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Children whose mothers had a recorded depression diagnosis around the time of pregnancy were slightly more likely to need special educational support in school, and those whose mothers were also prescribed antidepressants had a small additional increase in risk. However, the researchers could not rule out that this extra risk reflects more severe depression rather than the medication itself. The research was published in PLOS Medicine.
Expectant mothers often face difficult decisions regarding mental health treatment, especially given concerns about how medications might affect fetal brain development. Fears about potential side effects lead some pregnant women to stop taking prescribed antidepressants, which can leave both mother and child vulnerable to the harms of untreated depression. In an educational setting, a special educational need refers to situations where a child requires additional support at school to help with learning, communication, physical, or behavioral challenges compared to their peers.
Early observational studies fueled worries about medication safety during pregnancy. A 2016 study reported that taking antidepressants during pregnancy was associated with an increased risk of autism spectrum disorder in children. Follow-up research, however, suggested that the mother’s underlying depression and shared family traits might actually explain the connection.
Studies that accounted for those factors often saw the link fade. For instance, a 2018 systematic review found that apparent risks of autism and attention-deficit hyperactivity disorder largely shrank or disappeared when researchers properly accounted for the mother’s mental health history. Similarly, a 2017 study using sibling comparisons showed that links to neurodevelopmental conditions, which affect how the brain develops, such as autism and ADHD, largely disappeared when comparing exposed children to their unexposed siblings, pointing to shared family factors rather than the drugs themselves.
Recent research covered by PsyPost in 2025 also found that children exposed to antidepressants in the womb showed no increased risk of anxiety or depression once maternal depression was factored in, while another study covered by PsyPost in 2025 indicated that population-level risks are largely driven by shared genetic and family factors.
To help address this ongoing debate, Saraid McIlvride and her colleagues at the University of Glasgow evaluated both depression and antidepressant use side by side in a large population. The authors sought to separate the potential side effects of the medications from the developmental effects of the illness itself.
“Women want to have confidence in their decision to take medication during pregnancy and know that long-term studies investigating potential effects have been carried out,” study lead author Saraid McIlvride, a Daphne Jackson Research Fellow at the University of Glasgow, told PsyPost. “Many studies have focused on pregnancy and neonatal outcomes, but fewer studies have looked at longer-term outcomes, particularly for newer or less common antidepressants, and there have been conflicting results.”
“This dataset, which linked child education and health records with their mother’s health records across the whole of Wales, allowed us to follow children up during primary school and gave a large enough sample size to look at some individual antidepressants and other educational outcomes beyond ASD and ADHD.”
Because this was observational research, the scientists analyzed existing health and education databases rather than assigning treatments to participants. The dataset linked primary care, maternity, and school records for 167,447 children born in Wales between 2009 and 2016. By tracking the children through 2022, when they were just under 6 years old on average, the team could identify any special educational needs recorded by schools.
Children were grouped by two separate measures: whether their mother had received at least one antidepressant prescription during pregnancy or in the month before conception, and whether she had a depression diagnosis recorded by her family doctor in the two years before giving birth. Overall, 7.6 percent of the children were born to mothers who had a recorded depression diagnosis but received no antidepressant prescriptions. Another 4.2 percent were exposed to both a maternal depression diagnosis and antidepressant prescriptions, while 3.6 percent were born to mothers prescribed antidepressants without a recorded depression diagnosis. The remaining children, who formed the comparison group, had neither exposure recorded.
The researchers adjusted their models for factors such as child sex, age, ethnicity, maternal age, smoking habits, and the level of deprivation in the family’s neighborhood. The analysis indicated that both untreated maternal depression and antidepressant prescriptions were associated with higher odds of a child developing a special educational need. Among children with neither exposure, the baseline rate of requiring special educational support was 20 cases per 100 children. For children whose mothers had untreated depression, this rate rose to 23.6 cases per 100 children.
Children whose mothers had both a depression diagnosis and antidepressant prescriptions had a predicted rate of 26.5 cases of special educational need per 100 children, while those whose mothers were prescribed antidepressants without a depression diagnosis had a rate of 26.3 per 100. When examining the additional risk linked to medication, the gap depended on whether the mother had a depression diagnosis. Prescriptions were associated with an extra 6.3 cases per 100 children among mothers without a recorded depression diagnosis, but only 2.9 additional cases per 100 children among mothers who had a recorded diagnosis.
The authors note that the smaller gap reflects the already elevated rate among children whose mothers had untreated depression, meaning the higher risk linked to maternal depression cannot be attributed solely to medication. Compared with unexposed children, both maternal depression and antidepressant exposure were associated with higher odds of autism, ADHD, learning difficulties, and behavioral, emotional, and social difficulties.
But when children of mothers with treated depression were compared with children of mothers with untreated depression, the differences for autism and ADHD were not statistically significant; only learning difficulties and behavioral, emotional, and social difficulties showed small differences, of about one additional case per 100 children each.
The researchers also looked at different types of antidepressants. Selective serotonin reuptake inhibitors, the standard first-line antidepressants, which include drugs such as sertraline and fluoxetine, made up about 83 percent of prescriptions and followed the same general pattern as the overall results.
Two less common classes, tricyclic antidepressants, an older type of medication, and serotonin and norepinephrine reuptake inhibitors, showed a larger gap between treated and untreated depression, with about 8.8 extra cases of special educational need per 100 children for each. Because relatively few children were exposed to these drugs, the estimates were imprecise, ranging from roughly 3 to 15 extra cases per 100.
