<p>Depressed mood and anxiety are common in pregnancy, affect the health of pregnant mothers, and set pathways for health and disease for mothers and their children long after birth. While non-pharmacological treatments are effective options, pharmacotherapy is often unavoidable, especially when maternal symptoms become moderate or severe. Selective serotonin reuptake inhibitor (SSRI) medications are the most common antidepressants prescribed in pregnancy with the expectation that they benefit a mother’s mental health and, by extension, child well-being. However, regardless of the impact of these medications on maternal mood and anxiety, research findings are often conflicting and contradictory and tend to focus on adverse developmental outcomes, leaving us with unresolved questions about whether such negative outcomes result from an enduring effect of maternal depressed mood, prenatal antidepressant exposure, or yet unknown environmental contextual or genetic factors. Ultimately, we need to ask whether SSRI treatment during pregnancy confers a developmental benefit over the effects of exposure to depression or anxiety in pregnancy. To answer this question, we need to ask what metholodolgical and conceptual approaches are needed to clarify the risks and benefits related to SSRI treatment in pregnancy. In this Perspective, we highlight key child developmental outcomes associated with prenatal SSRI exposure, outline methodological approaches needed to move beyond a search for prenatal SSRI-related adverse effects, and offer a conceptual framework that incorporates the role of multiple intersecting factors (that is, family relations, socioeconomic status and discrimination) that may also contribute to perinatal mental illness, the decision to use SSRIs as treatment during pregnancy, and child development.</p>