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The treatment of depression during pregnancy is both a common and complex clinical challenge. The decision to expose the fetus to antidepressant medication during pregnancy must be weighed against the risks of untreated maternal depression to both mother and fetus. Maternal depression during pregnancy has been associated with increased rates of preterm birth and maternal substance use. The safety of antidepressant use during pregnancy seems to be largely reassuring but there remain 2 areas of controversy including neonatal withdrawal syndrome and primary pulmonary hypertension of the newborn. Individualized treatment recommendations based on the patient's history are essential to optimize outcomes.