Depression and anxiety disorders are common among pregnant women and can adversely affect both maternal well-being and fetal development. Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), are often prescribed to manage these conditions, yet their use is associated with potential risks such as congenital malformations, preterm birth, low birth weight, and neonatal adaptation syndrome. Specifically, SSRIs like paroxetine and fluoxetine have been linked to an increased risk of cardiac malformations, and their use during pregnancy can lead to delayed neonatal adaptation, including low Apgar scores and respiratory distress. However, untreated maternal depression itself also poses significant risks, including preeclampsia, poor prenatal care, and postpartum depression. This highlights the importance of careful management and individualized treatment plans, considering both the benefits of treating maternal depression and the potential risks to the fetus. Pharmacokinetics of antidepressants during pregnancy and physiological changes can affect drug metabolism, necessitating careful monitoring and possible dosage adjustments. The decision to use antidepressants during pregnancy must be made in collaboration with healthcare providers, taking into account both maternal mental health needs and fetal safety. Ongoing research is essential to refine treatment guidelines and ensure optimal outcomes for both mother and child.