A large Welsh population study has found that both maternal depression around pregnancy and antidepressant use are associated with higher rates of special educational needs among children, though researchers stress the findings do not prove that medications cause developmental issues. The work, led by Saraid McIlvride of the University of Glasgow, emphasises that untreated depression itself also carries risks and that the question of causation remains unresolved.
The research linked child education and health records with maternal health data across Wales, following 167,447 children born between 2009 and 2016 through to 2022. The investigators used two main measures to group mothers: whether they had received at least one antidepressant prescription during pregnancy or in the month before conception, and whether they had a recorded depression diagnosis in the two years before birth. The cohort allowed examination of outcomes beyond autism and ADHD, including other educational and behavioural challenges.
In the study’s baseline, 20 children per 100 in the unexposed group required special educational support. Among those whose mothers had an untreated depression diagnosis, the rate rose to 23.6 per 100. When mothers had both a depression diagnosis and antidepressant prescriptions, the rate was 26.5 per 100, while those whose mothers were prescribed antidepressants without a recorded depression diagnosis had a rate of 26.3 per 100. The researchers adjusted for factors such as child sex, age, ethnicity, maternal age, smoking, and neighbourhood deprivation.
Looking at the broader autism and neurodevelopmental picture, the study noted higher odds of autism, ADHD, learning difficulties, and behavioural, emotional and social difficulties in children with either exposure. However, when comparing children of mothers with treated depression to those with untreated depression, differences for autism and ADHD were not statistically significant; only learning difficulties and behavioural, emotional and social difficulties showed small differences of about one extra case per 100 children each.
The team also investigated antidepressant classes. Selective serotonin reuptake inhibitors, which comprised about 83 per cent of prescriptions, followed the same general pattern as the overall results. Two less common classes — tricyclic antidepressants and serotonin and norepinephrine reuptake inhibitors — showed a larger gap between treated and untreated depression, with around 8.8 extra SEN cases per 100 children for each class. Because exposure to these drugs was relatively rare, the estimates carried greater uncertainty.
“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 urged caution in interpreting the modest differences. Asma Khalil, a professor of obstetrics and maternal-fetal medicine at City, University of London, noted that while the work provides helpful context, it cannot determine causation. “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,” Khalil said.
Angelica Ronald, a professor of psychology and genetics at the University of Surrey, emphasised that shared genetic influences could account for part of the link, while highlighting the study’s large sample size and use of linked records as notable strengths. “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.”
David Curtis, an honorary professor at UCL, questioned whether the observed association could reflect any harm in the womb. “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,” he said. He suggested that future cycles of depression and psychosocial factors could influence a child’s development and detection of problems rather than a direct fetal effect.
Several data gaps were noted. The antidepressant-only group likely included many with unrecorded depression or anxiety, as well as some treated for other conditions such as migraine or chronic pain. The researchers did not have information on maternal alcohol or illicit drug use, paternal mental health, or the potential impact of breastfeeding.
Looking ahead, McIlvride called for longer follow-up to see how outcomes evolve as children age, and for studies that document dose information and the potential effects of antidepressant use during breastfeeding. “The average age of children in our study was just under six, so it would be of interest to follow them longer,” 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.”
The study, titled 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.
