441 — Dr. Adam Urato on Obstetric Drugs That Harm Mothers and Babies

Dr. Adam Urato, Chief of Maternal-Fetal Medicine at MetroWest Medical Center, spent decades on the front lines of obstetric care before he couldn't ignore what the data was showing. In this episode, he walks Drs. May and Tim through the rise and fall of Makena — a drug prescribed to prevent preterm birth that was ultimately pulled by the FDA in 2023 after being proven ineffective — and connects it to a larger pattern of flawed trials, minimized risks, and industry-driven guidelines that have shaped standard obstetric care for years.

Dr. Urato then turns to SSRIs, now taken by roughly 1 in 10 pregnant women. He breaks down what the research actually shows about how these drugs cross the placenta, disrupt fetal serotonin pathways, and may impact long-term brain development in children — findings that rarely make it into the exam room conversation. He also addresses the fierce pushback from major medical organizations after an FDA advisory panel hearing, and why he believes the response had more to do with protecting a narrative than protecting patients.

The throughline: informed consent is broken in obstetrics, and fixing it starts with physicians being willing to say the uncomfortable things out loud.

GUEST BIO

Dr. Adam Urato is the Chief of Maternal-Fetal Medicine at MetroWest Medical Center in Framingham, Massachusetts — the same hospital where he was born. A Harvard Medical School graduate with nearly 30 years of experience caring for high-risk pregnancies, Dr. Urato has become one of medicine's most outspoken voices on pharmaceutical safety in obstetrics. He has testified before the FDA, written and lectured extensively on antidepressant use during pregnancy, and played a key role in exposing the failures of Makena. His free course, Antidepressants and Pregnancy, is available through Mad in America.

CONNECT WITH DR. URATO

• Mad in America course: madinamerica.com
• Follow on X: @AdamUrato1

CONNECT WITH US

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