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This review evaluates the link between SSRI/SNRI use during pregnancy and the risks of preterm birth, low birth weight, and neonatal adaptation disorders, factoring in maternal depression.

March 21, 2026Open Access

Use of Ssri and Snri During Pregnancy and the Risk of Preterm Birth, Low Birth Weight, and Neonatal Adaptation Disorders: A Systematic Review

Key Points

This review evaluates the link between SSRI/SNRI use during pregnancy and the risks of preterm birth, low birth weight, and neonatal adaptation disorders, factoring in maternal depression.
Conducted comprehensive searches in PubMed and Cochrane Library for relevant studies from 2015-2025.
Included meta-analyses, systematic reviews, and large cohort studies.
Examined outcomes related to preterm birth, low birth weight, and neonatal adaptation disorders.
SSRI use during pregnancy correlates with a 1.2-1.5 times increased risk of preterm birth.
Low birth weight is associated with SSRI use, showing a relative risk of about 1.4.
20-30% of third-trimester infants exposed to SSRIs experience neonatal adaptation syndrome, with an adjusted odds ratio of approximately 2.1.

Abstract

Background: Depression affects 10–15% of pregnant women and poses significant clinical management challenges. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are first-line treatments, yet their safety profile in pregnancy remains an active area of research and clinical concern. Objective: This systematic review synthesizes evidence from 2015–2025 on associations between SSRI/SNRI use during pregnancy and risks of preterm birth (PTB), low birth weight (LBW), and poor neonatal adaptation syndrome (PNAS), with attention to confounding by maternal depression. Methods: A comprehensive search of PubMed, Cochrane Library, and related databases identified meta-analyses, systematic reviews, and large cohort studies published 2015–2025. Outcomes examined included PTB (<37 weeks), LBW (<2500g), and PNAS. Results: SSRI exposure during pregnancy is associated with modest increases in PTB risk (adjusted OR approximately 1.2–1.5) and LBW (relative risk ~1.4), with strongest effects for late-pregnancy exposure. PNAS occurs in 20–30% of infants exposed in the third trimester (adjusted OR ~2.1), typically mild and self-limited. SNRI data are more limited but show similar patterns. Confounding by indication - the underlying maternal depression - contributes substantially to observed associations. Conclusions: Both untreated maternal depression and antidepressant exposure carry risks. Clinical decision-making should involve individualized risk–benefit assessment, shared decision-making, and recognition that sertraline and escitalopram demonstrate favorable safety profiles. Absolute risk increases are modest and must be weighed against consequences of untreated illness.

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