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We aimed to assess the association between antidepressant use during pregnancy and birth outcomes, alongside estimates of absolute risk to aid clinical interpretation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a multi\u2010country cohort study using data from the UK Clinical Practice Research Datalink (1996\u20132018), Norwegian Medical Birth Registry (2009\u20132020), and Swedish Medical Birth Register (2006\u20132020). Discordant sibling analyses and paternal negative controls were used to investigate associations with stillbirth, neonatal death, gestational age, size for gestational age, and Apgar score &lt;\u20097 at 5\u2010min among pregnancies delivered at \u2265\u200922\u2009weeks' gestation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 120\u2009209 (4.8%) pregnancies exposed to antidepressants, maternal use was associated with stillbirth (adjusted pooled odds ratio [aOR] 1.16, 95% CI 1.05\u20131.28), preterm delivery (aOR 1.26, 95% CI 1.23\u20131.30), and low Apgar score (aOR 1.83, 95% CI 1.75\u20131.91). Associations persisted in sibling analyses with greater uncertainty. The predicted absolute risk of stillbirth was 0.34% among unexposed pregnancies and 0.40% among exposed. When restricting to mothers with depression or anxiety, the association with stillbirth attenuated (aOR 1.07, 95% CI 0.94\u20131.21). Paternal antidepressant use was modestly associated with preterm delivery and low Apgar score.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Maternal antidepressant use during pregnancy may be associated with increased risks of preterm delivery and low Apgar score, though absolute risks remain low. Residual confounding related to parental mental health is likely to explain part of these associations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pds.70446","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T06:51:25Z","timestamp":1786603885000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Antidepressant Use During Pregnancy and Birth Outcomes: Analysis From the\n                    <scp>UK<\/scp>\n                    , Norway, and Sweden"],"prefix":"10.1002","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6804-008X","authenticated-orcid":false,"given":"Florence Z.","family":"Martin","sequence":"first","affiliation":[{"name":"MRC Integrative Epidemiology Unit University of Bristol  Bristol UK"},{"name":"Population Health Sciences University of Bristol  Bristol UK"},{"name":"Centre for Academic Mental Health University of Bristol  Bristol UK"},{"name":"Centre for Fertility and Health Norwegian Institute for Public Health  Oslo Norway"},{"name":"Epidemiology and Scientific Strategy IQVIA  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viktor H.","family":"Ahlqvist","sequence":"additional","affiliation":[{"name":"MRC Integrative Epidemiology Unit University of Bristol  Bristol UK"},{"name":"Department of Biomedicine Aarhus University  Aarhus Denmark"},{"name":"Institute of Environmental Medicine Karolinska Institutet  Solna Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2932-9486","authenticated-orcid":false,"given":"Paul","family":"Madley\u2010Dowd","sequence":"additional","affiliation":[{"name":"MRC Integrative Epidemiology Unit University of Bristol  Bristol UK"},{"name":"Population Health Sciences University of Bristol  Bristol UK"},{"name":"Centre for Academic Mental Health University of Bristol  Bristol UK"},{"name":"NIHR Bristol 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Institute for Public Health  Oslo Norway"},{"name":"Department of Chronic Diseases Norwegian Institute for Public Health  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dheeraj","family":"Rai","sequence":"additional","affiliation":[{"name":"MRC Integrative Epidemiology Unit University of Bristol  Bristol UK"},{"name":"Population Health Sciences University of Bristol  Bristol UK"},{"name":"Centre for Academic Mental Health University of Bristol  Bristol UK"},{"name":"NIHR Bristol Biomedical Research Centre University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol  Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harriet","family":"Forbes","sequence":"additional","affiliation":[{"name":"Department of Non\u2010Communicable Disease Epidemiology London School of Hygiene and Tropical Medicine  London 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