Antidepressants in pregnancy linked to a small rise in special educational needs among 167,000 children

Out of every 100 children in Wales whose mothers had neither depression nor an antidepressant prescription during pregnancy, an estimated 20 needed extra support at school. Where the mother had depression that was not treated with medication, the figure was about 24. Where she had depression and was prescribed an antidepressant, it was between 26 and 27.

Those three numbers are the core of a study published on September 29, 2026, in a medical journal, PLOS Medicine, by researchers at the University of Glasgow. They show a link between depression in pregnancy and children’s later difficulties that holds with or without medication, and a smaller additional link with the medication. The authors say plainly that they cannot tell whether that second link reflects the drugs or the illness the drugs were prescribed for.

What the antidepressants in pregnancy study measured

The team, led by Saraid McIlvride, worked from records. Their population-wide cohort included more than 167,000 children born in Wales, UK between 2009 and 2016, followed until 2022 using linked primary care, maternity and education records. Nobody was interviewed or tested for the study.

A child counted as exposed to antidepressants if the mother received one or more antidepressant prescriptions during pregnancy or up to one month before conception. A child counted as exposed to depression if the mother had a maternal depression diagnosis recorded in the two years before delivery.

That produced three exposed groups. In total, 12,630 children (7.6%) were exposed to untreated depression during pregnancy, 7,005 (4.2%) to treated depression, and 5,996 (3.6%) to antidepressant medication without a recorded depression diagnosis. Everyone else, the large majority, formed the comparison group.

The main outcome came from schools. Special educational need, or SEN, is the term used in Wales for a child who requires support beyond what classmates of the same age receive. The category is broad. It took in autism spectrum disorder (ASD), learning difficulties such as dyslexia, speech and language problems, sight or hearing impairment, physical and medical difficulties, and behavioral, emotional or social difficulties. Attention deficit hyperactivity disorder (ADHD) was tracked separately through school records, prescriptions and diagnoses.

By that measure, SEN was common in every group. Across the whole cohort 28.4% of children had it recorded at some point, most often for learning difficulties. That figure counts any record across a child’s school years, which is why it is higher than the model-based estimates in the next section.

How much higher the rate was in children exposed during pregnancy

After adjusting for the child’s sex, age and ethnicity, neighborhood deprivation, and the mother’s age, smoking, number of previous births and epilepsy, the researchers estimated the rate of SEN in each group.

Exposure during pregnancy	Estimated children with special educational needs, per 100	Plausible range
Neither depression nor antidepressants	20.0	19.8 to 20.2
Depression, no antidepressant	23.6	22.9 to 24.3
Antidepressant, no recorded depression	26.3	25.3 to 27.4
Depression and antidepressant	26.5	25.5 to 27.5

Depression alone was associated with an increase to 23.6 per 100 children, about three and a half more than in the comparison group. Antidepressant exposure without depression was associated with an increase to 26.3 per 100.

The comparison that matters most to a woman with depression is the one between the second and fourth rows. Among children of mothers with depression, an antidepressant prescription went with 2.9 more cases per 100, with a plausible range of 1.7 to 4.1. The authors summarized it in a statement issued by the journal: “Among children of mothers with depression, 24 in every 100 children had special educational needs if she was not on treatment, and this increased by just 3 in every 100 children if she was taking antidepressants.”

Associations with antidepressant exposure were observed across multiple outcomes including ASD and ADHD. For those two diagnoses, though, the gap between treated and untreated depression was too small to distinguish from chance. Only learning difficulties and behavioral, emotional or social difficulties showed a clear difference between the two depression groups.

The type of drug mattered somewhat. Selective serotonin reuptake inhibitors, or SSRIs, are the standard first choice, and the paper reports that among women prescribed antidepressants 83% were prescribed SSRIs, 10% were prescribed TCAs and 5% were prescribed SNRIs. TCAs are tricyclic antidepressants, an older class, and SNRIs are serotonin and norepinephrine reuptake inhibitors. For SSRIs, the rate of SEN with treated depression was not measurably different from the rate with untreated depression. For the other two classes the difference was larger, 8.8 per 100 in each case, with wide ranges of uncertainty. The overall gap of 2.9 per 100 pools all the classes together.

Why depression severity complicates the antidepressant result

The difficulty in reading these numbers has a name, confounding by indication. People are prescribed a medicine because of a condition, and the condition may itself affect the outcome being studied.

Here the condition is depression, and depression comes in degrees. The paper lists this first among its limitations, noting that the result is open to confounding as women prescribed antidepressants likely represent a more severely depressed group. The records showed whether a diagnosis existed. They did not show how ill anyone was. “We cannot rule out confounding by severity of indication as we lacked data on depression severity,” the authors write.

If more severe depression carries more risk for a child, through genes shared by mother and child, through stress during pregnancy, or through the home environment afterward, then the treated group would have a higher rate even if the medication did nothing. The authors put both readings side by side: this pattern may indicate additional risks from exposure to antidepressants or simply demonstrate that medication use serves as a marker of more severe depression.

The same reasoning applies to the drug classes. Since SSRIs are generally used as first-line therapy, with TCAs and SNRIs typically reserved for treatment-resistant or more severe depression, a larger gap for those drugs is what severity alone would predict.

