Fluoxetine Use During Pregnancy
Yes, you can and should continue taking fluoxetine during pregnancy, especially given your three-year history of stable treatment with no side effects. The evidence strongly supports continuing antidepressant therapy during pregnancy when it has been effective, as untreated depression poses significant risks to both mother and infant that outweigh the minimal medication risks 1, 2.
Key Safety Evidence
Fluoxetine does not increase the risk of major fetal malformations. A comprehensive meta-analysis found no increased risk of major malformations with first-trimester fluoxetine exposure (OR 1.12,95% CI 0.98-1.28) 3. Multiple large studies confirm no increased risk of spontaneous pregnancy loss or major structural anomalies 4, 5.
Cardiac Malformation Concerns Are Likely Confounded
While some cohort studies suggested a possible association with cardiac malformations (OR 1.6,95% CI 1.31-1.95), this risk has been shown to occur equally in depressed women who deferred SSRI therapy during pregnancy, indicating ascertainment bias rather than true medication effect 3. Case-control studies found no such association (OR 0.63,95% CI 0.39-1.03) 3.
Third Trimester Considerations
Neonatal adaptation syndrome may occur but is typically mild and self-limited. Infants exposed to fluoxetine in the third trimester may experience 2, 4:
- Transient respiratory distress, jitteriness, irritability, or feeding difficulties
- Symptoms typically appear within hours to days after birth
- Usually resolve within 1-2 weeks without intervention
- Increased risk of special-care nursery admission (RR 2.6,95% CI 1.1-6.9) 4
Persistent pulmonary hypertension of the newborn (PPHN) is a theoretical concern with late-pregnancy SSRI exposure, though the absolute risk remains very low (1-2 per 1000 live births baseline) and evidence is limited 2.
Critical Risk-Benefit Analysis
The risks of untreated depression during pregnancy substantially outweigh medication risks 1, 2. Untreated maternal depression is associated with:
- Premature birth
- Low birth weight
- Decreased breastfeeding initiation
- Harm to mother-infant bonding
- Increased risk of postpartum depression 1
Women with a history of severe depression or relapse when discontinuing treatment should absolutely continue antidepressant therapy during pregnancy 1.
Practical Management Recommendations
Continue Your Current Medication
- Maintain fluoxetine at your current effective dose throughout pregnancy 1, 2
- Do not discontinue therapy, as this significantly increases relapse risk 1
- Use the lowest effective dose, but prioritize adequate depression control 1
Monitoring Plan
- Arrange early follow-up after delivery for infant monitoring 1
- Monitor newborn for signs of neonatal adaptation syndrome in the first week of life (jitteriness, feeding difficulty, respiratory distress) 1
- Most symptoms are mild and self-limited 1
Breastfeeding Considerations
Continue fluoxetine during breastfeeding. While sertraline is technically preferred due to lower breast milk excretion 1, fluoxetine can be safely continued if you are already stable on it, avoiding the risks of switching medications postpartum 2.
Common Pitfalls to Avoid
- Do not discontinue fluoxetine due to pregnancy concerns - this creates greater risk from untreated depression than from medication exposure 1, 2
- Do not switch medications unnecessarily - you are stable on fluoxetine after three years; switching introduces new risks and potential for relapse
- Do not delay treatment - the FDA Pregnancy Category C designation means benefits may outweigh risks, not that the medication is contraindicated 2
Bottom Line
Your prescription refill should be approved without hesitation. The evidence overwhelmingly supports continuing fluoxetine throughout pregnancy and postpartum in your situation 1, 2, 3. Your three-year history of stable treatment with no side effects makes discontinuation particularly inadvisable, as you would face high relapse risk with potentially severe consequences for both you and your baby 1.