Is Prozac safe during pregnancy?

What does the evidence say about Prozac during pregnancy?

1. Fluoxetine use is not expected to increase the chance of birth defects, and a small number of studies found no greater chance of miscarriage when it was used in pregnancy. 1
2. The overall chance of persistent pulmonary hypertension with any SSRI stays below 1 in 100, and most studies found no increase in ADHD among children exposed to SSRIs like fluoxetine during pregnancy. 1
3. Two defects showed elevated estimates with early fluoxetine exposure in a Bayesian analysis of nearly 28,000 mothers: right ventricular outflow tract obstruction at 2.0 and craniosynostosis at 1.9, while five separate signals were tied to paroxetine. 2
4. First-trimester antidepressant exposure was not tied to a substantial increase in cardiac malformations across 949,504 pregnancies once depression severity and other confounders were adjusted for. 3
5. Depression itself is not expected to increase the chance of birth defects above the background rate, but one study found a five times greater chance of relapse among people who stopped their medication for major depression during pregnancy. 4

Is Prozac safe in each trimester?

• First trimester. The first-trimester picture is mostly reassuring with one caveat. A Bayesian analysis pooling data from nearly 28,000 mothers found elevated estimates for right ventricular outflow tract obstruction and craniosynostosis, roughly double the background rate, while most other defects showed no association at all.
• Second trimester. Mid-pregnancy fluoxetine use is studied less than early exposure. Some research points to preterm delivery and lower birth weight with SSRI use across pregnancy, and depression carries those same associations, so the two are difficult to separate in the data.
• Third trimester. Fluoxetine has a long half-life, so a baby exposed near delivery may be irritable or jittery, cry more, have tight muscles, breathe with effort, sleep oddly, or struggle to eat. MotherToBaby groups these as temporary newborn symptoms. Give your delivery team your medication list ahead of time.