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therefore, it is recommended that the lowest effective dose be used for the treatment of depressive or anxiety disorders to ensure therapeutic benefits in the mother while simultaneously reducing fetal risk ( FIGURE 2 An umbrella review of meta-analyses of observational studies archived in the PubMed and Embase databases that included 1,175,720 women who had used antidepressants during pregnancy reported that the use of SSRIs during pregnancy was associated with a 43% increase in the risk of preterm labor, a 43% increased risk of respiratory distress, a 33% associated with respiratory distress, a 26% increased risk of cardiovascular malformations, and a decrease in 1-min Apgar scores ( via telephone interviews without direct access to medical records or diagnostic information, which may have affected the accuracy of the data