Cognitive Effects of Prenatal Exposure to SSRIs in Children: A Systematic Review and Meta-Analysis.

Abstract

Background: Depression and anxiety occur in about 10% of pregnancies. Selective serotonin reuptake inhibitors (SSRIs) are often prescribed, but their potential effects on fetal neurodevelopment remain uncertain. Because serotonin influences brain maturation, prenatal SSRI exposure may affect later cognition, language, or motor function.

Methods: This systematic review and meta-analysis evaluated whether prenatal SSRI exposure is associated with differences in child cognitive, language, or psychomotor development. PubMed and Scopus were searched through June 2025 for cohort, case-control, or randomized studies reporting standardized neurodevelopmental outcomes in children (0-18 years) with documented in utero SSRI exposure compared with unexposed controls. Two reviewers independently screened studies, extracted data, and assessed bias (Newcastle-Ottawa Scale; RoB-2). Random-effects meta-analyses estimated standardized mean differences (SMDs) with 95% confidence intervals (CIs).

Results: Of 250 records identified, 17 studies met inclusion criteria, and 9 contributed to meta-analysis. For general cognition, pooled SMD = -0.20 (95% CI -0.50 to 0.10) showed no significant difference between groups. Sensitivity analyses restricted to SSRI-only cohorts and Bayley-specific instruments yielded similar findings. Secondary outcomes also showed no differences: receptive language (SMD = 0.04; 95% CI -0.16 to 0.23), expressive language (SMD = -0.17; 95% CI -0.40 to 0.06), and psychomotor development (SMD = -0.18; 95% CI -0.67 to 0.31).

Conclusions: Current evidence does not support a clinically meaningful impact of prenatal SSRI exposure on early cognitive, language, or psychomotor development. Observed effects were small, imprecise, and diminished when analyses were limited to SSRI-only cohorts and harmonized outcome measures.