Prozac during Pregnancy & Breastfeeding
Prozac (Fluoxetine) belongs to the FDA Pregnancy Category C which is a specification for drugs which have been shown to cause side effects to the fetus in animal studies but which have not been tested fully in pregnant women. The decision to take Prozac during pregnancy should be made by determining if the benefits to the mother outweigh the potential risks to the fetus. Prozac passes through the placenta but it is unknown if any long lasting effects occur to the fetus.
The manufacturer of Prozac, Eli Lilly & Co. has not conducted any controlled studies on women who took Prozac during pregnancy. However some independent reports cite occurrences of heart abnormalities in infants born to women who took Prozac during the first trimester. When looking back over the pregnancy of infants diagnosed with Persistent Pulmonary Hypertension (PPHN), the incidence of mothers taking Prozac during the 3rd trimester was higher in PPHN babies than in healthy babies, but no conclusions can be made.
Persistent pulmonary hypertension (PPHN) is a rare heart and lung condition found in newborns which causes an inability to breathe normally and can restrict the amount of oxygen circulating in the blood stream. In the general population, PPHN can occur in approximately two out of every 700 births. In women who took Prozac during the 3rd trimester of pregnancy, the risk of PPHN developing in the infant is 6 times greater.
Prozac Label Warning
The FDA has not found sufficient evidence to state that SSRI’s cause PPHN but there is a required warning on all SSRI product labels, including Prozac that states there may be an increased risk of PPHN when a fetus is exposed to an SSRI during pregnancy. PPHN is rare and the exact cause is unknown.
Making the Prozac Decision
Depending upon the type of depression being treated, the pregnant woman may be at risk for serious relapse if Prozac is discontinued. Taking Prozac to control depression symptoms that include suicidal tendencies may be necessary to a woman’s well being and that of her fetus. Prozac has not been proven to cause problems in pregnancy or for the fetus, but as with every drug, there is always a risk. Each individual is different but the decision must be made, ideally prior to conception.
Prozac During Breastfeeding
A woman who is breastfeeding her infant and also taking Prozac is passing the drug to her infant in breast milk. Although there is no proof that this harms the baby, it is not recommended.
A woman’s history may dictate that Prozac use continue not only as a continuation of symptom relief but as a guard against post partum depression as well. There are no documented studies to provide guidance in this decision making process. The individual should consult with her health care providers to make the best well informed decision possible.
Weighing the risks to the mother without Prozac versus the risks to the fetus with Prozac may be a very difficult deliberation. Consultations with the patient’s obstetrician, psychiatrist, and primary care physician should all play a role in this process.