Culture Apothecary with Alex Clark

Episode: Are Common Meds Harming Babies? Tylenol & Antidepressants In Pregnancy | Dr. Adam Urato, MD
Date: August 22, 2025
Host: Alex Clark
Guest: Dr. Adam Urato, Chief of Maternal Fetal Medicine, MetroWest Medical Center; Attending Physician at Tufts Medical Center

Episode Overview

In this thought-provoking episode, Alex Clark talks with Dr. Adam Urato, a leading voice in maternal-fetal medicine and pharmaceutical risk advocacy, about the impacts of commonly used medications—specifically SSRIs (antidepressants) and Tylenol—on fetal development during pregnancy. Dr. Urato shares his clinical and research-backed insights, highlighting concerns about structural changes in fetal brains, increased pregnancy complications, and a lack of proper warning labels or public education. The episode emphasizes the importance of informed consent, challenges pharmaceutical industry narratives, and calls for stronger regulatory warnings and cultural change in how medications are prescribed to women of childbearing age.

Key Discussion Points & Insights

1. What Evidence Shows about SSRIs in Pregnancy (00:00–02:40)

• SSRIs’ Impact on the Developing Fetus:

  • SSRIs disrupt fetal serotonin systems, a neurotransmitter crucial for brain development.
  • Studies (MRI, EEG, animal, and behavioral) show changes in fetal movement, increased agitation, and possible long-term neurological changes.
  • Evidence points to increased rates of complications: miscarriage, preterm birth, low birth weight, preeclampsia, birth defects, postpartum hemorrhage.

  "The MRI studies are showing structural changes in the brain. Some of them show smaller brain volume, differences in motor development even years later."
  — Dr. Urato (00:04)

• Prevalence:

  • 5–10% of pregnant women in the U.S. are estimated to be on SSRIs—1 in 10 or 1 in 20 babies affected. (11:27)

2. Risk Communication & Gaps in Patient Counseling (03:01–09:44)

• Lack of Risk Disclosure:

  • Many women are told it's safe or even beneficial to remain on SSRIs during pregnancy, with little discussion of risks.
  • The counseling often omits data on adverse outcomes, focusing instead on potential dangers of untreated depression.
  • Mainstream media coverage and professional societies often downplay or ignore risks.

  "The idea that if a mom stays on her medication during pregnancy, it's going to prevent complications...is more of a...pharmaceutical industry propaganda."
  — Dr. Urato (04:14)

• Industry Influence:

  • Pharmaceutical companies promote minimizing risks and maximize focus on the condition (depression), diverting attention from drug side effects.

  "It's a major problem because pregnant women need to realize there are risks to these medications during pregnancy."
  — Dr. Urato (03:05)

3. Research Findings: Structural and Behavioral Effects (09:44–11:21)

• Biological Mechanisms:

  • Serotonin’s fundamental role in fetal neural development is well-established.
  • SSRIs cross the placenta, disrupting this system, leading to observable effects in fetal behavior (jittery movements, agitation) and neonatal outcomes.

  "We've got 12 consecutive MRI studies showing that, yes, these drugs alter fetal brain development."
  — Dr. Urato (10:46)

4. Why Aren't There Stronger Warnings? (17:28–21:17)

• Regulatory Gaps:

  • FDA labels currently only warn about postpartum hemorrhage, newborn adaptation syndrome, and PPHN, but not miscarriage, birth defects, brain alterations, etc.
  • Research is complex: some data is mixed due to challenges in clean study design, dosage/duration variations; but animal and basic science consistently point to harm.

  "On the FDA label right now they're only warning about postpartum hemorrhage risk ... what needs to be added in are warnings regarding miscarriage, birth defects, preterm birth, low birth weight, preeclampsia, and alterations in fetal brain development."
  — Dr. Urato (17:39)

5. Parallels with Other Medications & Past Mistakes (37:30–44:01)

• Comparing Pharma Tactics:

  • Industry tactics for SSRIs compared to OxyContin and Makena: shifting focus from drug risks to severity of the underlying condition.
  • Historical lessons not learned, citing thalidomide and DES as previous failures to protect pregnant women.

  "We promised ourselves, oh, we'll never do that again...But we repeat these same mistakes."
  — Dr. Urato (60:34)

6. Effects of Other Medications in Pregnancy (48:34–60:21)

• Adderall and Stimulants:

  • Similar risks: chemical crossing placenta, affecting fetal brain, but less studied than SSRIs.

