Commentary: Studies of prenatal antidepressant exposures: what can you recommend? A reflection on Sujan et al. (2019).

The review by Sujan et al. asks a question of clinical and public health importance: are antidepressant medications safe to use during pregnancy from the perspective of their potential effects on the infant and growing child? They provide a thorough review of the animal and human literature to date, focusing primarily on offspring neurodevelopmental outcomes (autism spectrum disorder, ASD, and attention deficit hyperactivity disorder, ADHD). They conclude, based on their review, that antidepressant exposure in pregnancy does not substantially increase the risk of these outcomes, and that women should therefore be reassured about the safety of these medications when used in pregnancy. While their review should be of interest to clinicians and researchers, we would advocate a more conservative approach. Even if associations with ASD and ADHD are equivocal, there is still evidence that SSRI exposure may be associated with outcomes occurring at other developmental timepoints. Clinical recommendations should be based on a fuller picture of potential risks and benefits to both the mother and the fetus, in the context of the mother's underlying depression. In this commentary, we also suggest some approaches that future observational studies may adopt to help strengthen the interpretability of findings.