Use of serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) during pregnancy: Effect on fetal growth and long-term reproductive outcomes

Anxiety and depression during pregnancy are recognized as major public health concerns. Depression and anxiety, if untreated, severely affect both mother and the fetus, especially during pregnancy. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are frequently prescribed drugs to manage above conditions during pregnancy. Although these medications affect the levels of neurotransmitters, research indicates their potential impact on development of the fetus. Studies on maternal exposure to SSRIs and SNRIs show possible risks of offspring's congenital cardiovascular abnormalities and anomalies of the kidney and digestive system. Maternal exposure to selective SSRIs and SNRIs during pregnancy has been associated with certain adverse perinatal outcomes, including preterm birth, low birth weight, and neonatal adaptation syndrome. Exposure to SSRIs and SNRIs also increases the possible risk of persistent pulmonary hypertension in the newborn. However, evidence regarding long-term neurodevelopmental outcomes remains inconclusive, with studies showing mixed results. Therefore, based on the available data, it is hypothesized that these drugs may potentially have direct or indirect effects on reproductive outcomes of the progeny. Because of the increasing occurrence of maternal depression worldwide and the consequent usage of SSRIs and SNRIs, there is an urgent need for additional data to better understand the risk of developmental toxicity related to the use of these antidepressants during pregnancy. This review, therefore, aims to examine the effects of SSRIs and SNRIs exposure during pregnancy on fetal growth, postnatal development and long-term reproductive outcomes of the progeny with regard to a careful consideration of better treatment options.