The problem with Prozac in pregnancy

The popular SSRI, fluoxetine (Prozac), commonly prescribed during pregnancy, is associated with a small but significant increased risk of congenital malformations, Chinese researchers warn.

They found statistically significant increased risks of both major malformations and cardiovascular malformations in babies exposed to the drug during the first trimester.

The researchers say this adds to a growing body of research that links fluoxetine to the risk of malformations.

However, they note there is no evidence that fluoxetine increases the risk for other system-specific malformations, including the nervous system, eye, urogenital system, digestive system or musculoskeletal system.

The researchers say their meta-analysis, using pooled data from 16 studies, is “the most comprehensive” to date.

"The results ... suggest healthcare providers and their patients should carefully consider risk-benefit analyses before proceeding with fluoxetine therapy ... during the first trimester,” write the study authors in the British Journal of Clinical Pharmacology.

While they are still unsure of the exact biological mechanism that causes fluoxetine-induced congenital malformations, they note the drug has a longer half-life than other SSRIs (four days compared with one), and "is known to cross the human placenta because high concentrations of fluoxetine are detected in umbilical cord blood”.

You can access the research here.