Antidepressant Use in Pregnancy Not Linked to Increased Autism or ADHD Risk, Study Finds

Researchers at the University of Hong Kong examined 37 existing studies that together included 600,000 pregnancies with maternal antidepressant use and 25 million pregnancies without such exposure. Published in *Lancet Psychiatry*, the analysis compared rates of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) in offspring. After adjusting for maternal mental-health history and other confounders, the study found no statistically significant association between in-utero antidepressant exposure and either ASD or ADHD.

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Previous epidemiological work reported elevated risks of neurodevelopmental disorders among children whose mothers took antidepressants during pregnancy, prompting clinical uncertainty and public concern. The present meta-analysis sought to clarify whether observed associations persisted after accounting for underlying psychiatric conditions and genetic predispositions.

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• Dr Wing-Chung Chang, Professor, University of Hong Kong – lead author of the meta-analysis.

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• Prof. James Walker, Professor Emeritus of Obstetrics and Gynaecology, University of Leeds – commentator on clinical implications.

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• Unadjusted analyses suggested a 35 % higher ADHD risk and a 69 % higher ASD risk among exposed children.

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• Adjusted models, controlling for pre-existing maternal mental health and related factors, rendered these risk estimates non-significant.

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• No dose-response relationship was detected; high- and low-dose antidepressant groups showed comparable outcomes.

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• Elevated risks also appeared in children of fathers who used antidepressants and in children of mothers who used antidepressants before, but not during, pregnancy, indicating a likely genetic or familial component.

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Dr Chang emphasized that the findings provide reassurance to expectant parents while noting that discontinuing medication carries its own hazards, especially for women with moderate-to-severe depression. Prof. Walker highlighted that untreated maternal depression poses risks such as preterm birth, postnatal depression, and impaired mother-infant bonding, and he reiterated guideline-consistent recommendations to prioritize non-pharmacologic therapies for milder cases.

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The analysis acknowledges residual confounding: women prescribed antidepressants often experience more severe depression, which may not be fully captured even after statistical adjustment. Additionally, the study lacked data on socioeconomic status, lifestyle factors, and low birth-rate populations, limiting the granularity of risk assessment.

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A key discrepancy emerges between the initial unadjusted risk elevations and the null findings after adjustment, underscoring the importance of accounting for maternal mental-health severity. The authors note that bias may persist despite controls, and that future investigations should incorporate broader demographic and lifestyle variables.

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• “Dr Wing-Chung Chang, a professor at the University of Hong Kong and lead author of the study, said: “We know many parents-to-be worry about the potential impact of taking medication during pregnancy; our study provides reassuring evidence that commonly used antidepressants do not increase the risk of neurodevelopmental disorders such as autism and ADHD in children.” — Dr Wing-Chung Chang, University of Hong Kong

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• “Although our study found a small increase in the risk of autism and ADHD in the children of women who had used antidepressants during pregnancy, it also found that this risk disappeared when we accounted for other factors.” — Dr Wing-Chung Chang, University of Hong Kong

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• “Women with moderate or severe depression should not stop their antidepressants in pregnancy out of fear of causing autism or ADHD.” — Prof. James Walker, University of Leeds

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• “Depression that goes untreated in pregnancy carries real risks of its own, for the mother, the pregnancy and for the developing baby, including a higher chance of premature birth, postnatal depression and difficulties bonding with the baby.” — Prof. James Walker, University of Leeds

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The findings inform clinical decision-making by balancing the potential harms of medication exposure against the documented dangers of untreated maternal depression. They support guideline-aligned practice: reserving pharmacotherapy for moderate-to-severe cases while encouraging psychotherapy for milder symptoms.

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Researchers recommend prospective studies that integrate socioeconomic, lifestyle, and birth-rate data to refine risk estimates and guide personalized treatment strategies for pregnant individuals with depression.

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