Do Antidepressants in Pregnancy Raise Autism and ADHD Risk?

<jats:p>A meta-analysis of 37 studies and over 25 million pregnancies linked prenatal antidepressant use to modestly higher ADHD and autism. The quality of evidence, however, was rated very low. These signals lost statistical and clinical significance after adjusting for maternal illness, genetics, and shared environment. Only tricyclics (amitriptyline, nortriptyline) retained a signal. Paternal use showed the same unadjusted pattern, supporting confounding. Counsel as risk-versus-risk, weighing maternal mental health against fetal exposure, and explain confounding-aware designs like sibling-match comparisons. If an antidepressant is otherwise indicated, the evidence does not support stopping it or lowering the dose during pregnancy.</jats:p>