Depression is a condition that is very common among women of childbearing age with a prevalence of 25-35%. There are many characteristics associated with depression, including: low income, low education level, marital status, tobacco and alcohol use, and illicit drug use. Drinking and smoking occur frequently among those who are depressed and are linked with many adverse outcomes in the fetus. SSRIs (selective serotonin reuptake inhibitors) are the most commonly used antidepressants. Some studies have shown that the use of SSRIs are linked with either an increase or decrease in smoking and drinking during pregnancy depending on personal characteristics. The purpose of this cross-sectional study was to determine the true prevalence of alcohol and cigarette use among pregnant women who take SSRIs in the first trimester of pregnancy. A cohort of 2169 pregnant women were studied to test the associations of SSRI use with drinking, drinking and smoking simultaneously, the greatest number of drinks consumed, binge episodes, and average number of drinks. Results of the study found that smoking (p-value=<0.0001) and greatest number of drinks (p-value=0.01) were significantly associated with SSRI use. The odds of smoking were 2.73 (95% CI 1.70, 4.38) times more likely among those that took an SSRI versus those that did not take an SSRI after controlling for mother education, age, SES, pre-pregnancy weight, maternal weight gain, greatest number of drinks, illicit drug use, and race. Women who take an SSRI have an increase of 0.07 greatest number of drinks versus women who do not take an SSRI, after controlling for smoking, illicit drug use, parity, and SES. There were two significant interaction terms. It was concluded that the odds of smoking and drinking simultaneously varied across levels of illicit drug. SSRI use and binge episodes varied across levels of socioeconomic status. The odds of smoking and drinking among those that did not use an illicit drug were higher for those that took an SSRI versus those that did not. Among those with Low SES, those who took an SSRI had a higher number of binge episodes (p-value=<0.0001) than those who did not take an SSRI (p-value=0.30). Average number of drinks was found to not be significantly associated to SSRI use. Results from these findings can greatly benefit healthcare professionals in determining possible ways to treat depression and may be helpful in developing interventions that can reduce the rates of alcohol and cigarette use among the high-risk population of pregnant women who are depressed. Future research is needed to confirm the relationship between the use of an SSRI, smoking, and drinking.