The group with a prescription and no diagnosis is a puzzle of its own. Its rate was as high as that of the treated-depression group. The authors think the explanation is incomplete records, writing that it is likely that many of these mothers had unrecorded depression (or anxiety). Some were probably prescribed the drugs for something else, since TCAs and SNRIs are also prescribed for other indications including migraine, fibromyalgia and neuropathic pain.

The authors’ own summary is cautious. “We showed that if women with depression took antidepressants while pregnant their children were more likely to have special educational needs, but it was only a very slight increase and may have been due to them having more severe depression, rather than an effect of the medicine,” they said.

What sibling and father comparisons show about antidepressants in pregnancy

Other research teams have tried to get around the severity problem with designs the Welsh study did not use. Three approaches recur.

The first compares siblings. Brothers and sisters share a mother, much of their genetic inheritance and a home, so if one was exposed to an antidepressant before birth and the other was not, family background is largely held constant. A United States study led by Elizabeth Suarez examined 3.2 million pregnancies. Crude results suggested up to a doubling in risk of neurodevelopmental outcomes associated with antidepressant exposure; however, no association was observed in the most fully adjusted analyses. Between exposed and unexposed siblings, the rate of any neurodevelopmental disorder was essentially the same, with a ratio of 0.97 and a range from 0.88 to 1.06.

A Swedish study of 1.6 million children told a similar story. In the whole population, 5.28% of exposed children and 2.14% of unexposed children were diagnosed with autism spectrum disorder by age 15 years. That difference disappeared in models that compared siblings while adjusting for pregnancy, maternal, and paternal traits, and the same was true for ADHD. One association did survive the comparison of siblings, a higher rate of preterm birth.

The second approach looks at fathers. A father’s antidepressant cannot reach the fetus through the placenta, so any link between his prescription and his child’s diagnosis has to run through something else, such as inherited risk or family circumstances. A meta-analysis published in June 2026 in The Lancet Psychiatry pooled 37 studies. It treated fathers as a negative control, meaning an exposure that could not itself have reached the fetus. In it, paternal antidepressant use during pregnancy served as a negative control and was associated with increased ADHD risk and with increased autism risk.

The third looks at timing. In the same meta-analysis, similar associations were found for pre-conception exposure, before any fetus existed to be exposed.

Its authors rated the whole body of research soberly: the certainty of evidence was low to very low. Once confounding by indication was minimized, only amitriptyline and nortriptyline were associated with increased risk, and those are both tricyclics. That exception lines up with the larger gap the Welsh study saw for tricyclics, though neither study can exclude severity as the reason.

What risks untreated depression in pregnancy carries

The alternative to treatment is not a pregnancy without risk. The Welsh numbers themselves show a higher rate of SEN with untreated depression than with none. The paper’s introduction adds that untreated maternal depression is associated with adverse obstetric and neonatal outcomes, including preterm birth, low birth weight and restricted growth in the womb.

Stopping medication was followed by more relapses in the one study that tracked it. That study enrolled 201 pregnant women with a history of major depression whose illness was under control on treatment at the start, and compared two groups among them. Of the 82 who maintained their medication, 21 relapsed during pregnancy, or 26%. The figure was 44, or 68%, of the 65 women who discontinued medication. The women chose for themselves whether to continue, so the comparison was not randomized, and those who stopped may have differed in other ways.

The Glasgow authors drew the same line. “Our results don’t suggest that women should automatically stop taking their antidepressants because depression can harm both mother and baby if not treated,” they said.

What the pregnancy study cannot show

Beyond severity, the records had other gaps. There was no information on alcohol or illicit drug use which could be associated with both maternal depression and subsequent child neurodevelopment. Breastfeeding status was poorly recorded in the available datasets, so exposure through breast milk could not be examined. Depression after the birth, and depression in fathers, were not available either.

A prescription is not proof that a medicine was taken. Some women given antidepressants will not have used them, which would tend to blur any real effect.

The setting limits how far the result travels. The Welsh population is predominantly White, and the authors caution that the result may not apply to more ethnically mixed populations. Many of the children were also still in their first years of school when follow-up ended in 2022, and some conditions are diagnosed later than that.

What changes for pregnant women taking antidepressants

Clinical guidance has not changed. In the United Kingdom SSRIs are recommended as the first-line treatment of depression during pregnancy, the paper notes, and the American College of Obstetricians and Gynecologists recommends against discontinuing mental health medication solely because of pregnancy. The Lancet Psychiatry reviewers reached a matching conclusion from 37 studies: antidepressant treatment should be continued for pregnant women with moderate-to-severe depression.

The authors suggest a practical use for their result that has nothing to do with prescribing. “Our study indicates that exposure to antidepressants during pregnancy could serve as a marker for additional support being needed at school,” they said.

Do not stop or change a prescribed medicine without talking to your doctor. The balance between treating depression and any risk from treatment differs from one pregnancy to another, which is assessed by a woman’s doctor.

In these records depression in pregnancy went with more special educational needs whether or not it was treated, and the three extra children in 100 seen with antidepressants could reflect the medicine or the more severe illness for which it was prescribed.