The tricyclic result is consistent with a 2026 meta-analysis, which found that tricyclic antidepressants were the only class where links to neurodevelopmental conditions persisted after accounting for maternal mental health, though that study also could not rule out underlying illness severity.
“Maternal depression during pregnancy was associated with an increased chance of children having special educational needs,” McIlvride said. “Taking antidepressants during pregnancy was linked to a small increase in this risk, compared to untreated depression, but we weren’t able to show if this increase is due to these women having more severe depression or an effect of the medication. Untreated depression can have a serious impact on the well-being of both mother and baby so it is vital to keep taking antidepressants if they are needed.”
Independent specialists reviewing the research for the Science Media Centre emphasized that the modest differences in risk should be interpreted with caution. Asma Khalil, a professor of obstetrics and maternal-fetal medicine at City St George’s, University of London, who was not involved in the study, said in her comments that the work provides helpful context but cannot determine causation.
Khalil pointed to the gap of roughly three cases per 100 children between mothers with treated and untreated depression. “That difference is worth studying, but it does not show that antidepressants caused it,” Khalil said. “The researchers could not measure how severe the mothers’ depression was, and women prescribed medication may have differed in important ways from those who were not. A prescription also does not establish that a medicine was taken throughout pregnancy.”
“The main outcome was a broad measure of special educational needs, which is not the same as a clinical diagnosis,” Khalil added. “This study adds valuable evidence about the needs of children and families, but it cannot tell an individual woman whether taking or stopping an antidepressant would change her child’s developmental risk.”
McIlvride similarly emphasized that population-level statistics do not translate directly into an individual pregnancy’s personal outcome.
“This study has estimated an association at a population level and so can’t tell an individual about their personal risk,” McIlvride noted. “It gives women and their families information which could potentially benefit their child’s development by identifying a need for support earlier. This study also shows that antidepressant use during pregnancy is increasingly common – around 1 in 12 women were taking antidepressants in our study, and we can expect this figure to be even higher today – therefore this is an area which deserves more research.”
As with all research, there are some caveats to consider. The biggest limitation is that the researchers had no data on how severe each mother’s depression was. Because doctors typically prescribe medications like tricyclic antidepressants for more severe or treatment-resistant depression, the higher risks seen with these specific drugs might simply reflect the fact that the mothers prescribed them were experiencing a more intense form of the illness.
“This study does not show that depression or antidepressant use during pregnancy causes autism or ADHD in children – it shows an association, which could be due to many different reasons,” McIlvride emphasized. “The increased risk associated with antidepressants we observed in our study could be due to more severe disease, as it is likely that women who are taking antidepressants will have more severe depression.”
Angelica Ronald, a professor of psychology and genetics at the University of Surrey who was not involved in the study, said in comments to the Science Media Centre that shared genetic influences could account for part of the link, while describing the large sample size and linked records as notable strengths of the study.
“There is evidence from a range of sources that depression and neurodevelopmental conditions such as autism and ADHD share some genetic influences,” Ronald said. “This means we expect autism, ADHD and depression to run in the same families to some degree. This new study does not account for the fact that autism, ADHD and depression share some inherited (genetic) influences. Shared genetic influences might explain some of the associations found here between maternal depression in pregnancy and maternal use of antidepressants in pregnancy and offspring special educational needs.”
David Curtis, an honorary professor at the UCL Genetics Institute at University College London who was not involved in the research, questioned in his comments to the Science Media Centre whether the depression link reflects any harm in the womb at all.
“Although this study shows that children of mothers who suffered depression or took antidepressants have increased rates of special educational needs, we cannot assume that this represents a causal relationship,” Curtis said. “In fact, for me it seems somewhat implausible that a mother being depressed in the two years before birth would somehow cause the child to be at subsequently increased risk of having learning difficulties. Typically, a depressive illness per se does not produce profound physiological changes such as might be expected to substantially disrupt fetal development. Alternative explanations seem more likely.”
“A mother depressed in the years before delivery would be more likely to have subsequent episodes of depression and these subsequent episodes might impact a child’s psychosocial development,” he explained. “A mother with a previous diagnosis of depression might have more contact with support services which could result in a higher probability of problems with the child being detected.”
The researchers also lacked some data. The group of women prescribed antidepressants without a recorded depression diagnosis likely included many with unrecorded depression or anxiety, as well as some treated for other conditions, such as migraine and chronic pain, for which tricyclic antidepressants and serotonin and norepinephrine reuptake inhibitors are also prescribed. The researchers did not have data on maternal alcohol or illicit drug use, nor could they account for the mental health of fathers or the potential influence of breastfeeding.
McIlvride pointed to several next steps for expanding on this line of inquiry. “The average age of children in our study was just under 6 years old, so it would be of interest to follow the children up for a longer period,” she said. “Further research is needed to answer questions around the dose of medications or how taking medication while breastfeeding could affect children’s development.”
Future studies that include detailed measures of depression severity, environmental factors, and longer follow-up windows could help better explain the relationship between maternal mental health care and long-term child development.
The study, “Prenatal exposure to maternal depression and antidepressants and neurodevelopmental outcomes: A population cohort study,” was authored by Saraid McIlvride, Neha Rao, Sarjit Singh, Scott M. Nelson, Jill P. Pell, and Michael Fleming.