  "A lot of what I've had to say about SSRIs applies to Adderall...We don't have as much information because it's not used as widely, but it does affect the developing brain."
  — Dr. Urato (48:34)

• Seizure Medications:

  • Increasing evidence that risks (e.g., birth defects) are from medication, not condition itself.

  "It's becoming clear the complications in pregnancy that we see with the seizure medications, do appear to be related to the seizure medications and not the underlying condition epilepsy."
  — Dr. Urato (58:57)

• Tylenol (Acetaminophen):

  • Association with increased risk of asthma, neurodevelopmental issues (e.g., ADHD). Use should be weighed carefully.

7. Tapering, Withdrawal, and Informed Decision-Making (29:55–36:31)

• Coming Off SSRIs:
  • Withdrawal from SSRIs can be prolonged—months or years—not just a few weeks as previously thought.
  • Tapering should be gradual, under medical supervision.
  • Counseling must be patient-specific; not all women should stop, but all must have full information.

8. Alternatives & Holistic Approaches (49:38–51:41)

• Non-Pharma Options for Mental Health:
  • Psychotherapy, exercise, improved sleep and nutrition, relationship support, and group or couples counseling recommended as first-line or adjunctive approaches.
  • “Untreated depression” doesn’t mean doing nothing—it means considering other treatments beyond medication.

9. Key Takeaways: Chemicals Have Consequences (51:41–55:09)

• Universal Message:

  • All medications are chemicals that affect the complex human body and brain—not just the targeted symptom.
  • Example: Singulair (asthma drug) later found to cause neuropsychiatric effects, illustrating unforeseen consequences.

  "Chemicals have consequences."
  — Dr. Urato (51:41)

• Effect on Men's Fertility:

  • SSRIs have documented impact on sperm motility and DNA, potentially affecting male fertility (55:09).

10. Advocacy & Activism (62:43–64:36)

• Citizen Petitions:

  • Dr. Urato and colleagues are working on a citizen petition to push the FDA to strengthen SSRI warnings.
  • Public comments on petitions welcome and encouraged for increased impact.

  "The message doesn't have to be...that pregnant women can't take these medications...It's about getting the right information out to patients and the public."
  — Dr. Urato (63:46)

Notable Quotes & Memorable Moments

• On Evidence:

  "All of this evidence is pointing towards impact of the SSRIs on the developing fetal brain."
  — Dr. Urato (00:04 / 10:54)

• On Industry Influence:

  "The pharmaceutical industry promotes this idea...which is to downplay risks, reassure...and overemphasize benefits."
  — Dr. Urato (13:08)

• On Withdrawal:

  "It's become apparent now that these can take a long time to come off of. Not days or weeks, but months or years."
  — Dr. Urato (35:32)

• On Chemicals & Consequences:

  "If a guy's taking an ssri, that SSRI...is going throughout his body, including into his testicles, and including affecting sperm development."
  — Dr. Urato (55:16)

• On FDA Action:

  "I feel very strongly that the FDA needs to have better warnings...including a boxed warning to let pregnant women in the public know about this."
  — Dr. Urato (21:17)

Important Timestamps

• SSRIs and Fetal Brain Development: 00:00–04:06
• Pregnancy Complications from SSRIs: 04:14–06:44
• MRI/Ultrasound/EEG Evidence Overview: 07:20–11:21
• Prevalence of SSRI Use in Pregnancy: 11:21–11:42
• How Professional Societies & Industry Frame the Issue: 13:08–15:35
• Lack of FDA Warning and Regulatory Gaps: 17:28–21:17
• Advocacy, FDA Petitions, and how listeners can get involved: 62:43–64:36
• Alternatives to Medication: 49:38–51:41
• Impact of Other Drugs (Adderall, Tylenol, Epilepsy meds): 48:34–60:21
• Men’s SSRI Use and Fertility: 55:09–57:14

Final Takeaways & Dr. Urato’s Remedy

Remedy for a Sick Culture:

"Take good care of each other and try to look out for each other. In that, a lot of people will find a lot of purpose, which can really heal a sick culture."
— Dr. Urato (65:26)

Action Steps for Listeners

• Stay informed and question narratives about medication safety during pregnancy.
• Demand transparent, comprehensive counseling on all pharmaceutical risks—before and during pregnancy.
• Monitor citizen petitions and participate in public comment opportunities to push for stronger FDA warnings.
• Consider all alternatives for mental health support—not just pharmaceuticals.
• Follow Dr. Adam Urato for ongoing updates on new studies and advocacy via Twitter (@amurado1).

For more episodes and resources:

• Subscribe to Culture Apothecary on Spotify & YouTube
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• Follow @RealAlexClark on Instagram