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Anne Pastuszak, BSc; Betsy Schick-Boschetto, MSN; Carol Zuber, MSN; Marcia Feldkamp, MS; Maria Pinelli; Sally Sihn; Alan Donnenfeld, MD; Michael McCormack, PhD; Marsha Leen-Mitchell; Cindy Woodland; Allan Gardner, MD; Mary Horn; Gideon Koren, MD

JAMA. 1993;269(17):2246-2248.

Abstract
Objective.
—To compare pregnancy outcome following first-trimester fluoxetine (Prozac) exposure with pregnancy outcome in two matched control groups. Fluoxetine is a new antidepressant used by many young women. Currently, no published data exist on its safety in pregnancy.

Design.
—We prospectively collected and followed up 128 pregnant women exposed to a mean daily dose of 25.8 mg (±13 mg) of fluoxetine during the first trimester and compared pregnancy outcome with two matched groups of women exposed during the first trimester of pregnancy to either nonteratogens or tricyclic antidepressants.

Results.
—Rates of major malformations were comparable within the three groups and did not exceed those expected in the general population. Women treated with fluoxetine had a tendency for increased risk for miscarriage when compared with women exposed to nonteratogens (relative risk, 1.9; 95% confidence interval, 0.92 to 3.92). The rate of miscarriages in the fluoxetine group was comparable with the tricyclic group (13.5% and 12.2% vs 6.8% in the nonteratogens).

Conclusions.
—Our study suggests that the use of fluoxetine during embryogenesis is not associated with an increased risk of major malformations. Women exposed to both fluoxetine and tricyclic antidepressants tended to report higher rates of miscarriage; further studies will be needed to confirm this observation and to separate the effects of the psychiatric condition from the associated drugs. Long-term studies will be warranted to rule out potential developmental teratology of fluoxetine, which affects a central nervous system neurotransmitter.

(JAMA. 1993;269:2246-2248)

Author Affiliations
From The Motherisk Program, Hospital for Sick Children, Toronto, Ontario (Mss Pastuszak, Pinelli, Sihn, and Woodland and Dr Koren); Pregnancy Healthline, Department of Obstetrics and Gynecology at Pennsylvania Hospital, Philadelphia (Mss Schick-Boschetto and Hom and Dr Donnenfeld); Pregnancy Risk Information Service, Camden, NJ (Ms Zuber and Dr McCormack); Pregnancy Risk-Line, University of Utah, Salt Lake City (Mss Feldkamp and Leen-Mitchell); and Department of Genetics, Oshawa General Hospital, Oshawa, Ontario (Dr Gardner),

Footnotes
Reprint requests to Division of Clinical Pharmacology, Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada M5G 1x8 (Dr Koren).

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