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To the Editor.— As an investigator whose research¹ evaluating the effects of fluoxetine (Prozac) exposure on pregnancy outcomes was misrepresented in the letter by Dr Yonkers and colleagues,² I am concerned that health care practitioners might be misled, resulting in harm to patients. Yonkers and colleagues ignored the interpretations and conclusions of other authors,^{1, 3-4} such as Chambers et al, who noted that "the rate of spontaneous pregnancy loss did not differ significantly between women treated with fluoxetine and control women."⁴

Yonkers et al⁵ have recommended that preference be given to sertraline because of its shorter half-life, mistakenly assuming that only active drug and active metabolites are responsible for fetal risk. Fetal effects may be related to other factors beside the primary mechanism of action. Thus, fetal risk needs to be evaluated for each medication.

It is important to determine the pregnancy risk of medications likely to be used by women . . . [Full Text of this Article]