOS Medicine on 29 September 2026
Abstract
Background
The long-term effects of antidepressant use in pregnancy on child neurodevelopment are unclear; meanwhile antidepressant use in pregnancy is increasing. We aimed to clarify associations between prenatal maternal depression and/or antidepressant exposure and neurodevelopmental outcomes in school-age children.
Methods and findings
This population-wide cohort study included 167,447 children born in Wales, UK between 2009 and 2016, followed until 2022 (mean age 5.68 years) using linked primary care, maternity and education records. Exposures were one or more antidepressant prescriptions during pregnancy or up to one month before conception, and/or maternal depression diagnosis recorded in the two years before delivery. Outcomes were all-cause and cause-specific special educational need (SEN), including autism spectrum disorder (ASD), sensory impairment, communication difficulties, learning difficulties, physical and medical difficulties, and behavioural-emotional-social difficulties, as well as attention deficit hyperactivity disorder (ADHD). Generalised estimating equation models with an interaction term between maternal depression and antidepressant exposure were used to investigate SEN and causes of SEN. Predicted probabilities and marginal effects were derived to quantify absolute risk. Separate models were fitted for individual antidepressant classes and combinations. Cox proportional hazards regression and flexible parametric survival models were used for time to ADHD diagnosis. Covariates included child sex, area-level deprivation quintile, ethnicity, age, maternal age, smoking, parity, multiple birth and epilepsy.
In total, 12,630 children (7.6%) were exposed to untreated depression during pregnancy; 7,005 (4.2%) to treated depression; and 5,996 (3.6%) to antidepressant medication without a recorded depression diagnosis. SEN was associated with both maternal depression (adjusted odds ratio (aOR) 1.25 (95% CI [1.20,1.31])) and antidepressant medication exposure (aOR 1.46 (95% CI [1.38,1.56])). Predicted probabilities of all-cause SEN were highest among children exposed to both maternal depression and antidepressants (26.5 per 100 children (95% CI [25.5,27.5])) and lowest among unexposed children (20.0 per 100 (95% CI [19.8,20.2])). Depression alone was associated with an increase to 23.6 per 100 children (95% CI [22.9,24.3]), while antidepressant exposure without depression was associated with an increase to 26.3 per 100 (95% CI [25.3,27.4]). Antidepressant exposure was associated with a 6.3% absolute increase in SEN risk (95% CI [5.2,7.4]) among children of mothers without depression and 2.9% absolute increase (95% CI [1.7,4.1]) among children of mothers with depression. Associations with antidepressant exposure were observed across multiple outcomes including ASD (aOR 1.59 (95% CI [1.31,1.92])) and ADHD (adjusted hazard ratio (aHR) 1.89 (95% CI [1.57,2.27])). No antidepressant class showed a markedly different association with SEN risk, although tricyclic antidepressants (TCAs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) had significant differences in absolute risk of SEN when comparing treated and untreated depression (TCAs 8.8% (95% CI [3.2,14.4]); SNRIs 8.8% (95% CI [2.6,15.0])). Key limitations include potential confounding by indication and depression severity, as women prescribed antidepressants likely represent a more severely depressed group.
Conclusions
Offspring of mothers with depression have a higher risk of SEN that cannot be attributed solely to antidepressant exposure. Prenatal exposure to antidepressants may confer a small additional absolute risk, but findings may partly represent confounding by depression severity. Further research is needed.
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