Selective serotonin reuptake inhibitors in pregnancy

The use of antidepressant drugs, such as selective serotonin reuptake inhibitors (SSRIs), during pregnancy is rapidly increasing. To date, the effects of SSRI on pregnant women and fetuses are controversial and still a matter of debate. Although a number of studies have shown that these antidepressants are not teratogenic, some of them have reported an increase of congenital malformations after antenatal exposure to SSRIs. Moreover, fetal behavior is affected by these drugs, 30% of infants suffer from neonatal withdrawal symptoms and long term sequelae have not yet been excluded. Since there are no clear guidelines for SSRI treatment in pregnancy, potential risks must be balanced against the effects of untreated maternal depression. Treatment with SSRIs before and during pregnancy should only be considered in case of real necessity. Milder forms of depression should be treated with alternative methods. In this paper we have reviewed the literature on effects of SSRIs on embryonic, fetal and infant development.